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Catch Glaucoma before symptoms show to slow disease progression: Glaucoma, which can cause severe vision impairment if untreated, can be diagnosed only with an eye exam.

Glaucoma is an eye disease in which elevated intraocular pressure (IOP) causes damage to the optic nerve, resulting in impaired vision. Glaucoma accounts for as much as 12 percent of all cases of blindness in the U.S., and it is the leading cause of blindness among African Americans, according to the National Eye Health Program/National Institutes of Health. However, many people who have glaucoma are unaware that they have it, since most people have no symptoms in the early stages.

"Glaucoma generally affects peripheral vision first, and it's usually a slow process. Many people don't realize they are losing their peripheral vision until it's very advanced," explains Leila Rafla-Demetrious, MD, an ophthalmologist at Weill Cornell Medicine. "This is why it is so important to have regular eye exams, especially as you get older."

The American Academy of Ophthalmology recommends having a baseline, comprehensive vision exam by the age of 40, and at a younger age for people who have risk factors for eye disease, such as diabetes, high blood pressure, or a family history of eye disease. They advise that people age 65 and older have an eye exam every one or two years, even if they have not noticed any changes in their vision.

Risk Factors

"A family history of glaucoma puts a person at higher risk, as well as a history of visual problems, such as extreme nearsightedness or farsightedness. Conditions such as diabetes, hypertension, and migraines also elevate the risk," says Dr. Rafla-Demetrious.

African Americans are also at higher risk--they are six to eight times more likely to develop glaucoma than other races. If you have suffered an eye injury, your risk is higher. And, people taking steroid medication have an elevated risk of glaucoma, since these drugs can significantly increase eye pressure.

Types of Glaucoma

The most common form of glaucoma is open-angle glaucoma. In this condition, the angle in the eye where the iris meets the cornea is normal, but the eye's trabecular meshwork (its drainage canals) becomes clogged over time, causing an increase in IOP and damaging the optic nerve.

The second most common type is angle-closure glaucoma, where the angle between the iris and cornea is narrow and doesn't permit adequate fluid drainage, resulting in increased IOP Unlike open-angle glaucoma, angle-closure glaucoma develops quickly; symptoms include eye pain, blurred vision, nausea and vomiting, and seeing halos around lights. Some people have low-tension or normal-tension glaucoma, where optic nerve damage occurs even when the IOP is in the normal range (12-22 millimeters of mercury).

Treating Glaucoma

Treatment usually begins with eye drops, which, for many patients, can reduce the IOP sufficiently to prevent further dam age to the optic nerve. The type of eye drop depends on the person's age, activity level, and other medical issues.

Several types of laser surgery can reduce IOP:

> Trabeculoplasty opens the drainage canals of the eye in patients with open-angle glaucoma.

> Iridotomy makes a hole in the iris through which fluid can drain for patients with angle-closure glaucoma.

> Cyclophotocoagulation damages parts of the ciliary body, the part of the eye that makes fluid and reduces fluid production.

If medications and laser surgery do not work to control glaucoma, more complicated eye surgery may be warranted to save visual function.

"Surgeries for glaucoma include trabeculectomy, in which a surgeon makes a flap/pocket to allow fluid to drain out, and implantation of a valve device into which fluid drains. For patients undergoing cataract surgery who also have mild to moderate glaucoma, an 'iStent' that contains a very small 'snorkel' through which fluid drains can be implanted," says Dr. Rafla-Demetrious.

All of the treatments may save existing vision, but they cannot restore or improve central or peripheral vision already lost.

"If you have been diagnosed with glaucoma, you need to stay on top of it," says Dr. Rafla-Demetrious. "Have an ophthalmologist monitor your condition every four to six months, even if everything is under control. Most people do well with medical treatment, but it requires a lifelong commitment to eye care and exams."


For comprehensive eye exams, see an ophthalmologist--a physician who specializes in medical and surgical care of the eye. These specialists consider three factors--the IOP, the condition of the optic nerve, and the patient's visual field (peripheral vision)--to determine if glaucoma is present. Optometrists have a doctor of optometry degree, but they are not medical doctors.

Caption: Normal vision

Caption: Advanced glaucoma
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Title Annotation:VISION
Publication:Women's Health Advisor
Date:Feb 1, 2017
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