Glaucoma

What is Glaucoma?

Glaucoma, the silent thief of sight, is the leading cause of irreversible blindness worldwide.

Glaucoma refers to a group of eye conditions that over time damage the optic nerve, and permanently affects the quality of vision. While glaucoma occurs more often with increasing age, it can also affect babies and young adults.

Vision loss due to glaucoma is permanent; therefore it is important to have regular eye exams that include measurements of your eye pressure to detect this early.

If glaucoma is diagnosed early, vision loss can be slowed or prevented. Once diagnosed, treatment is generally needed lifelong.

Who is at Risk of Glaucoma?

Glaucoma can occur at any age but is more common in older-aged people. People over 40 years have an approximately 1% chance of developing glaucoma.

Glaucoma is a multifactorial disease and some people have a higher-than-normal risk of getting glaucoma.

This includes people who:

are aged 40 or over
have a family history of glaucoma
have high pressure inside the eye (intraocular pressure)
are of African or Hispanic heritage
are farsighted (hyperopic) or nearsighted (myopic)
have corneas that are thin in the centre
have diabetes, migraines, poor blood circulation or other general health problems that affect the eye
have had an eye injury

People with more than one of the above risk factors have an even higher risk of glaucoma, and they should have regular comprehensive eye examinations from the age of 40.

Intraocular pressure is the only known modifiable risk factor and the currently is the focus of treatment in glaucoma.

What are the Types of Glaucoma?

Glaucoma can be categorised as follows:

Open-Angle Glaucoma

Open-angle glaucoma is the most common type of glaucoma in Caucasians and is also called primary or chronic glaucoma.

The angle between the iris and cornea is wide and open.
This type of glaucoma occurs when the microscopic pores within the eye’s drainage system (trabecular meshwork) becomes clogged leading to a gradual increase in the intraocular pressure.
It usually has no warning signs.

The effects are so gradual that a change in vision may not be noticed until the condition is at an advanced stage.

Narrow Angle Glaucoma

Narrow angle glaucoma is more common in Asians and can cause more severe visual loss.

The angle between the iris and the cornea is narrow or closed.
It occurs when a portion of or the entire drainage angle becomes zipped closed so that the aqueous fluid within the front of the eye cannot drain smoothly out of the eye through the trabecular meshwork. This inability to drain can cause a build-up of pressure in the eye.

People with small eyes, or those who are longsighted, are predisposed to developing angle-closure glaucoma because they tend to have narrow drainage angles.

Acute Angle-Closure Glaucoma

Normal Tension (Pressure) Glaucoma

Other types of Glaucoma include:

How is Glaucoma diagnosed?

Open-angle glaucoma gives few warning signs. Some people may observe patchy blind spots in their peripheral or central vision as an early sign of permanent damage in vision. Many people have no symptoms.

A regular eye examination is a key step in detecting glaucoma early enough to successfully slow or prevent vision loss.

Those with multiple risk factors for glaucoma should have a comprehensive eye examination that may include:

eye pressure measurement
measurement of the central corneal thickness
gonioscopy (assessing the anterior chamber drainage pathway)
dilated eye examination
optical coherence tomography (OCT) scans of the optic nerve and retina
visual field testing

How is Glaucoma treated?

Once glaucoma is diagnosed, it needs to be treated for life. There is no known cure for glaucoma, so it is important to continue treatment and maintain regular follow up with your ophthalmologist once a diagnosis of glaucoma is made.

Glaucoma is a progressive condition. Over time, the delicate nerve tissue is affected by progressive damage, in addition to the loss experienced with increasing age. It is important to have regular tests to establish and assess the rate of progression and tailor treatment accordingly.

Treatment of glaucoma depends on the cause identified. Glaucoma occurs due to a number of underlying risk factors, and cannot be controlled by modifying lifestyle alone. Controlling intraocular pressure is currently the main method to treat glaucoma.

There are 3 main ways to treat glaucoma:

Eye drops are the most common initial treatment of glaucoma. At the early stage of the disease, patients can usually be managed medically with eye drops that lower the eye pressure. In some cases, more than one eye drop may be required. It is important that the eye drops are administered regularly as prescribed.
Laser treatment to lower eye pressure may be beneficial in some forms of glaucoma.
Glaucoma surgery is usually reserved for more advanced cases, when drops and laser have not been successful at controlling the progression of glaucoma.

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