Glaucoma Management

Open Angle Glaucoma

 The term "glaucoma" refers to several eye diseases in which a blockage in the eye's fluid drainage system causes fluid to back up, increasing the intraocular pressure (pressure within the eyeball). If the pressure stays too high for that eye, the optic nerve can be permanently injured. The optic nerve is like a telephone cable transmitting images from the eye

 

 to the brain. If it is damaged by pressure, blind areas develop in the visual field that can progress to partial or even total blindness. 

        Open-angle glaucoma (OAG) is the most common type. It is particularly dangerous because there are no symptoms -- no pain or other warning that you are losing vision -- until it is too late.

        OAG usually occurs after midlife and affects both eyes. Sometimes it runs in families. Glaucoma is not contagious and is not related to cancer. The high pressure in the eyes is not the same as high blood pressure.

What Causes Open Angle Glaucoma?

        A clear fluid called aqueous (or aqueous humor) fills the anterior chamber, a small compartment between the iris (colored part of the eye) and the cornea (clear "window" covering the iris). Aqueous is produced and circulated in the eyeball to supply essential nutrients to the eye and keep a gentle pressure within it, like a balloon or tire.

        The pressure is maintained within a tight range by a control system that delicately balances aqueous production and drainage. Drainage takes place through the trabeculum and Schlemm's Canal, channels that are located near the "angle," a wedge-shaped space that encircles the iris where it meets the edge of the cornea.

        In open-angle glaucoma, a microscopic blockage gradually develops in the drainage mechanism, preventing aqueous from leaving the eye easily. Since aqueous continues to be produced, the pressure within the eye steadily builds up (over months to years). If the pressure stays much above a normal level, the delicate blood supply and nerve fibers in the optic nerve will be damaged. 

glaucoma awareness link

Examination and Diagnosis

        Since OAG causes no symptoms, it is frequently detected only during a routine eye examination. As part of the exam, the pressure within your eyes will be checked by a painless test called tonometry. Depending on the type of tonometer used, you may be given anesthetic eye drops. An elevated pressure is a sign that you may have glaucoma, but pressure alone will not tell if you do have glaucoma or that the pressure needs treatment.

 A diagnosis of open-angle glaucoma can be made only after evaluating certain eye functions and structures inside the eye. The interior of your eyes will be examined with several instruments. A gonioscope (special type of contact lens that allows a view into the angle structures) will be placed on your eye so the drainage channels can be studied. The retina and optic nerve will be examined with an ophthalmoscope. A visual field test can identify if any areas of vision have been lost.

        If the optic nerve is not damaged and there is no loss of visual field, a mildly increased eye pressure does not necessarily need to be treated. But it does need to be examined regularly (every few months) to watch for any developing changes; if these occur, treatment will be started.

Treatment

According to the  Glaucoma Research Foundation it is important to have your eyes examined regularly.

Your eyes should be tested:
  • before age 40, every two to four years
  • from age 40 to age 54, every one to three years
  • from age 55 to 64, every one to two years
  • after age 65, every six to 12 months
  • Anyone with high risk factors should be tested every year or two after age 35.

High risk factors are:

  • people with diabetes
  • people with a family history of glaucoma
  • African-American and 50 or older
  • Hispanics and 65 or older

 

 The goal of treatment is to lower your eye pressure. Almost always, this involves the regular use of prescription eye drops. Some drops improve the filter drainage mechanism, some reduce the production of aqueous, and some do both. More than one medication may be prescribed for you.

        Sometimes, even when eye drops are faithfully used, they may not stop the disease from progressing. Then, laser surgery may be recommended to make tiny new openings in the drainage channels. This procedure, called laser trabeculoplasty (LTP), can lower the pressure, sometimes dramatically; but you may still need to take some medication. Unfortunately, a successful LTP is not always a permanent solution; months or years later, pressure may again rise and threaten vision.

        If all other therapy combinations have not been successful, filtration surgery may be recommended. The most common of these procedures, called trabeculectomy, is the surgical creation of a new drainage channel. Other surgical procedures can provide even greater drainage, if needed, to reduce the ocular pressure and save vision. 
 
 Surgery always has risks and side effects. If it becomes necessary in your case, those risks will be carefully explained to you along with the potential benefits.

        Open-angle glaucoma is usually a lifelong problem. Never assume that you have been cured, and do not stop treatment unless you have been told to do so. Left untreated, this disease can cause total blindness. On the other hand, proper treatment and regular checkups can help you to preserve your precious eyesight for the rest of your life.

To learn more about Glaucoma and the health care we can provide,

 please call us at 208-523-6868


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