Glaucoma Treatments

What is glaucoma?

Glaucoma is an eye disease that occurs when pressure behind the eye builds up, damaging the optic nerve, which is responsible for sight. This eye disease is the leading cause of blindness around the world and typically doesn’t show symptoms in its early stages. As intraocular pressure (IOP) builds, vision loss begins to occur and if not managed can prompt irreversible blindness. 

Signs and Symptoms of Glaucoma

Signs of glaucoma may be difficult to detect early on, which is why it’s paramount to schedule routine appointments with your optometrist and opthamologist. Furthermore, signs of glaucoma can look similar to countless other eye problems and eye diseases. Those at higher risk for developing glaucoma must be diligent about eye exams. Some signs and symptoms of glaucoma may include but are not limited to: 

• Patchy blindspots 
• Headache
• Blurred vision
• Tunnel vision (as glaucoma advanced)
• Eye pain
• Nausea 
• Eye redness
• Seeing halos around lighting fixtures

Types of Glaucoma

There are two types of glaucoma – open angle and closed angle. While much is known about the symptoms and treatment of glaucoma, medical professionals are still theorizing possible root causes. 

Primary open angle glaucoma is the most common type and is caused by inefficiency in the eye’s fluid drainage system. Over time, the fluid drainage system retains more and more liquid, causing the pressure to build and eventually damage the optic nerve. 

Primary open angle glaucoma is harder to catch early on as it causes almost no pain or symptoms. Damage to the optic nerve is only noticed when the vision becomes completely corrupted.  

Closed angle glaucoma is also called angle-closure glaucoma or narrow-angle glaucoma. This type of eye disease comes on suddenly and can cause blindness in as little as one day. Acute angle closure glaucoma is a medical emergency and occurs when the drainage angle between the cornea and iris becomes blocked suddenly. Chronic angle-closure glaucoma may also occur but still must be treated as quickly as possible to reduce the risk of blindness, blurred vision, and vision loss. 

Who is at risk? 

Glaucoma can affect anyone, however, there are certain factors that put one in a higher risk category for developing glaucoma as they age. Risk factors include: 

• Family history of glaucoma
• African Americans over the age of 40
• Hispanics over the age of 60
• Having medical conditions including diabetes, heart disease, sickle cell anemia, and high blood pressure
• Experiencing an eye injury
• Strabismus 
• Thin corneas
• Retina injury
• Having extreme nearsightedness or farsightedness
• Having other eye conditions or eye diseases
• Long-term corticosteroid use 
• Individuals with age-related macular degeneration taking medication
• Amblyopia 

Causes of Glaucoma

Generally, glaucoma occurs when the eye’s drainage system fails to maintain an appropriate amount of fluid in the eye. As fluid production continues normally, high eye pressure builds if the fluid cannot drain out adequately. 

Millions of nerve fibers comprise the optic nerve, which is responsible for sending signals from the eye to the brain. As pressure in the eye builds, it presses on this bundle of nerves, causing damage to the sensitive, fragile fibers. 

There is no eye pressure measuring gauge that dictates when glaucoma will develop. Some individuals with high intraocular pressure may never develop glaucoma, while others with normal pressure may develop glaucoma (normal tension glaucoma). 

The optic nerve in each eye is unique and can handle a certain amount of pressure. If this pressure point is surpassed, damage to optic nerve fibers can occur. Opthamologists, doctors, and researchers continue to study all facets of the eye to better identify blockage points that may contribute to glaucoma. One such point occurs in the trabecular meshwork located near the cornea. Many believe that this pinch point may be the greatest hindrance to aqueous humor flow. 

The cause of this build up of pressure is varied but underlying issues, family history, or chronic medical conditions are often to blame. Diabetes can trigger an eye disease called diabetic retinopathy that causes harm to blood vessels in the retina. Diabetic retinopathy may cause swelling, leaking, or complete closure of these blood vessels, stopping any passage of blood and prohibiting clear vision. 

How is glaucoma diagnosed?

Because warning signs are relatively minimal, glaucoma is diagnosed through routine examinations by your ophthalmologist. Over time, you will build a medical history with your opthamologist, allowing him or her to better spot optical changes if and when they occur. 

If you are experiencing symptoms of glaucoma, your opthamologist will conduct exams and tests to appropriately assess the situation. These may include: 

• Test for optic nerve damage
• Gonioscopy test to analyze the ocular drainage angle
• Measure pressure in the eyes through tonometry test
• Analyze the structure of the macula
• Conduct a visual field test
• Perform peripheral vision tests
• Measure corneal thickness

Glaucoma Treatment Options

Early detection is key. While glaucoma isn’t curable yet, it is manageable with a variety of non-invasive and surgical methods. Glaucoma surgery has given many people relief and helped prevent further complications down the line. When caught early on, severe vision impairment and blindness may be mitigated with treatment. Treatments and management techniques include: 

• Prescription eye drops. Depending on the type of glaucoma you are experiencing, eye drops may reduce the fluid or help the fluid flow better. Typically, eye drops must be used daily. Symptoms from medicated eye drops can include stinging, burning, itching, and irritation around the eye. 
• Laser trabeculectomy. This glaucoma surgery creates a new pathway in the eye where fluid can drain. A trabeculectomy remains one of the most popular and effective surgeries to treat glaucoma. 
• Laser treatment. Also called laser trabeculoplasty, this treatment is straightforward and can often be conducted in the office. Your doctor will use a laser to remove fluid in the eye. Symptoms may include swelling and soreness, but usually reside within a day. 
• Glaucoma medications. Your ophthalmologist may prescribe oral medication for glaucoma treatment. These can include beta blockers, systemic carbonic anhydrase inhibitors, and osmotic agents. 
•  Drainage surgery. This surgery implants an artificial drainage duct in the eye so that fluid can flow more freely. An individual that undergoes drainage surgery may need to use artificial tears to keep eyes hydrated. 
• Cataract surgery. When an individual has glaucoma and cataracts, cataract surgery has often proven to reduce intraocular pressure. This method isn’t fool proof and more research is needed to definitively prove that cataract surgery is a beneficial glaucoma treatment. Cataract surgery costs may vary based on your insurance. Nonetheless, cataract surgery can help clear up vision, which is a side effect of glaucoma as well. 
• Iridotomy. This surgery creates a hole in the iris, allowing fluid to filter into the front of the eye, reducing pressure and build up behind the eye and preventing further optic nerve damage. 

Patient’s Role in Glaucoma Treatment

Because this eye disease is incurable, the glaucoma patient has a major responsibility in managing their treatment. From daily eye care to eye surgery, treatment of glaucoma runs the gamut of practices and procedures. Establishing a relationship with an ophthalmologist in Orlando who can monitor your eye health is crucial in managing glaucoma and its symptoms. 

Additionally, utilize resources from the American Academy of Ophthalmology and the National Eye Institute to learn more about glaucoma treatments, causes, and risk factors. A great deal of money, time, and research is going into seeking a cure for this relatively common eye disorder. 

Living a healthy lifestyle, staying on top of daily treatment if applicable, and routinely visiting your eye doctor are pivotal to reducing the risk of blindness caused by glaucoma. Staying healthy reduces your risk of high blood pressure and diabetes, which can increase your risk of developing glaucoma or suffering from complications of glaucoma. 
UCF Health offers ample resources on leading a healthy, active life. Our patient portal allows individuals to take control of their health. With COVID-19 updates for patients and an online scheduling tool, access to healthcare is just a few clicks away.