Glaucoma

The optic nerve is a bundle of nerve fibers that carry messages between the eyes and the brain to help you see. Glaucoma is a condition that damages the optic nerve. It’s caused by high pressure in the eye because of fluid buildup. Glaucoma causes vision loss and, when not treated, can lead to permanent blindness.

The highly skilled ophthalmologists at University Hospitals Eye Institute’s Center for Anterior Segment Diseases and Surgery offer expert diagnosis and treatment of all types of glaucoma.

Types of Glaucoma

There are many different types of glaucoma, including:

• Open-angle glaucoma
• Low-tension or normal-tension glaucoma
• Angle-closure glaucoma
• Chronic angle-closure glaucoma
• Childhood glaucoma, including primary congenital glaucoma and juvenile glaucoma
• Neovascular glaucoma (NVG)
• Normal tension glaucoma (NTG)
• Pigmentary glaucoma
• Primary open-angle glaucoma (POAG)
• Pseudoexfoliation glaucoma (PXG)
• Secondary open-angle glaucoma (SOAG)
• Traumatic glaucoma
• Uveitic glaucoma

What Causes Glaucoma?

In a healthy eye, the fluid that flows inside it – called the aqueous humor – drains through a tissue located near where the iris and cornea meet. When the eye produces too much aqueous humor or the fluid doesn’t drain properly, it can build up and cause increased pressure. However, even people with normal eye pressure can get glaucoma.

When there is no identifiable cause for glaucoma, the condition is called primary glaucoma. When glaucoma is caused by injury, another illness or a reaction to medication, it’s called secondary glaucoma.

Glaucoma Risk Factors

Anyone can get glaucoma, but some people are at higher risk than others. Risk factors for glaucoma include:

• High fluid pressure inside the eyes: Individuals with a high fluid pressure inside the eyes are at an increased risk.
• Race: Glaucoma is a major cause of blindness in African Americans, especially those older than 40.
• Age: People age 60 and older are at higher risk for developing glaucoma.
• Family history: You are more likely to develop the disease if it runs in your family.

Glaucoma Symptoms

Most people with glaucoma don’t notice symptoms until they begin gradually losing their vision. As the disease damages the optic nerve, small blind spots may begin to develop, typically in the peripheral vision. Many people don’t notice these blind spots until major optic nerve damage has already occurred.

Glaucoma symptoms may include:

• Blurred or narrowed field of vision
• Halos or “rainbows” around lights
• Severe eye pain
• Upset stomach (nausea)
• Vomiting

In the case of acute glaucoma, symptoms appear suddenly because of a rapid buildup of pressure in the eye. This type of glaucoma is considered a medical emergency and immediate medical care is required to prevent blindness.

How Is Glaucoma Diagnosed?

To diagnose glaucoma, your healthcare provider will take your complete health history and examine your eyes. You may also have some combination of the following tests:

• Pupil dilation: Your pupil is dilated (widened) with eye drops to allow your eye doctor to perform a close-up examination of the retina and optic nerve.
• Visual acuity test: You are asked to read the smallest letters you can on a standardized chart or a card held 20 feet away.
• Visual field: Measures your peripheral vision, or how well you can see above, below and to the sides of an object you’re looking at. Loss of peripheral vision may indicate glaucoma.
• Tonometry: Measures fluid pressure inside your eye (also called intraocular pressure).

Glaucoma Treatment

Treatment depends on your symptoms, age, overall health, and the progression of your condition. Although glaucoma can’t be cured, early treatment can often control it.

Treatment may include:

• Medication: Your doctor may prescribe oral medication or prescription eyedrops to produce less fluid. Others glaucoma medications improve fluid drainage from the eye to lower intraocular pressure.
• Surgery: Surgery may be performed to create a new opening that allows fluid to drain from the eye. Surgical options for glaucoma include:
  • Trabeculectomy: Your doctor creates an opening in the white of the eye (the sclera), which allows fluid to leave the eye.
  • Drainage tube: Your doctor places a flexible plastic tube (shunt) in your eye to help drain fluid.
  • Minimally invasive glaucoma surgery (MIGS): MIGS includes several surgeries that use tiny incisions and microscopic-sized equipment to lower intraocular pressure. MIGS is associated with fewer complications than trabeculectomy and the drainage tube procedure.
  • Laser surgery: Several types of laser surgeries are used to lower intraocular pressure to treat glaucoma.
  • Cataract surgery: Cataract surgery reduces eye pressure in most cataract patients and may be used as a treatment for glaucoma in some situations.

In some cases, repeated surgeries or continued treatment with medication is needed to successfully manage glaucoma.