About Glaucoma
Glaucoma is a disease of the optic nerve that is most often associated with high pressure inside the eye-Intraocular Pressure (IOP)-that damages the nerve and causes progressive loss of vision. In the United States, there are more than three million people with glaucoma. The most common form, Primary Open Angle Glaucoma (POAG) begins without any symptoms or obvious loss of vision. With early detection, diagnosis, and treatment, in the vast majority of cases, glaucoma vision loss can be controlled or prevented. It is critical to diagnose and treat glaucoma as early as possible through regular eye exams to prevent vision loss.
Glaucoma Risk Factors
There are several known health, ethnic, lifestyle, and demographic factors that influence your risk of developing glaucoma, including:
- High Intraocular Pressure-regardless of age anyone with high IOP is at risk
- Age-Risk increases after the age of 40 and is 6 times greater if you are over 60
- Race-African-Americans have a six-to-eight-fold increased risk for glaucoma
- Myopia-Severely nearsighted people have a higher risk of developing glaucoma
- Hypertension or High Blood Pressure
- Diabetes
- Family History-Any family history of glaucoma is considered a very significant risk factor, especially among siblings
- Steroids-Taking steroid medication for allergies, asthma, or arthritis
- Early Menopause
- Sleep Apnea
- Thin Corneal Tissue
- Eye Trauma
- Smoking
Types of Glaucoma
Primary Open Angle Glaucoma (POAG) and Angle Closure Glaucoma are the two most common types of glaucoma we see at Mitchell & Morin Eye Institute.
Primary Open Angle Glaucoma (POAG) is the most common type of glaucoma whereby the production and/or drainage of fluid inside the front of the eye, called aqueous humor, is imbalanced, resulting in an elevation in eye pressure (IOP). This pressure deprives the optic nerve of oxygen and nutrients causing irreversible changes and damage, which if left untreated results in vision loss and ultimately blindness.
Angle Closure Glaucoma accounts for about 10% of all cases of glaucoma and about 2/3 of these produce no symptoms for patients.
Acute Angle Closure Glaucoma is one of the only types of glaucoma that produces distinct symptoms that include pain, light sensitivity, redness, blurred vision, colored haloes around lights, and nausea or vomiting. Acute Angle Closure Glaucoma is considered a medical emergency. If you experience a sudden onset of pain, redness, blurred vision, light sensitivity, haloes around lights, nausea, and vomiting, please call Mitchell & Morin Eye Institute and relay these symptoms to the staff member so that you can be given an appointment immediately. In the event that you are at risk for Angle Closure Glaucoma or in the event that you have Acute Angle Closure Glaucoma, we may initially prescribe some medication to begin to lower the pressure but will also perform a type of in-office glaucoma laser procedure called Laser Peripheral Iridotomy (LPI) to produce a small opening or hole in the Iris so that Aqueous Humor can drain from the eye more effectively. Fortunately, these treatments are very effective at quickly lowering pressure and preserving vision.
Glaucoma Testing
During your exam or as part of a special glaucoma testing visit, we may perform several tests to be able to provide early detection and make the most accurate diagnosis of glaucoma. These may include the following:
- Tonometry-Intraocular Pressure (IOP) measurement.
- Ophthalmoscopy-Examination of the optic nerve through a dilated pupil which may be performed using special instruments or a high magnification lens at the Slit Lamp Biomicroscope.
- Visual Field Perimetry-A computerized examination to plot an actual map of the field of your vision.
- Gonioscopy-Direct examination of the drainage structures of your eye called “trabecular meshwork”-using a specialized contact lens at the Slit Lamp Biomicroscope.
- Computerized Imaging of Optic Nerve & Fibers-OCT uses a method called “optical coherence tomography” to create digital images with beams of light to examine the optic nerve and measure the retinal nerve fiber thickness.
- Pachymetry Measurement of Corneal Thickness
From this testing, we will be able to make a diagnosis and recommendations for additional visits and treatment as required. They will be sure to answer all questions you may have and help you understand how we will work together to help maintain your eye health and vision.
Medical, Laser & Surgical Treatment of Glaucoma
The goal of glaucoma treatment is to stabilize and control your eye pressure to provide the best chance of preserving your vision. The three main glaucoma treatments are medical-using eyedrops, glaucoma laser treatment, and glaucoma surgery, most often minimally invasive glaucoma surgery (MIGS).
Medical Treatment of Glaucoma
Primary Open Angle Glaucoma can initially be treated with eye drops and/or an in-office laser treatment called Selective Laser Trabeculoplasty (SLT). By using one or two types of glaucoma eyedrops most patients can achieve stable and lowered eye pressure. Some patients are unable to achieve adequate control with eye drops alone or may experience intolerable side effects from the eye drops, and do better with an office glaucoma laser treatment to maintain control as the first choice of treatment.
Laser Treatment of Glaucoma
Selective Laser Trabeculoplasty (SLT) is a type of glaucoma laser treatment for Primary Open Angle Glaucoma that helps to reduce the Intraocular Pressure (IOP) by creating more effective drainage of fluid through the trabecular meshwork. We perform this painless procedure in the comfort of our office and often patients are able to obtain good stability and also reduce the number or frequency of eyedrops they need to use. Laser Peripheral Iridotomy (LPI) is a type of glaucoma laser treatment for Angle Closure Glaucoma that creates a hole on the outer edge, or rim, of the iris, the colored part of the eye which allows the aqueous humor fluid to easily flow between the anterior chamber, the front part of the eye, and the area behind the iris, the posterior chamber. This is performed for patients with narrow chamber angles or those patients experiencing angle closure to prevent sudden buildup of pressure within the eye, which occurs during an episode of acute closed-angle glaucoma.
Surgical Treatment of Glaucoma
Even with the maximum eye drop medical therapy and glaucoma laser treatment, for some patients it is still not possible to achieve good stable control of their disease and stop the progression of vision loss. For many patients we are able to perform Minimally Invasive Glaucoma Surgery (MIGS) including the OMNI Canaloplasty procedure to help patients lower their eye pressure and reduce the need for eye drops.