Glaucoma
What is glaucoma?
Glaucoma is one of the leading causes of blindness in the United States. It is a disease that typically affects older people, but it can occur at any age. Loss of vision is preventable if the disease is detected early and treatment is started.
“Glaucoma” describes a whole group of diseases affecting the eye, but all share the common fact that the pressure within the eye (the intraocular pressure) is at an unhealthy level for the affected eye. Because many different types of glaucoma exist, treatment depends upon the type of glaucoma present as well as a variety of other factors.
In many patients, the disease is not noticed in the early stages, because there is no pain and no noticeable change in vision. Early detection by an eye doctor is the key to the prevention of vision damage from glaucoma.
Most types of glaucoma are chronic, and are present for the person’s lifetime. Some types of glaucoma occur suddenly, but most develop slowly, over months or years.
What are the risk factors?
Family history increases risk four to nine times above average
Diabetes increases risk two times above average
African American race increases risk 3 times above average
People over age 60 are six times more likely than those who are younger to develop glaucoma
If there is glaucoma in one eye, there is a 29% chance of developing glaucoma in the opposite eye within five years.
Where does damage occur?
The eye has over 1 million tiny nerve fibers which run from the back of the eye to the brain. These nerve fibers are responsible for our vision. Glaucoma is a disease in which there is a loss of these tiny fibers. No matter if the eye pressure is high, normal, or below normal, it can still cause damage to susceptible nerve fibers and result in loss of vision. The stages of disease progression are seen below based on nerve damage.
Common Misconceptions about Glaucoma
One of the reasons so many patients with glaucoma get worse is that they have serious misunderstandings and misconceptions about it. Here are some of the more common ones:
People with glaucoma have a noticeable loss of vision.
In most people, the initial damage to vision is a mild generalized loss of sensitivity to contrast. Usually, the first area of vision lost is the peripheral vision near the nose. Since this area of vision is also served by the opposite eye, the loss is not usually noted until a large portion of the peripheral vision is lost in one eye or both eyes.
People who have glaucoma must use drops forever.
Behind the misconception is a truth that frequently does apply; specifically, that glaucoma tends to be a chronic condition that requires life-long therapy. However, in some people the need for drops to control eye pressure may spontaneously disappear or improve reducing the need for eye drops or may lesson after cataract surgery.
Surgery is appropriate only in desperate cases.
Some types of glaucoma are best treated right from the start with surgery, such those types related to an advanced cataract or diabetes. On the other hand, certain types of glaucoma are best treated with drops instead of surgery because the risk associated with glaucoma surgery is greater than the potential benefits at a given stage of glaucoma.
Glaucoma control can be solely determined by monitoring one’s eye pressure.
It is true that glaucoma is damage to the nerve tissues of an eye that is at least partially caused by a pressure higher than the nerve can tolerate. Nevertheless, people can go blind even though their intraocular pressure is constantly below the so-called “normal” level of pressure. When optic nerve damage is occurring, the glaucoma must be defined as “uncontrolled,” regardless of the level of eye pressure and treated.
What the glaucoma patient understands about glaucoma does not make a difference.
This is a particularly tragic misconception about glaucoma. In fact, how a person manages his or her life is probably the single most important factor when determining whether that person maintains his or her sight. Perhaps the most important thing to understand about glaucoma is that each case is different and the greatest success in terms of quality of life (in relation to quality of vision) occurs when the individual patient really takes responsibility for his or her own well-being and then works with a knowledgeable, competent physician, who truly listens and truly cares for the person as an individual