Glaucoma

Overview

Glaucoma has no early symptoms. Nevertheless, glaucoma is the leading cause of legal blindness in the United States. The vision loss is painless and difficult to notice in the early stages. Over 7 million office visits occur annually to monitor patients who are at risk for or who have glaucoma. It is often referred to as the ‘sneak thief of sight’, because nearly half of those affected are unaware of their disease.

What is glaucoma?

Glaucoma is an eye disease which affects the optic nerve, which is found in the back of the eye and sends our visual signals to the brain for processing and interpretation. There are a number of different types of glaucomas, but they all result in damage to the optic nerve. Traditionally, this damage first results in loss of one’s peripheral vision. This damage, because it does not affect our central sharp vision, can go unnoticed for quite some time. This is perhaps the most dangerous aspect of glaucoma, that many people who have it do not know it.

In the past, glaucoma was synonymous with high pressure in the eye. We now have a much better understanding of the complexity of glaucoma and its risk factors. For example, glaucoma can occur with normal eye pressures and high pressures do not always mean glaucoma. Since there is no single test to detect glaucoma, we are diligent in screening and monitoring our patients who are at risk for developing vision loss. Risk factors for glaucoma include older age, high eye pressure (intraocular pressure, or IOP), a family history of glaucoma, nearsightedness, African ancestry, diabetes, high blood pressure, or prior injury to the eye.

How can glaucoma be detected?

Glaucoma can be diagnosed by your eye doctor during a comprehensive eye exam including special testing. These special tests include:

  • Checking the eye pressure (tonometry)
  • Evaluating for optic nerve damage (ophthalmoscopy)
  • Assessing the fluid outflow system of the eye (gonioscopy)
  • Measuring the central corneal thickness (pachymetry)
  • Performing standardized visual field testing (perimetry)
  • Taking computerized scans of the thickness of the optic nerve (OCT)

Routine eye exams and an eye doctor on the lookout for glaucoma are important, because early diagnosis and treatment can save sight.

How is glaucoma treated?

Since the pressure in the eye is the only risk factor we can influence, this is where treatment efforts are focused. Typically the first line treatment of glaucoma involves a patient starting eye drops to lower the eye pressure to a range deemed acceptable by their eye doctor. However, some drops have side effects which can affect a patient’s ability to take them on a prolonged basis. Additionally, sometimes using the eye drops is simply not enough to lower the eye pressure into a safe range.

Can lasers be used to treat glaucoma?

Lasers can also be used to treat glaucoma. Recent technological advances in laser technology have given eye surgeons the ability to safely and precisely use laser therapy to target the fluid drainage system in the eye. These lasers can help “unclog the drain” and lower the eye pressure, sometimes allowing a patient to stop using some or all of their glaucoma eyedrops.

What is glaucoma surgery?

Traditional glaucoma surgery involves creating a new passageway for the fluid in the eye to drain, thus lowering the pressure inside the eye. While these surgeries are still performed today, they are often seen as the last line of defense as they are not without complications. However, recent advances in biomedical engineering have allowed companies to manufacture extremely small stents which can be placed in the eye to help improve fluid outflow and lowering of the eye pressure. This has created the field of MIGS, which stands for “Micro-Invasive Glaucoma Surgery”. The iStent is one such device, which is typically implanted at the same time a patient with glaucoma has cataract surgery. The Express Mini-Shunt is another device which can be placed to help lower a patient’s eye pressure. The eye surgeons at NVEC were among the first in northern Michigan to begin using these devices and are proud to offer these cutting edge services to eligible patients.