Glaucoma

Ophthalmic Partners provides diagnosis and treatment of glaucoma and related disorders for patients in Philadelphia, Pennsylvania and the surrounding communities.

WHAT IS GLAUCOMA?

Glaucoma is a disease of the optic nerve, and the term refers to a group of conditions that can damage the optic nerve through increased intraocular pressure in the eye. If untreated, the pressure associated with glaucoma can lead to permanent loss of vision or even blindness. It is often diagnosed during a routine eye examination. Glaucoma is one of the most common causes of blindness.

The front of the eye is filled with a clear liquid called aqueous humor, which is produced behind the iris (colored part of the eye). It moves through channels in the front of the eye in an area called the anterior chamber angle. If the movement of this fluid is blocked, intraocular pressure will build up and can damage the optic nerve.

WHAT CAUSES GLAUCOMA?

We do not fully understand why some individuals are more susceptible to glaucoma, but risk factors can increase a person’s risk of developing the disease. Age and race are factors, but the single most important risk factor is higher intraocular pressure. Other risk factors include specific medical conditions, a family history of glaucoma, and other eye disorders that may predispose to glaucoma.
Glaucoma has four main types: open-angle (chronic), angle closure (acute), congenital, and secondary:

The Angle and Intraocular Pressure

The eye is a dynamic organ. It constantly produces clear fluid (aqueous), which keeps the eye in its proper shape and provides nutrients to intraocular structures such as the lens. This fluid is also constantly draining from the eye and into the vascular system through the trabecular meshwork in the angle.

Open Angles vs. Narrow Angles

Of the different types of glaucoma, the most common type is open-angle glaucoma. The angle appears open when examined, but the optic nerve has glaucoma damage and the pressure may or may not be higher than normal.
In some individuals, the angle is narrow or closed. In these cases, the intraocular pressure could increase if the trabecular meshwork (“drain”) were blocked. A sudden blockage of the angle is called an angle closure attack and is a true emergency. The intraocular pressure can be extremely elevated, and permanent loss of vision can occur if treatment is not initiated.

Congenital and Secondary Glaucoma

Congenital glaucoma may be present at birth and is caused by abnormal eye development. Drugs, trauma, and certain diseases can also cause secondary glaucoma.

WHAT ARE THE RISK FACTORS FOR GLAUCOMA?

People with elevated internal eye pressure are at greater risk for developing glaucoma. Other risk factors include:

• Age, especially in people over 60 years old
• Ethnicity, especially African-Americans, Mexican-Americans, and people of Asian and Japanese descent
• Family history
• Certain medical conditions, including diabetes heart disease, high blood pressure, and hypothyroidism
• History of eye conditions
• Long-term corticosteroid use.

HOW CAN GLAUCOMA BE PREVENTED?

A comprehensive eye exam prior to age 40 is essential prevention, and this is particularly important if you are part of a high-risk group in Pennsylvania and New Jersey. Patients with glaucoma should be examined regularly and may require periodic glaucoma testing, such as visual fields or imaging of the optic nerve.

HOW IS GLAUCOMA DIAGNOSED?

In open-angle glaucoma, the patient may have no symptoms but may have severe damage by the time vision loss is noticeable. With angle closure glaucoma, symptoms can come and go. Severe pain in one eye is often a first indicator. Colored halos around lights, nausea, cloudy vision, and red, swollen eyes can be symptoms. Congenital glaucoma manifests as cloudiness in the front of the eye, light sensitivity, and enlargement of one or both eyes.

HOW IS GLAUCOMA TREATED?

Open-angle glaucoma has no cure, but symptoms can be managed by following the recommendations of the eye doctors at Ophthalmic Partners. Angle-closure glaucoma is considered a medical emergency, requiring immediate treatment to avoid vision loss. Congenital glaucoma is treated successfully in infants and young children when diagnosed and treated early, and the success of secondary glaucoma treatment is dependent on the underlying condition.

At Ophthalmic Partners, the overall glaucoma treatment goal is to reduce eye pressure, with individual treatment dependent on the type of glaucoma. Treating the underlying disease often makes the symptoms of glaucoma go away. For open-angle glaucoma, treatment usually entails lowering the intraocular pressure, typically with glaucoma eye drops or medications, but laser procedures and eye surgery are other options based on individual needs.

Drops or laser procedures are not effective for some patients in controlling the intraocular pressure or glaucoma could continue to worsen. In these cases, glaucoma surgery may be recommended. Although different operations and devices are available, most glaucoma surgeries attempt to allow drainage of aqueous fluid from the eye to a space outside of the eye wall and under the conjunctiva.