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Early diagnosis, treatment can limit vision loss from glaucoma: glaucoma is detectable during an eye exam, and the most common form usually responds well to medication.

As many as four million Americans have glaucoma, a disease that can lead to blindness if untreated--but half of them don't know they have it, since there are rarely any warning signs. The good news is that glaucoma can be detected during a routine eve exam.

"By definition, glaucoma is caused by elevated intraocular pressure (10P), which causes damage to the optic nerve," explains Leila Rafla-Demetrious, MD, Assistant Professor of Ophthalmology at Weill Cornell Medical College. "It generally affects peripheral vision first, central vision last, and it's usually a slow process. Many people don't realize they are losing their peripheral vision until its very advanced."

One disease, several forms

The most common form of the condition is open-angle glaucoma, according to the Glaucoma Research Foundation. 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 10P 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 10P. 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, in which, optic nerve damage occurs even when the IOP is in the normal range (12-22 millimeters of mercury).

Who's at risk?

"Everyone should have a baseline vision exam by the age of 40, if not younger, says Dr. Raila-Demetrious. "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.

"In women, the risk increases in the postmenopausal age group, which might be related to lower estrogen levels," she adds.

African-Americans are six to eight times more likely to develop the condition, and people who have sustained an injury in which the eye is damaged are especially vulnerable. Long-term steroid Use also can result in glaucoma, because the drugs can significantly increase eye pressure.

Diagnosis based on three factors

Dr. Rafla-Demetrious says that most people learn that they have glaucoma because they are seeing a doctor for some other reason, such as getting a routine check-up or having their glasses prescription adjusted.

She advises people not to depend on optical store exams to diagnose the disease. Instead, consult an ophthalmologist. a physician who specializes in medical and surgical care of the eve. These specialists use three factors-10P, the condition of the optic nerve, and the patient's visual field (peripheral vision)--to arrive at a diagnosis.

Treatment options

Treatment usually begins with eye drops, with a goal of reducing the pressure to the degree that it does not cause Further damage to the optic nerve. The type of eye drop depends on the person's age, activity level, other medical issues, and even eye color, because some drops can irreversibly change the color of the iris. Several types of laser surgery can reduce IOP (see What You Should Know).

If medications and laser surgery do nor work to control glaucoma, more complicated eye surgery may be warranted to save visual function.

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

What you can do

"Know your family's history in regard to glaucoma and conditions that predispose the disease," says Dr. Rafia-Demetrious. "Get checked by an ophthalmologist at least every two years after the age of 40. If you notice changes in your vision, get exams more frequently.

"Stay on top of this situation," she adds. "Once glaucoma has been diagnosed, have an ophthalmologist monitor your condition every four to six months. Most people do well with medical treatment, but it will he a lifelong project."

RELATED ARTICLE: WHAT YOU SHOULD KNOW

Types of laser surgeries for glaucoma include:

* Trabeculoplasty, which opens the drainage canals of the eye in patients with open-angle glaucoma.

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

* Cyclophotocoagulation, which reduces fluid production by damaging parts of the ciliary body, the part of the eye that makes fluid.
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Title Annotation:VISION
Publication:Women's Health Advisor
Article Type:Disease/Disorder overview
Date:Jan 1, 2015
Words:710
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