Understanding Glaucoma

Las Vegas, Nevada

Glaucoma is a common eye disease that is one of the leading causes of preventable blindness. Even in the United States hundreds of people lose vision from glaucoma every year. Glaucoma occurs when pressure builds up in the eye and causes damage to the optic nerve. The pressure increases when the drainage area of the eye becomes clogged. This pressure elevation can occur slowly as a result of aging, or suddenly in the case of acute glaucoma.

Glaucoma often has no symptoms until the condition is advanced and vision loss has started to occur. Fortunately, if it is caught early it can be controlled. If you are over 50, African-American, have a relative with glaucoma, are diabetic or very nearsighted, you should have your eyes checked every year.

What causes glaucoma?

Clear liquid called aqueous humor circulates inside the front portion of the eye. To maintain a healthy level of pressure within the eye, a small amount of this fluid is produced constantly while an equal amount flows out of the eye through a microscopic drainage system. (This liquid is not part of the tears on the outer surface of the eye.)

Because the eye is a closed structure, if the drainage area for the aqueous humor - called the drainage angle - is blocked, the excess fluid cannot flow out of the eye. Fluid pressure within the eye increases, pushing against the optic nerve and causing damage.

Clear liquid called aqueous humor is constantly being produced within the eye (left). If the drainage angle of the eye is blocked, fluid cannot flow out of the eye (right).

What are the different types of glaucoma?

Chronic open-angle glaucoma:

This is the most common form of glaucoma in the United States.

The risk of developing chronic open-angle glaucoma increases with age. The drainage angle of the eye becomes less efficient over time, and pressure within the eye gradually increases, which can damage the optic nerve. In some patients, the optic nerve becomes sensitive even to normal eye pressure and is at risk for damage. Treatment is necessary to prevent further vision loss.

Typically, open-angle glaucoma has no symptoms in its early stages and vision remains normal. As the optic nerve becomes more damaged, blank spots begin to appear in the field of vision. You typically won't notice these blank spots in your day-to-day activities until the optic nerve is significantly damaged and these spots become large. If all the optic nerve fibers die, blindness results.

Closed-angle glaucoma:

Some eyes are formed with the iris (the colored part of the eye) too close to the drainage angle. In these eyes, which are often small and farsighted, the iris can be sucked into the drainage angle and block it completely. Since the fluid cannot exit the eye, pressure inside the eye builds rapidly and causes an acute closed-angle attack.

Symptoms may include:

• Blurred vision
• Severe eye pain
• Headaches
• Rainbow-colored halos around lights
• Nausea and vomiting

This is a true eye emergency. If you have any of these symptoms, call your ophthalmologist immediately. Unless this type of glaucoma is treated quickly, blindness can result. Unfortunately, two-thirds of those with closed-angle glaucoma develop it slowly without any symptoms prior to an attack.

Who is at risk for glaucoma?

Your ophthalmologist considers many kinds of information to determine your risk for developing the disease.

The most important risk factors include:

• Age
• Elevated eye pressure
• Family history of glaucoma
• African or Spanish-American ancestry
• Farsightedness or nearsightedness
• Past eye injuries
• Thinner central corneal thickness
• Systemic health problems, including diabetes, migraine headaches, and poor circulation.

Your ophthalmologist will weigh all of these factors before deciding whether you need treatment for glaucoma, or whether you should be monitored closely as a glaucoma suspect. This means your risk of developing glaucoma is higher than normal, and you need to have regular examinations to detect the early signs of damage to the optic nerve.

How can I tell if I have glaucoma?

Unfortunately you can't! Most people have no symptoms when glaucoma is in its early stages. The only way to find out if you have glaucoma is to have a regular eye examination.

Why do I need an annual glaucoma check?

If you wait until your vision is impaired, glaucoma may already be quite advanced. As the optic nerve becomes more damaged, blank spots begin to appear in your field of vision. You typically won't notice these blank spots in your day-to-day activities until the optic nerve is significantly damaged and these spots become large. If all the optic nerve fibers die, blindness results. With early detection and appropriate treatment, your vision can be preserved.

How is glaucoma detected?

Regular eye examinations are the best way to detect glaucoma. A glaucoma screening that checks only the pressure of the eye may miss certain types of glaucoma. The only sure way to detect glaucoma is to have a complete eye examination.

During your glaucoma evaluation, Dr. DeBry will:

• Measure your intraocular pressure (tonometry);
• Measure the thickness of your cornea (corneal pachymetry);
• Inspect the drainage angle of your eye (gonioscopy);
• Evaluate whether or not there is any optic nerve damage (ophthalmoscopy);
• Test the peripheral vision of each eye (visual field testing, or perimetry).

Photography of the optic nerve or other computerized imaging may be recommended. Some of these tests may not be necessary for everyone. These tests may need to be repeated on a regular basis to monitor any changes in your condition.