Catching the Eye Thief

Glaucoma Prevention

In glaucoma, what you don’t know can blind you. Glaucoma is an insidious eye thief which can literally rob a person blind. Because there are hardly any symptoms in the earlier stages of the disease, most glaucoma sufferers are unaware they have it. In the more advanced stages of glaucoma though, a patient may only have occasional difficulty in her peripheral vision or experience a discreet form of visual field loss called a visual scotoma.  A patient often will describe the latter as if someone has smudged, cut or torn out a piece of an image they are looking at.

It is common for glaucoma to be detected incidentally during a routine eye examination for an eyeglass fitting. The optometrist will usually be the first to notice a slight elevation in a patient’s intraocular pressure (IOP) or observe subtle changes in the optic nerve. Hence IOP and optic nerve damage are the two basic clinical parameters most glaucoma specialists use in assessing a glaucoma patient’s risk for visual impairment.  Through the use of modern exam lenses and imaging technology, eye doctors can document glaucoma onset and severity from optic nerve thinning or visually noted irregularities. More recent technologies include in-office scans which can provide precise computer generated images of the nerve fiber.

Rage against the Dying Light

Glaucoma Prevention TreatmentGlaucoma prevention and treatment is about seizing the thief of sight in its tracks. Blindness prevention is the essence of every glaucoma treatment- both for suspected and diagnosed cases.  And if caught in its early stages, there is a higher chance that blindness and visual disability will be prevented. Optic nerve damage is estimated to increase 13 fold with rises in IOP in the 22-29 mm Hg range, and as much as 40 fold in extremely high pressures of 40 mmHg or more [1]. Hence aggressive IOP lowering is the focus of every glaucoma specialist, whether through medical or surgical means. In one study alone, it showed that those who were able to maintain a 12-18 mmHg IOP range during the course of follow-up did not show progression of glaucoma in terms of visual impairment or loss.

A glaucoma specialist’s decision to start treatment, however, may not depend solely on the presence of elevated intraocular pressures. This is especially true among the 20-30% of documented open-angle glaucoma cases who have normal intraocular pressures of (10-21mgHg) despite obvious optic nerve damage on examination.  Even when the initial intraocular pressures are normal the treatment is the same: lower the eye pressure further.

Some individuals are at a greater risk of developing glaucoma.  Such risks include:

    • Age greater than 40
    • African Americans and Hispanics
    • Family history of glaucoma
    • Medical history of migraine, diabetes and systemic hypertension (high blood pressure)
    • Myopia (near-sightedness)
    • Thin corneas

Genetically predisposed and high risk individuals for glaucoma warrant early glaucoma prevention through regular diagnostic eye evaluations from an ophthalmologist (or in really high risk persons, a glaucoma specialist). Since advancing age is one of the common risk factors for glaucoma, it is advised that

  • Adults in their 40’s should have their eyes checked every 2-4 years.
  • Adults in their 60’s should do so every 1-2 years.
  • African Americans and Hispanics may show signs of glaucoma as early as their 20’s to early 30’s and are recommended to have their eyes tested every 2-3 years.

With modern advances in medical, surgical and less invasive procedures like canaloplasty, there is no reason for a glaucoma patient to be left in the dark. If you have glaucoma or know someone who is at risk, seek the advice of a skilled ophthalmologist.  Board certified and experienced ophthalmologist such as Dr David Richardson can guide you through your journey – from diagnosis to planning a specific treatment unique to your needs. A consultation or a call today could save a lifetime of sight. 

References

1) Jody R. Piltz-Seymour & Rebecca S. Walker. When to Treat Glaucoma 

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