living with glaucoma

what is glaucoma?
what is eye pressure? 
the optic nerve
who gets glaucoma?
does glaucoma run in families?
what are the different types of glaucoma?
what are the symptoms of glaucoma?
how is glaucoma diagnosed?
can glaucoma be treated?
how does the doctor treat glaucoma?
protecting your vision
drugs used in this condition
when to consult your doctor

Glaucoma need not limit your lifestyle. If some of you have only recently discovered that you have glaucoma and are in the process of adjusting to live with it you need to read the following. First of all you need to understand what exactly is glaucoma. Next, what you and your eye doctor can do to control the process. And finally how you can live a full life without the fear that glaucoma will blind you. All you need to do is to take your medication regularly and have regular eye checkups.
Your own Doctor should be the main source of information about glaucoma and you should follow the treatment prescribe by your doctor. This article can only help you understand glaucoma better so that you are no longer afraid of it.

what is glaucoma?

Glaucoma is that condition of the eye in which the pressure within the eye exceeds the tolerance of the affected eye thereby causing damage to the optic nerve. It is estimated that 2% of all people over the age of 40 will encounter it. It can also occur in children and young adults. And over 25% of the people affected by glaucoma don’t even know that they have it. They are slowly going blind.

what is eye pressure?

The eyeball is a hollow sphere. It has fluid inside it that maintains its shape. This fluid is constantly entering and leaving the eye. Normally the rate of entry and the rate of exit are the same and there is no pressure build up in the eye. This is the intraocular pressure or IOP. If for some reason there is a block in the outflow the pressure inside the eye climbs up damaging the sensitive optic nerve within the eye. Very rarely this damage may occur in an eye with normal pressure.

Top

what is the optic nerve?

The optic nerve is a collection of nerve fibres that tell the brain what the eye is seeing. This bundle of nerves leaves the eyeball from the back of the eye. This is the weak spot in the wall of the eye and this is where eye pressure presses the nerve fibres strangling them one by one. This leads to vision loss and glaucoma is said to have begun.

Top


who gets glaucoma?

Although anyone can get glaucoma, some people are at higher risk than others. They include:

  • People over the age of 55

  • Those with Family history of glaucoma.

  • People with a history of injury to the eye.

Top

does glaucoma run in families?

The blood relatives of a person with glaucoma have a four-fold increase in the risk of encountering glaucoma than other people. Once glaucoma is diagnosed all blood relatives should have a detailed eye examination.

Top

what are the different kinds of glaucoma?

Primary glaucoma is an inherent condition of the individual, while secondary glaucoma may be a result of inflammation, injury, cataract, drugs or tumors. The open angle glaucoma is a slow disease process. It is the common type of glaucoma affecting 90% of all glaucoma patients. Since its onset is insidious and without symptoms this condition goes undetected until some irreversible damage has occurred. Usually both the eyes are involved though one eye may be affected more than the other. Angle closure glaucoma is less common and its onset is sudden. The condition is very painful, the eye red, vision is blurred and often patient may have nausea and vomiting.

Top

what are the symptoms of glaucoma?

At first, open-angle glaucoma has no symptoms. Vision stays normal, and there is no pain. As glaucoma remains untreated, you notice that although you see things clearly in front, you miss objects to the side and out of the corner of the eye. Without treatment, you will find that you suddenly have no side vision. It will seem as though you are looking through a tunnel. Over time, the remaining central vision will also be snuffed out until there is no vision left.

Top

how is glaucoma diagnosed?

Most people think that they have glaucoma if the pressure in their eye is increased. This is not always true. High pressure puts you at risk for glaucoma. It may not mean that you have the disease. Whether or not you get glaucoma depends on the level of pressure that your optic nerve can tolerate without being damaged. This level is different for each person. The normal pressure in the eye varies between 12-21 mm Hg; but a person might have glaucoma even if the pressure is in this range. That is why an eye examination is very important. To detect glaucoma, your doctor will do the following tests:

  • Visual acuity test measures how well you see at various distances.

  • Tonometry determines the pressure inside the eye. There are different types of tonometers; each of these is adequate for evaluating glaucoma.

  • Pupil dilation allows a better view of the optic nerve to check for signs of damage.

  • Visual Field measures your side vision. It helps the doctor find out if you have lost side vision, an early sign of glaucoma.

  • Gonioscopy looks at that part of the eye from which fluid drains out. This helps in determining whether this drainage angle is open or not.

Top

can glaucoma be treated?

Yes. Glaucoma can be successfully controlled with eye drops, pills, laser and surgical operations.
Although you will never be cured of glaucoma, treatment often can control it. This makes early diagnosis and treatment important to protect your sight.
Periodic eye examinations are vital in keeping glaucoma under control and in preserving vision.

Top

how will the doctor treat glaucoma?

Eye drops are usually chosen first. Some cause the eye to make less fluid others lower the pressure by helping fluid drain from the eye. Glaucoma drugs may be taken several times a day. Some medicines can cause headaches, stinging, burning, and redness in the eye. Ask your doctor to show you how to put the drops into your eye. If you have problems with any drops tell the doctor. Treatment using a different dosage or a new drug may be possible. You will need to use the drops and/or pills as long as they help to control your eye pressure. This is very important. Because glaucoma very often has no symptoms, you may be tempted to stop or may forget to take their medicine. Also, you may say, “I am putting the drops but my vision is not getting any better”. You have to understand that in the treatment of glaucoma the doctors are attempting to save what vision you have left. What is already lost cannot be brought back.
Laser surgery helps fluid drain out of the eye. Although your doctor may suggest laser surgery at any time, it is often done after trying treatment with medicines. In many cases, you will need to keep taking glaucoma drugs even after laser.

Surgical operation makes a new opening for the fluid to leave the eye. This surgery is often done after medicine and laser surgery have failed to control your pressure. Conventional surgery works best if you have not had previous eye surgery, such as a cataract operation. Keep in mind that while glaucoma surgery may save remaining vision, it does not improve sight. In fact, your vision may not be as good as it was before surgery. Like any operation, glaucoma surgery can cause side effects. These include cataract, problems with the cornea, inflammation or infection inside the eye, and swelling of blood vessels behind the eye. However, if you do have any of these problems, effective treatments are available.

Angle closure glaucoma is best treated by a laser operation.

Top

what are some other forms of glaucoma?

Although open-angle glaucoma is the most common form, some people have other forms of the disease. In low-tension or normal-tension glaucoma, optic nerve damage and narrowed side vision occur unexpectedly in people with normal eye pressure. People with this form of the disease have the same types of treatment as open-angle glaucoma.

In congenital glaucoma, children are born with defects in the angle of the eye that slow the normal drainage of fluid. Children with this problem usually have obvious symptoms such as cloudy eyes, sensitivity to light, and excessive tearing. Surgery is usually the suggested treatment, because medicines may have unknown effects in infants and be difficult to give to them. The surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision.

Secondary glaucomas can develop as a complication of other medical conditions. They are sometimes associated with eye surgery or advanced cataracts, eye injuries, certain eye tumors, or uveitis (eye inflammation). One type, known as pigmentary glaucoma, occurs when pigment from the iris flakes off and blocks the meshwork, slowing fluid drainage. A severe form, called neovascular glaucoma, is linked to diabetes.

Also, corticosteroid drugs—used to treat eye inflammations and other diseases—can trigger glaucoma in a few people. Treatment is with medicines, laser surgery, or conventional surgery.

Top

what can you do to protect your vision?

If you are being treated for glaucoma, be sure to take your glaucoma medicine every day and see your eye doctor regularly. You can also help protect the vision of family members and friends who may be at high risk for glaucoma. Encourage them to have an eye examination through dilated pupils every two years.

Glaucoma requires lifelong care to prevent further vision loss. Once your eye pressure is under control do not lower your guard. The main treatment is in keeping it under control with regular medications taken on time and as per the dosage prescribed.

  • Stay informed about glaucoma

  • Know your medications, and how to use them

  • Pay attention to how your eyes feel

  • Above all don’t let glaucoma limit your life.

Top


drugs used in this condition

Diamox.a drug which when taken orally reduces pressure in the eye
Pilocarpine, timolol. these drugs are used in eye drops in patients with glaucoma. They cause the pupil to constrict, and at the same time relieve eye pressure.

Top


when to consult your doctor

Eye diseases should always be taken seriously. Pain in the eye, changes in visual acuity and blurring of vision should prompt an urgent visit to the doctor.gall stones or after an alcoholic binge)

Top


Author

Dr Ivan Singh, MBBS, MS , DNB (Opth), MAMS, is a practising ophthalmologist attached to Noida Medicare Center.
Contact Nos: 91-4539001,isingh@vsnl.com


Editorial board: 

Dr Suneet Sood,MS, MAMS, Editor in chief
Dr Anurag Krishna, MS, MCh, MAMS
Dr Ivan Singh, MS, MAMS


Back to Top

Last revised: May 11, 2000