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Catch glaucoma early to minimize vision loss.

If you think that only people who need eye - glasses develop glaucoma, better think again. Glaucoma is one of the most prevalent eye diseases among older adults, affecting more than four million Americans--less than half of whom know they have it, according to the National Institutes of Health. Most people with glaucoma have no early symptoms, but left unchecked, the disease is a leading cause of blindness.



The key to minimizing vision loss is early detection and treatment. "When we catch glaucoma early, and closely monitor and treat people, we can significantly slow its progression and minimize vision loss," says Paul Lee, MD, clinical assistant professor of ophthalmology at Mt. Sinai School of Medicine.

What is glaucoma? Glaucoma refers to a group of disorders that can cause increased pressure within the eye, and eventually, damage to the optic nerve, which connects the retina to the brain. A clear, watery fluid (aqueous humor) flows between the lens and the cornea and lubricates the eye. Normally, this fluid leaves the eye through a spongy meshwork at the open angle where the cornea and iris meet. But sometimes the fluid drains too slowly through the meshwork and pressure builds up within the eye, which can cut off blood supply to the optic nerve, eventually leading to blindness. This is known as open-angle glaucoma., and is by far the most common form of the disease.

However, not every person with increased eye pressure will develop glaucoma--it simply means you are at greater risk. According to the National Eye Institute, other risk factors include being 60 or older (especially for Mexican Americans), being African American and over 40, having a family history of the disease, diabetes, hypertension, or a traumatic eye injury.

At first, glaucoma manifests no symptoms. But as the disease progresses, you may notice your peripheral vision slowly deteriorating, and eventually, forward vision may diminish as well, resulting in blindness.


Fortunately, an annual eye examination can catch glaucoma early, and timely treatment can minimize your chances of vision loss, says Dr. Lee.

Managing the condition. Glaucoma treatment is aimed at reducing eye pressure by improving fluid drainage, reducing fluid production, or both. This is accomplished with eye drops, oral medications, laser treatment, surgery, or a combination of approaches.

Eye drops. Eye drops are the most common first-line treatment for glaucoma (see "Glaucoma Eye Drops"). According to Dr. Lee, "Regular, consistent use of eye drops is required to best manage glaucoma."

However, applying eye drops can be difficult, because you need to prevent them from escaping through your tear drainage system (see "How to Apply Eye Drops"). Otherwise, the medication can pass into your sinuses and be absorbed into your bloodstream, where it can cause low or high blood pressure and changes in heart rhythm.

Oral medications. According to Dr. Lee, "In rare instances, if eye drops don't bring your eye pressure down to the desired level, oral medication may need to be taken." Commonly prescribed drugs include acetazolamide (Diamox) and methazolamide (Neptazane). Side effects may include upset stomach, loss of appetite and vomiting, as well as headache, fever, rash, and even seizures.

Surgery. Surgery may be needed to treat glaucoma if other methods prove ineffective. Patients should discuss the following options with their physician:

* Laser surgery. A procedure called trabeculoplasty is being used more often. The doctor uses a high-energy laser beam to shrink part of the trabecular mesh-work, which causes other parts of the meshwork to open up. This procedure is less invasive than conventional surgery and can be done in the doctors office. However, one of the side effects is the development of cataracts.

* Conventional surgery. Dr Lee recommends conventional surgery over laser surgery because "It can decrease eye pressure by as much as 40-50 percent, compared to only 25 percent with laser surgery." The procedure, called a trabeculectomy, is typically done in a hospital or walk-in surgical center.

* Drainage implants. This procedure may be an option for people with secondary glaucoma, in which another disease causes increased eye pressure that damages the optic nerve.


* Get an annual, comprehensive eye exam that includes careful evaluation of the optic nerve and measurement of eye pressure.

* When seeing your eye doctor, ask what your current pressure is and what your target pressure should be.

* To prevent eye injuries, wear protective goggles when playing sports such as tennis or squash.

RELATED ARTICLE: How to Apply Eye Drops

1. Tilt your head back--it may be easier to do this if you sit in a high-backed chair or lean against the wall.

2. Pull your lower eyelid down to provide a 'pocket' for the drops; apply the drops without your lid (if the hand holding the bottle has a tremor, rest it on the bridge of your nose to steady it).

3. Close your eye and prevent the drops from escaping by placing the tip of your index finger over the inner corner of your eye and gently pressing down for one to three minutes.

Drug Names    Action       Side Effects       Contraindications
Betagan,      Reduces      Difficulty         Asthma,
Betimol,      production   breathing, slowed  bronchitis,
Timoptic,     of aqueous   pulse, hair loss,  chronic
Ocupress,     humor        lower blood        obstructive
OptiPranolol               pressure,          pulmonary disease
                           impotence,         (COPD), heart
                           fatigue,           failure,
                           weakness,          emphysema, or
                           depression,        diabetes treated
                           memory loss        with insulin.

Iopidine,     Reduces      Fatigue,           Tell your doctor
Alphagan      production   dizziness, red,    if you are taking
              of aqueous   itchy or swollen   antidepressants,
              humor        eyes, dry mouth,   blood pressure
                           allergic           medication,
                           reactions          digoxin, insulin
                                              or sleeping pills,
                                              or if you have
                                              heart, liver or
                                              kidney disease.

Trusopt,      Reduces      Frequent           Do not use if you
Azopt         amount of    urination,         have an allergy or
              aqueous      tingling           sensitivity to
              humor        sensation in       sulfa drugs.
                           fingers and toes

Xalatan,      Increases    Mild reddening     Tell your doctor
Lumigan,      drainage of  and stinging of    if you are taking
Travatan      aqueous      eyes and           antihistamines or
              humor        darkening of the   cough/cold
                           iris, changes in   medicines, or if
                           pigment of         you have asthma,
                           eyelid, blurred    ulcers, high blood
                           vision             pressure, heart
                                              thyroid, seizures
                                              or Parkinson's

Isopto        Increases    Pain around or     Tell your doctor
Carpine,      drainage of  inside the eyes,   if you are taking
Pilocar       aqueous      brow ache,         antihistamines or
              humor        blurred or dim     cough/cold
                           vision,            medicines, or if
                           nearsightedness,   you have asthma,
                           allergic           ulcers, high blood
                           reactions, stuffy  pressure, heart
                           nose, sweating,    disease,
                           increased          overactive
                           salivation,        thyroid, seizures
                           digestive          or Parkinson's
                           problems           disease.
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Title Annotation:EYE HEALTH
Publication:Focus on Healthy Aging
Date:Aug 1, 2008
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