A serious eye disease that usually strikes adults 40 years and older, glaucoma is a degeneration of the Optic nerve, usually caused by a build-up of pressure inside the eye. This excessive pressure prevents retinal cells and optic nerve fibers to get the proper blood flow, which causes them to degenerate. Normal pressure ranges are from 14-22. Patients can have elevated eye pressure and never develop glaucoma which is called Ocular Hypertension. Conversely, although it is not fully understood, patients with normal eye pressure can develop glaucoma. This is called Normal Tension Glaucoma. Both types left untreated, may lead to severe, irreversible vision loss.
| Glaucoma is often called the “sneak thief of sight” because, in its most common form, it progresses gradually before victims realize they're losing their sight. | ||
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| Increased pressure inside the eye can lead to vision loss | Teri measuring the Eye Pressure with a TONOMETER | |
The loss of sight starts at the sides and continues toward the center until a small field or “tunnel” of vision remains. People with normal vision can stand at a street intersection and see traffic from both directions. Those with advanced glaucoma can see only straight ahead, as if they were looking through a long tube. Eventually all vision may be lost. Sight lost to glaucoma cannot be restored, but glaucoma can usually be controlled if it is detected in time.
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| Patients view of the world who has glaucoma (tunnel vision) |
Glaucoma is the leading cause of preventable blindness in the U.S. This year, approximately 67 million people worldwide will suffer from glaucoma. Yet, approximately 2 million Americans don't even know that they have the disease. Others will be diagnosed only when it's too late to save vision.
Glaucoma, it should be emphasized, is not an infection. It is not cancer. It is not a drying up of tear ducts or caused by overuse of your eyes. It is, however, a serious disease and one that deserves prompt medical attention. It is not caused by too much reading or watching too much television.
Are You at Risk?
Glaucoma is not contagious, but it does run in families. Higher risk factors are if you have a sibling who has glaucoma. Injuries to the eye, severe nearsightedness and various other eye diseases and medications may also be associated with increased incidence of glaucoma.
Glaucoma can be treated and controlled if detected early. Detection of glaucoma requires periodic eye exams with ancillary testing. It is especially important for people over 40 and/or those with any of the higher risk factors explained above.
A Look at Three Types of Glaucoma
Although there are many different varieties of glaucoma, but the most common are chronic, primary open angle, normal tension glaucoma, and acute closed angle glaucoma.
Open Angel Glaucoma
It is by far the most common. It is painless. It slowly destroys vision without warning. By the time a vision problem is noticeable, irreversible damage may have occurred. Chronic glaucoma can be detected through a routine eye exam. Because it is silent and strikes adults, it is important for people over 40 to have a periodic eye exam.
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Normal Tension Glaucoma
Although it is not fully understood, but patients with normal eye pressure can develop glaucoma. This is called Normal Tension Glaucoma. It is believed that the Optic Nerve is deprived from the nutrients in the blood, thus causing it's degeneration. Eye pressure is just one bit of data needed to diagnose this disease. That is why often more than just the “puff of air” test is needed to determine if you have glaucoma.
Acute, Closed Angle Glaucoma
Acute, closed angle glaucoma is not very common. It is marked by a sudden, severe pain in and around the eye, sharply decreased vision, headache, nausea and vomiting, and halos around lights. Acute glaucoma causes extremely high pressure, which can lead to blindness in less than 24 hours. To alleviate this pressure, immediate, emergency treatment is required. Surgery or laser treatment may also be necessary to prevent further attacks. In cases where a predisposition is detected, laser surgery can prevent an attack from happening.
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| Photo of Normal Optic Nerve | Glaucomatous Optic Nerve (notice large white center) |
| Photos taken for diagnostic and monitoring purposes at Skowron Eyecare Notice the progressive increase in size of the center white area (cup) |
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Diagnosing and Monitoring Glaucoma
At Skowron Eye Care, we have invested in the latest in technology to enable us to properly diagnose, treat and manage Glaucoma. Now there are fast, comfortable and non-intrusive ways to diagnose glaucoma earlier (up to 5 years earlier) and manage it:
- GDX Nerve Fiber Analysis
- Cirrus OCT Optical Coherence Tomography
- Digital Retinal (Optic Nerve Head) Photography
- Visual Fields (Perimetry-peripheral vision evaluation)
- Pachymetry (measuring corneal thickness)
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| Dr. Skowron and Diane performing a Cirrus OCT and its corresponding printout. | Deb finishing a GDX Nerve Fiber Analyzer exam and its corresponding information printout. |
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Because many of the standard tests are inconclusive for glaucoma, we have invested in both of these technologies at Skowron Eyecare to give us as much data as possible to accurately assess the health of your eye.
These technologies (GDX and OCT) essentially do a laser ultra sound to determine the thickness of the Optic nerve cells. In fact, these technologies are the only glaucoma tests that evaluate the site of damage before you experience any vision loss. These tests are simple, quick, and painless. Nothing ever touches the eye!
This is a significant breakthrough compared to existing tests. The standard eye pressure check (tonometry or “puff of air”) is inconclusive for detecting glaucoma in many of these patients diagnosed with the disease. Abnormal results with Visual field testing (perimetry) don't show up until after millions of nerve fiber cells have been damaged by glaucoma. However, Visual Field Testing (Perimetry) is still the standard method of following glaucoma. This is the test that shows you a series of lights in your peripheral vision.
At Skowron Eyecare, we have raised the standard of care for glaucoma by performing a GDX or OCT in addition to perimetry testing. This enables us to very accurately assess any progression of Glaucoma, and in turn determine the proper treatment to ensure eye health.
Watch Out for These Warning Signs
While glaucoma can occur without warning, any one of the following symptoms is possible and warrants a complete eye exam.
- Rainbow colored halos around lights.
- Narrowing of your vision (loss of side vision)
- Frequent changes in prescription glasses without improving vision.
- Abnormally poor vision in dim light.
- Fuzzy or blurred vision which may come and go.
- Headaches, especially after watching TV or movies in the dark.
Humphrey Visual Fields Analyzer (perimeter). This instrument measures the extent of any damage caused by glaucoma. Many patients refer to this as “the test with all the lights”. Below is the result of the Humphrey test that shows a patient has damage from glaucoma. Notice the black spot in the upper right quadrant. This patient has permanently lost vision in this area due to glaucoma.
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| Genoveva performing a visual field on a glaucoma patient | Printout of patient who has vision lossin the upper right from glaucoma |
Eye doctors and medical researchers continue to seek better ways to treat and control glaucoma. Their efforts in recent years have led to earlier detection of the disease, new drugs, laser surgery and more successful surgical techniques.
While chronic glaucoma cannot be cured, it can be controlled and held in check, chiefly through the use of daily eye drops that either increase fluid removal from the eye or decrease the amount of fluid produced within the eye. Laser surgery is an additional option if the eye medications fail to hold the pressure in check. In more severe cases, surgery may be required to improve the drainage of eye fluids.
Anyone who has glaucoma, who is suspicious of glaucoma, or who has a family history of glaucoma should have one or all of these tests performed. Insurance companies usually cover this new technology. However, the test itself is not very expensive. If you fall in any of the above categories, please call the office and schedule a complete eye examination.
