Glaucoma is often called the "silent thief of sight" because, in its most common form, it progresses slowly and painlessly before victims realize that they have lost their sight. It is a serious eye disease that usually strikes adults 40 years and older. Glaucoma is a degeneration of the optic nerve, usually caused by a build-up of pressure inside the eye. This excessive pressure prevents retinal cells and optic nerve fibers from getting the proper blood flow, which causes them to degenerate and die. Normal pressure ranges are from 10-22. Patients can have elevated eye pressure (ocular hypertension) and never develop glaucoma. Conversely, although it is not fully understood, patients with normal eye pressure can also develop glaucoma. This is called normal tension glaucoma. Both types left untreated may lead to severe, irreversible vision loss.

The peripheral vision is first affected and becomes constricted leaving one with tunnel vision. People with normal vision can stand at a street intersection and see traffic from both directions. Those with advanced glaucoma can see only straight ahead as if they were looking through a long tube. Eventually, all vision may be lost. Any vision loss from glaucoma can not be restored, but can be kept at a minimum if detected and treated early.

Glaucoma is the leading cause of preventable blindness in the U.S. This year, approximately 67 million people worldwide will suffer from glaucoma. Yet, approximately 2 million Americans are unaware they have the disease. Many will be diagnosed only after vision has been lost. It should be emphasized that glaucoma is not an infection. It is not cancer. It is not a drying up of the tear ducts. It is not caused by overuse of the eyes. It is not caused by too much reading or too much television. It is, however, a serious eye disease that deserves prompt medical attention.

Are You at Risk?

Glaucoma is not contagious, but does run in families. Higher risk factors include having siblings with glaucoma, eye trauma, severe nearsightedness, and certain medications. Glaucoma can be treated and controlled if detected early. Detection of glaucoma can only be determined with a thourough eye examination. It is especially important for people over 40 and/or those with any of the higher risk factors explained above.

A Look at the most common types of Glaucoma

Although there are many different varieties of glaucoma, the most common are chronic, primary open-angle, normal-tension glaucoma, and acute closed-angle glaucoma.

Open-Angle Glaucoma

It is by far the most common. It is painless. It slowly destroys vision without warning. By the time a vision problem is noticeable, irreversible damage has occurred. Because it is silent and strikes adults, it is important for people over 40 to have an eye exam at least every two years.

Normal-Tension Glaucoma

Although not fully understood, normal tension glaucoma occurs in patients with normal eye pressure. It is believed that the optic nerve degenerates from deprivation of nutients in the blood. Eye pressure is just one piece of information needed to diagnose this disease. Additional tests, such as OCT and Visual Fields are required to detect and monitor for glaucoma. Some forms of glaucoma are believed to be associated with low blood pressure, and people who suffer from sleep apnea are at greater risk.

Chronic Narrow-Angle Glaucoma

Chronic Narrow-angle glaucoma is a condition where the eye drainage ducts cannot adequately filter out the eye fluid (aqueous humor), causing a build-up of pressure. Over a period of time, this causes a build up of pressure that damages the optic nerve. Patients with narrow angles need to be cautious with certain medications, such as antihistamines, as they can precipitate a devastating acute angle closure attack, which can cause total blindness within 24 hours. A five minute in office laser procedure, called a peripheral iridotomy, may be advised during a routine exam as a permanent treatment to prevent this catastrophic event from ever ocurring.

Acute Closed-Angle Glaucoma

Fortunately, acute closed-angle glaucoma is not very common, but it can be devastating. It is caused when the eye's drainage ducts become totally blocked from the pupil dilating from certain medications or even entering a dark room. It is marked by a sudden, severe pain in and around the eye, headache, decreased or foggy vision, halos around lights, nausea, and vomiting. The eye pressure is extremely high (50-60), which can lead to vision loss in as little as 24 hours. To alleviate this pressure, immediate, emergency treatment is required.

Diagnosing and Monitoring Glaucoma

At Skowron Eye Care, we have the latest technology to properly diagnose, treat, and manage glaucoma. There are fast, comfortable, and non-intrusive ways to diagnose glaucoma up to 5 years earlier and manage it:

• IOP (Intraocular Pressure), can be taken several ways, I Care, tonopen, or Goldmann tonometry. No more "air puff" test

• Zeiss Cirrus 6000 OCT optical coherence tomography

• Digital retinal (optic nerve head) photography, and/or Optomap

• Zeiss Visual fields (perimetry-peripheral vision evaluation)

• Pachymetry (measuring corneal thickness)

• Optomap by Optos

• Gonioscopy (evaluating the integrity of the drainage angle

OCT (OPTICAL COHERENCE TOMOGRAPHY)

Because many of the standard tests are inconclusive for glaucoma, we have invested in all the technologies above to give us as much data as possible to accurately assess the health of your eye. The most recent technology, the Cirrus 6000O CT essentially does a laser ultrasound beneath the surface of the retina to determine the thickness of the optic nerve cells. By taking100,000 scans/second, it can detect glaucoma as much as five years earlier than prior testing methods. This test is simple, quick, and painless, with no contact to the eye. The standard eye pressure check (tonometry or "puff of air") is often inconclusive. Noticeable peripheral vision loss doesn't show up until millions of nerve fiber cells have been damaged by glaucoma.

ZEISS HFA-3 FULL THRESHOLD PERIMETER

The Zeiss Humphrey Visual field testing (perimetry) is still the gold standard for following glaucoma, especially moderate to advanced. This requires the patient to respond to series of lights in the peripheral vision. It then maps out the areas of vision loss in decibles and can compare it to previous tests.

At Skowron Eye Care, we have raised the standard of care for glaucoma by performing OCT, Pachymetry, Gonioscopy, Retinal Photography, and Optos in in addition to perimetry (Visual field testing). This enables us to very accurately assess any progression of glaucoma and, in turn, recommend early, proper treatment to prevent vision loss.

​​​​​​​Watch out for These Warning Signs

While glaucoma can occur without warning, any one of the following symptoms is possible and warrants a complete eye exam.

• Rainbow-colored halos around lights

• Vision narrowed, i.e., loss of side vision

• Frequent changes in prescription glasses without improving vision

• Abnormally poor vision in dim light

• Fuzzy or blurred vision which may come and go

• Headaches, especially after watching TV or movies in the dark
  
  

Medical researchers continue to seek better ways to treat and control glaucoma. Their efforts in recent years have led to earlier detection of the disease, new drugs, laser surgery, and more successful surgical techniques. While chronic glaucoma cannot be cured, it can be controlled chiefly through the use of daily eye drops. Laser surgery is an additional option in controlling the pressure if eye drops are inadequate. In more severe cases, surgery may be required to improve the drainage of eye fluids.

Anyone who has glaucoma, who is suspicious of glaucoma, or who has a family history of glaucoma should have these tests performed for a baseline. These tests are not very expensive and insurance companies usually do cover these new technologies. If you fall in any of the above categories, please call the office and schedule a complete eye examination.

GLAUCOMA TREATMENTS

Glaucoma, like Diabetes, can not be cured, but it can be controlled. The eye is constantly producing new fluid (the aqueous humor) to nourish the eye and expel byproducts. New fluid comes in....old fluid goes out. It's a simple balancing act. As long as the same amount of fluid leaves the eye as is produced, the eye pressure remains the same. Open-angle glaucoma occurs when either the eye is producing more fluid than it can expel, or the drainage ducts get clogged and can't drain all the fluid, or a combination of both. A good example is street can flood from a heavy downpour of rain or from a light rain with clogged sewers.

GLAUCOMA EYEDROPS

This is usually the first line of treatment to lower the pressure and control the Glaucoma. From the example above, to lower the pressure, one either can DECREASE the amount of fluid produced or INCREASE the amount of fluid that is drained, or BOTH. There are many different classifications of drops that are used to treat glaucoma. in prior times, patients would have to put in multiple drops 4 times a day in order to control the eye pressure. Today, usually one drop in the evening or in the morning will suffice. Of course, if the condition progresses, more drops may be needed. If it is determined that the drops are ineffective in lowering lowering the pressure, then the other procedures need to be performed.

GLAUCOMA SURGERIES (performed by a surgeon)

1. Selective Laser Trabeculoplasty (least invasive)

2. MIGS (Minimally Invasive Glaucoma Surgery)

3. Glaucoma filtration Surgery (Trabeculectomy - most invasive)
   
   

Laser Peripheral Iridotomy (LPI - used only to treat closed-angle glaucoma)

Laser Peripheral Iridotomy (LPI)

This preventative technique is used to prevent the occurrence of an acute closed angle glaucoma attack. During an eye examination, an eye doctor may notice that the drainage angles in the eye appears to be too narrow. A narrow angle tends not to drain properly and can lead to a build-up of fluid and pressure, a precursor to glaucoma. In LPI, a laser is used to place a tiny opening in the iris in order to improve drainage. The treatment requires no sutures and is handled on the same-day, outpatient basis. The patient needs to use anti-inflammatory eye drops for approximately one week following the treatment. LPI has a very high success rate.

SelectiveLaser Trabeculoplasty (SLT)

SLT is used for patients who have already been diagnosed with glaucoma and eye drops have been ineffective in lowing the pressure. This laser treatment causes stretching of the pores in the drainage channel which increases the outflow of fluid, lowering the eye pressure.

SLT is a same-day, outpatient procedure that causes minimal discomfort. A topical anesthetic is administered in the eye prior to the treatment. Then a clear lens is placed on the eye to help focus light. Approximately 30 to 40 flashes of laser light is applied. The treatment takes about ten minutes per eye and patients usually go home after another hour. Anti-inflammatory eye drops are administered for approximately one week following the treatment. Any reduction in IOP is seen within the first four weeks following the procedure. The success rate for SLT is approximately 75%, and it can last up to 6 years before needing to be repeated.

MIGS (Minimally Invasive Glaucoma Surgery)

MIGS procedures involve placing a small stent in the eye that increases the drainage output of the aqueous humor, thus lowering the eye pressure. There are several different stent designs. Advances in technology have enabled outpatient insertion of these microscopic devices with very little irritation to the eye. Often after a MIGS procedure, one can discontinue the use of pressure-lowering eye drops.

Trabeculectomy (Glaucoma Filtration Surgery)

When all other treatments fail, glaucoma filtration surgery is needed. The purpose of the surgery is to create a new outflow channel that works in tandem with the existing channels. The resulting increased drainage reduces the pressure in the eye and prevents or slows any further vision loss. Any damage done can not be reversed. The surgery has a good success rate.

Glaucoma surgery is handled on an outpatient basis; no overnight hospital stay is needed. The procedure takes less than one hour. A local anesthetic is administered. The surgery does require some sutures, which may need to be removed during recovery. Patients use antibiotic and anti-inflammatory eye drops for several weeks following the procedure. Blurry vision may occur after the surgery but is typically temporary.

OTHER OPTIC NERVE DISORDERS

Multiple Sclerosis

Often times the first symptoms of Multiple Sclerosis are eye related. Patients will experience blurred vision or loss of color vision. Many times it is the visual field testing that alerts the eye doctor. Although we can not diagnose Multiple Sclerosis, we can get a pretty good idea through an eye exam and refer to the appropriate healthcare provider for further diagnostic testing.