Glaucoma

Glaucoma is a group of eye diseases that can lead to vision loss and possibly blindness by damaging a nerve in the back of your eye called the optic nerve. Optic nerve damage usually occurs in the presence of high eye (intraocular) pressure.

The symptoms can start so slowly that you may not notice them. The only way to find out if you have glaucoma is to get a comprehensive dilated eye exam.

There’s no cure for glaucoma, but early treatment can often stop the damage and protect your vision.

What Are The Types of Glaucoma?

There are many types of glaucoma, but the two most common types are open-angle glaucoma and closed angle (angle-closure) glaucoma. 

Open-angle glaucoma, (also called primary open-angle glaucoma and chronic glaucoma) accounts for 90 percent of all glaucoma cases and occurs when the trabecular meshwork becomes blocked and the fluid can’t get to the normal drainage canals. This blockage results in fluid build-up and intraocular pressure. The fluid build-up happens gradually. 

Closed angle glaucoma, (also called acute glaucoma or angle closure glaucoma), accounts for about 9 percent of all glaucoma cases and occurs when the opening between the cornea and iris narrows, such that the fluid cannot get to the trabecular meshwork and normal drainage channels. This narrowing results in fluid build-up and intraocular pressure. The fluid build-up happens very quickly. 

What Are The Symptoms of Glaucoma?

At first, glaucoma doesn’t usually have any symptoms. That’s why half of people with glaucoma don’t even know they have it.

Over time, you may slowly lose vision, usually starting with your side (peripheral) vision — especially the part of your vision that’s closest to your nose. Because it happens so slowly, many people can’t tell that their vision is changing at first.

As the disease gets worse, you may start to notice that you can’t see things off to the side anymore. Without treatment, glaucoma can eventually cause blindness.

Am I At Risk For Glaucoma?

Anyone can get glaucoma, but some people are at higher risk than others. People at highest risk are those with any of the following:

• Age older than 60
• African-American and over age 40
• Family history of glaucoma
• Farsightedness or nearsightedness
• Diabetes
• Long-term use of corticosteroid drugs
• Previous eye injury

How Will Dr. Jong Check For Glaucoma?

Dr. Jong checks for glaucoma through a comprehensive dilated eye exam. The exam is simple and painless; Dr. Jong will give you eye drops to dilate your pupil, and he will check your eye for any problems. He may also conduct a visual field exam to assess your peripheral vision.

What Is The Treatment For Glaucoma?

If you have glaucoma, it’s important to start treatment right away. Treatment won’t undo any damage to your vision, but it can stop it from getting worse.

The most common treatment for glaucoma is prescription eye drops. They lower your eye pressure and prevent damage to your optic nerve. Dr. Jong may prescribe a combination of eye drops. 

Another option to treat glaucoma is laser treatment. There are many different types of laser treatment, but they are all simple procedures that can be performed in office. Laser treatment normally lowers eye pressure, but the length of time that pressure remains low depends on many factors, including the age of the patient, the type of glaucoma and other medical conditions that may be present. In many cases, continued medication is necessary, but potentially in lower amounts. Some people may need to get laser treatment more than once.

• Types of laser treatments include:
  • Trabeculoplasty is often used to treat open-angle glaucoma. In argon laser trabeculoplasty (ALT), a high-energy laser is aimed at the trabecular meshwork to open areas in these clogged canals. These openings allow fluid to bypass drainage canals and flow out of the eye. In selective laser trabeculoplasty (SLT) a low-energy laser treats specific cells in the trabecular meshwork. Because it affects only certain cells without causing collateral tissue damage, SLT can potentially be repeated.
  • Laser peripheral iridotomy (LPI) is frequently used to treat closed-angle glaucoma, in which the angle between the iris and the cornea is too small and blocks fluid flow out of the eye. In LPI, a laser creates a small hole in the iris to allow fluid drainage.
  • Cyclophotocoagulation is usually used to treat more aggressive or advanced open-angle glaucoma that has not responded to other therapies. A laser is directed through the sclera or endoscopically at the eye fluid-producing ciliary body. This helps decrease the production of fluid and lower eye pressure. Multiple treatments are often required.

If glaucoma medicines and laser treatment haven’t helped to treat your glaucoma, Dr. Jong may recommend surgery. Surgery can’t cure glaucoma or undo vision loss, but it can help protect your vision and stop it from getting worse.

• There are a few different types of surgeries that can help to lower the pressure in your eye:
  • Trabeculectomy – usually used to treat open-angle glaucoma. Dr. Jong will create a tiny opening in the top of your eye. The opening will be under your eyelid, where no one will see it. This opening allows extra fluid in your eye to drain away, lowering pressure in your eye.
  • Glaucoma implant surgery – used to treat several types of glaucoma. Dr. Jong will implant a tiny tube, or shunt, into the white part of your eye. The tube helps extra fluid drain out of your eye, lowering your eye pressure.
  • Minimally invasive glaucoma surgery (MIGS) – If you have mild glaucoma, Dr. Jong may recommend minimally invasive glaucoma surgery (MIGS). This also lowers eye pressure, but it has fewer risks and side effects and helps you recover faster.