Glaucoma

 

Glaucoma is a disease that may be associated with elevated intraocular pressure that causes progressive loss or damage to the optic nerve with eventual blindness.

We utilize advanced retinal fundus photography, OCT (Optical Coherence Tomography), Tonometry (eye pressure), and neurological Visual Field and VEP (Visual Evoked Potential) testing to diagnose, electronically document and monitor optic nerve health as well as provide a treatment plan.

Dr. Loveland is experienced and licensed to diagnose and treat Glaucoma and will screen for signs and risk factors during a yearly exam for both adults and children.


Light enters your eye and travels to the retina, the inner layer of the eye. The retina sends signals to the optic nerve, which then transmits the signals to your brain. In the normal eye, a fluid called aqueous humor is formed in the front of the eye, and then drains out through tiny drains called the trabecular meshwork. There is a pressure inside the eye that is required for health and falls within a certain range, 10-21 mmHg. With glaucoma, the aqueous humor does not drain properly, leading to increased pressure in the eye. The fluid build-up can be gradual, with slow progression of the disease and no early symptoms. Glaucoma is a silent thief that steals your sight very slowly.
 
Symptoms of Glaucoma


Elevated IOP

Patients who have open angle glaucoma may not experience symptoms in the early stages. As the glaucoma progresses with damage to the optic nerve, you may notice blind spots in your side (peripheral) vision. Patients who are risk for narrow angle glaucoma, because the drainage angle gets blocked, may not have any symptoms until they get an attack. Some early symptoms of early narrow (acute) glaucoma include halos, headaches, eye pain, redness, or blurred vision. During an attack of acute glaucoma, symptoms include eye redness, blurry vision, headache, nausea and vomiting, halos around lights, and intense eye or brow pain.

In some patients with normal tension glaucoma, the pressure in the eye is in the normal range, but they develop symptoms of glaucoma such as trouble seeing in there side (peripheral) vision. In other patients (almost 8%), their pressure can be higher than normal, but not experience any symptoms of glaucoma. These patients are called "glaucoma suspects".

What is Glaucoma?

Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and blindness. However, with early detection and treatment, you can often protect your eyes against serious vision loss.

The Optic Nerve
The optic nerve
The optic nerve is a bundle of more than 1 million nerve fibers. It connects the retina to the brain. (See diagram above.) The retina is the light-sensitive tissue at the back of the eye. A healthy optic nerve is necessary for good vision.

How does the optic nerve get damaged by open-angle glaucoma?
Several large studies have shown that eye pressure is a major risk factor for optic nerve damage. In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid leaves the chamber at the open angle where the cornea and iris meet. (See diagram below.) When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye.
In open-angle glaucoma, even though the drainage angle is "open", the fluid passes too slowly through the meshwork drain. Since the fluid builds up, the pressure inside the eye rises to a level that may damage the optic nerve. When the optic nerve is damaged from increased pressure, open-angle glaucoma-and vision loss—may result. That’s why controlling pressure inside the eye is important.
Another risk factor for optic nerve damage relates to blood pressure. Thus, it is important to also make sure that your blood pressure is at a proper level for your body by working with your medical doctor.
Fluid Pathway

Fluid pathway is shown in teal.

Can I develop glaucoma if I have increased eye pressure?
Not necessarily. Not every person with increased eye pressure will develop glaucoma. Some people can tolerate higher levels of eye pressure better than others. Also, a certain level of eye pressure may be high for one person but normal for another.
Whether you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. This level is different for each person. That’s why a comprehensive dilated eye exam is very important. It can help your eye care professional determine what level of eye pressure is normal for you.
Can I develop glaucoma without an increase in my eye pressure?
Yes. Glaucoma can develop without increased eye pressure. This form of glaucoma is called low-tension or normal-tension glaucoma. It is a type of open-angle glaucoma.

Who is at risk for open-angle glaucoma?
Anyone can develop glaucoma. Some people, listed below, are at higher risk than others:
  • African Americans over age 40
  • Everyone over age 60, especially Mexican Americans
  • People with a family history of glaucoma


A comprehensive dilated eye exam can reveal more risk factors, such as high eye pressure, thinness of the cornea, and abnormal optic nerve anatomy. In some people with certain combinations of these high-risk factors, medicines in the form of eyedrops reduce the risk of developing glaucoma by about half.

Glaucoma Symptoms

At first, open-angle glaucoma has no symptoms. It causes no pain. Vision stays normal. Glaucoma can develop in one or both eyes.

Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. As glaucoma remains untreated, people may miss objects to the side and out of the corner of their eye. They seem to be looking through a tunnel. Over time, straight-ahead (central) vision may decrease until no vision remains.

Normal Vision Glaucoma Vision

Normal vision vs. the same scene as viewed by a person with glaucoma.

 

 

How do we detect glaucoma?


Glaucoma Detected
Glaucoma is detected through a comprehensive dilated eye exam that includes the following:

Visual acuity test. This eye chart test measures how well you see at various distances.

Dilated eye exam. In this exam, drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.

Tonometry is the measurement of pressure inside the eye by using an instrument called a tonometer. A tonometer measures pressure inside the eye to detect glaucoma.

Pachymetry is the measurement of the thickness of your cornea. Your eye care professional applies a numbing drop to your eye and uses an ultrasonic wave instrument to measure the thickness of your cornea.

Fundus photography of the Optic nerve provides measurements and documentation for changes.

OCT (Optical Coherence Tomography) to discriminate normal eyes and eyes with early glaucoma and to compare it with that of peripapillary retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) measurements.

Visual field test. This test measures your peripheral (side vision). It helps your eye care professional tell if you have lost peripheral vision, a sign of glaucoma.

 

Can glaucoma be cured?
No. There is no cure for glaucoma. Vision lost from the disease cannot be restored.

Glaucoma Treatments


Immediate treatment for early-stage, open-angle glaucoma can delay progression of the disease. That’s why early diagnosis is very important.
Glaucoma treatments include medicines, laser trabeculoplasty, conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma.

Medicines. Medicines, in the form of eyedrops or pills, are the most common early treatment for glaucoma. Taken regularly, these eyedrops lower eye pressure. Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.
Glaucoma medicines need to be taken regularly as directed by your eye care professional.
Because glaucoma often has no symptoms, people may be tempted to stop taking, or may forget to take, their medicine. You need to use the drops or pills as long as they help control your eye pressure. Regular use is very important.