What is Glaucoma?

Glaucoma is a leading cause of blindness in the United States. Glaucoma is an eye disease that is most commonly associated with elevated intraocular pressure. This can cause damage to the optic nerve which is the cable that connects the eye to the brain. With glaucoma, there is gradual loss of peripheral vision which can often go unnoticed. Damage to the visual system is permanent, and in advanced glaucoma, blindness can occur. With early detection and treatment, progression of vision loss can be slowed down, and even prevented.

What are risk factors for glaucoma?

Glaucoma can occur in anyone, but those patients with a higher risk include:

  • Age>60
  • African, Asian, or Hispanic descent
  • Family history of glaucoma
  • Those who are very near-sighted (myopic) or very far-sighted (hyperopic)
  • Chronic use of steroid medication
  • Have high eye pressure
  • Have a thin central cornea
  • Have had an eye injury

It is still possible to have glaucoma with normal intraocular pressures. Therefore it is important to have regular eye exams.

What are symptoms of glaucoma?

In the most common form of glaucoma, vision loss occurs in the later stages. Most patients have a gradual build up of pressure, and will not experience significant symptoms. In certain types of glaucoma, pressure in the eye can rise rapidly. Symptoms can include hazy vision, eye or head pain, nausea and/or vomiting, rainbows around lights, and sudden vision loss.

How is glaucoma diagnosed?

Glaucoma is diagnosed by a combination of tests done during your visit. All patients will have their intraocular pressure checked and a dilated examination to evaluate the optic nerve during their yearly examination. If warranted, a field of vision test may be done to detect early vision loss. A scan of the optic nerve using optical coherence tomography (OCT) can be done as well to detect any damage from glaucoma. Other measurements that may be undertaken include gonioscopy which is used to evaluate the internal drainage system of the eye and pachymetry which measures the thickness of the front surface of the eye, also known as the cornea.

How is glaucoma treated?

Glaucoma is typically treated with eye drop medications that help lower the intraocular pressure. If glaucoma continues to progress, or a patient stops responding to the eye drops, a laser procedure may be done to help lower pressure, or prevent certain types of glaucoma. In advanced cases of glaucoma, surgery may be indicated to help shunt fluid out of the eye, and therefore lower the pressure.

Micro-invasive glaucoma surgery (MIGS) is a rapidly developing field that allows surgeons to treat glaucoma in a less invasive manner compared to traditional surgery. The iStent is a type of MIGS surgery and can be performed at the same time as cataract surgery for a patient with mild to moderate glaucoma. This procedure can help lower Intraocular Pressure (IOP), and in some cases, decrease dependence of eye drop medications.