Omni Eye Specialists - Services

GLAUCOMA - The silent threat

Glaucoma is commonly associated with slow, progressive loss of peripheral vision. Although there are many types of glaucoma, "open angle glaucoma" is the most common. Loss of vision is painless and usually not noticed by the patient. It is a leading cause of blindness. The incidence increases with age, that is, it becomes more common as a patient ages. Regular testing of the peripheral visual field is important in identifying those at risk and in monitoring treatment plans.

Common Types of Glaucoma are listed below. Some have a genetic predisposition while others do not.

"Open Angle Glaucoma" is very common (the most common in the United States). We try to identify those at risk before loss of vision occurs. Risk factors include; race, family history, hypertension, diabetes, appearance of the optic nerve and eye pressure. Therapy usually includes drops, but may also involve specialized glaucoma surgery, including laser. It is painless and there are usually no symptoms noted by the patient. Only thorough examination can determine if you have glaucoma.
"Narrow Angle Glaucoma" is somewhat uncommon in the United States, but is much more prevalent in Asian countries (this is the type that may be precipitated by certain over-the-counter cold medicines). Patients can complain of eye pain, headache, halos around lights and nausea. Definitive laser treatment is usually helpful in this condition.
"Angle Recession Glaucoma" is associated with severe blunt trauma. This type of glaucoma results in higher intraocular pressure due to damage to the drainage portion of the eye (trabecular meshwork). Patients usually do not experience symptoms and it may take years for the glaucoma to develop.
Other types of Glaucoma include pigmentary dispersion, phacomorphic, phacolytic and uveitic. These types of glaucoma are less common, yet can be detected by thorough eye examination.

Treatment of Glaucoma - requires monitoring eye pressure and measuring changes in the peripheral field. "Control" of glaucoma usually means that the eye pressure is at an acceptable level and that there has been little or no loss of the visual field, as measured by a visual field analyzer. Although there are many risk factors for developing glaucoma, control of eye pressure is the mainstay of therapy. Intraocular pressure may be controlled by a variety of ways;

Topical Drops are usually the first line of treatment. Taken on a daily basis, these usually are very effective in controlling eye pressure. Over time, these drops may become less effective and your doctor may elect to change your medications. Drops either decrease production of intraocular fluid or increase its absorption.
Oral Medications may also be effective, but may have more systemic side effects. If tolerated, these can be useful adjuncts to other glaucoma treatments.
Selective Laser Trabeculoplasty (SLT) is extremely successful in lowering eye pressure in certain types of glaucoma such as open angle glaucoma, pigment dispersion syndrome and pseudo-exfoliation. Treatment is focused on the trabecular meshwork (responsible for fluid drainage from the eye) to increase fluid outflow and thereby reduce eye pressure. This treatment may replace topical drops and can be repeated, if necessary.
Laser Iridotomy involves the creation of a small hole in the iris (colored portion of eye) to permit an alternate channel or pathway for intraocular fluid to reach the trabecular meshwork and be drained from the eye. This procedure is usually indicated in narrow angle glaucoma.
Trabeculectomy is a type of surgery whereby intraocular fluid (aqueous humor) is directed to the outside of the eye to increase its absorption. This is commonly performed when medications fail, although some practitioners may recommend this as initial treatment.
Seton or shunt placement for glaucoma also involves the creation of an alternate pathway for aqueous humor to be absorbed outside the eye. It, too, is not a first line of treatment and may be reserved for very difficult situations.

The treatment and management of glaucoma is essential in preventing long term vision loss. The key to successful management is early detection and regular follow-up examination.