Glaucoma is one of the leading causes of blindness in the world. It is a slow and progressive disease that can lead to vision loss over a long period of time. Many people with glaucoma might not even know they have the disease or if they are aware of it, they may not notice it until they have significant vision loss.
During my training as an ophthalmologist, I learned a technique for diagnosing patients who had or were suspected to have advanced stage glaucoma before even conducting an eye exam. I would walk into the waiting room and introduce myself to the seated patient by holding my hand out at waist level. Those with restricted visual fields caused by long-standing glaucoma were often unable to see my hand until I raised it up higher. For these patients, an exam usually would confirm a diagnosis of advanced glaucoma.
Glaucoma is what I call a “disease of decades” in that it takes awhile for it to progress. Once one has it, while there is no cure, there are steps to take to help slow the progression even though it will always be there. Regular eye exams, early detection and follow-up are key to managing this disease. First, it’s important to understand what glaucoma is.
What is Glaucoma?
Glaucoma is a condition defined as optic nerve damage, most often caused when fluid inside the eye does not drain properly. As the fluid builds, eye pressure also builds up. This increase in eye pressure causes damage to the optic nerve (the nerve for vision). At normal or low pressure, under certain circumstance damage can still occur to cause glaucoma. In advanced stages, it can lead to severely limited vision or even blindness.
Symptoms and Signs
For open angle glaucoma, there are usually no signs or symptoms. The loss of peripheral vision (vision outside of the center of what one sees in front of them) usually occurs so slowly, the patient does not notice it until it they have lost a good deal of vision. In fact, some patients with glaucoma can have a great deal of damage to their optic nerve fibers before there are any visual field changes.
With advanced disease, people may show signs of vision loss, such as knocking over cups or eating utensils on a table, or missing steps or street curbs leading to an increase in falls. Unfortunately, by this time, the patient has already experienced some degree of vision loss. This vision loss and blindness due to glaucoma are not reversible.
Can it be Prevented?
Glaucoma cannot be prevented. But it is possible to help prevent or slow down the vision loss. This can be done by having an eye doctor regularly monitor the optic nerve, intraocular pressure and visual field and provide individualized treatment to reduce the pressure in the eye from whatever the starting point is.
Who’s at Risk for Glaucoma?
While glaucoma can occur at any age and in anyone, depending on the structure of the eye, it is most common in people with the following risk factors:
- Increasing age: Risk starts increasing in middle age; individuals older than 40 years should discuss their risk with their health care team to decide when is the right time and how often to have a complete eye exam including an evaluation for glaucoma
- Race: People of African descent are 3 to 5 times more likely to be diagnosed with glaucoma at any age, not just at older ages. Latinos and people of Asian descent may also be at increased risk
- Family history: A person’s genetic background and family history of glaucoma increases the risk of the disease and should be clearly communicated to the doctor. People with parents, grandparents or close relatives diagnosed with glaucoma should consult with an eye doctor concerning when and how often to be examined
- High ocular pressure: Patients with glaucoma often have an increased pressure in the eye, though it is important to note that the eye pressure is not always high for some people. This is why it is important to get a complete eye examination. An eye doctor can diagnose the disease based on the risk to the patient, and on an exam that may include a careful look at the optic nerve, and other visual field tests
- Diabetes and hypertension: People with diabetes and hypertension (or high blood pressure) are at increased risk for a number of eye problems and conditions, including cataracts and glaucoma. Regular eye exams are important in managing these chronic diseases
What You Can Do
The most important thing that you can do is to be knowledgeable about your own risk for developing glaucoma and work with your health care team to decide when to get regular eye exams.
If you are diagnosed with glaucoma, it is important to follow the glaucoma treatment plan prescribed by your physician, which may include eye drops or other treatments that decrease eye pressure. For more advanced disease, laser treatment or surgery may be necessary. Because glaucoma is a chronic disease requiring life-long monitoring, regular follow-up appointments are very important.
The Foundation of the American Academy of Ophthalmology and EyeCare America can direct you to eye doctors who may provide free eye exams for those who qualify. Click here for more information.
Charles Tressler, M.D. is an ophthalmologist and a Senior Director in Worldwide Safety and Regulatory at Pfizer.
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