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Although normal
pressure is usually between 12-21 mm Hg, 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 eye care professional will do the
following tests:
Visual
acuity: This
eye chart test measures how well you see at various distances.
Tonometry:
This standard test determines the fluid pressure inside the eye.
There are many types of tonometry. One type uses a purple light
to measure pressure. Another type is the "air puff,"
test, which measures the resistance of the eye to a puff of air.
Pupil
dilation:
This examination provides your eye care professional with a
better view of the optic nerve to check for signs of damage. To
do this, your eye care professional places drops into the eye to
dilate (widen) the pupil. After the examination, your close-up
vision may remain blurred for several hours.
Visual
Field:
This test measures your side (peripheral) vision. It helps your
eye care professional find out if you have lost side vision, a
sign of glaucoma.
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Can glaucoma
be treated?
Yes. Although you will never be
cured of glaucoma, treatment often can control it. This makes
early diagnosis and treatment important to protect your sight.
Most doctors use medications for newly diagnosed glaucoma;
however, new research findings show that laser surgery is a safe
and effective alternative.
Glaucoma
treatments include:
Medicine:
Medicines are the most common early treatment for glaucoma. They
come in the form of eyedrops and pills. Some cause the eye to
make less fluid. But most lower pressure by helping fluid drain
from the eye.
Glaucoma drugs may be taken several times a day. Although most
people have no problems, some medicines can cause headaches or
bother the eye. Drops may cause stinging, burning, and redness
in the eye. Ask your eye care professional to show you how to
put the drops into your eye. In addition, tell your eye care
professional about other medications you may be taking before
you begin glaucoma treatment.
Many drugs are available to treat
glaucoma. If you have problems with one medication, tell your
eye care professional. 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 often has no symptoms, people may be tempted to
stop or may forget to take their medicine.
Laser
surgery
(also called laser trabeculoplasty):
Laser
surgery helps fluid drain out of the eye. Although your eye care
professional 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
surgery.
Laser
surgery is performed in an eye care professional's office or eye
clinic. Before the surgery, your eye care professional will
apply drops to numb the eye.
As you sit
facing the laser machine, your eye care professional will hold a
special lens to your eye. A high-energy beam of light is aimed
at the lens and reflected onto the meshwork inside your eye. You
may see flashes of bright green or red light. The laser makes
50-100 evenly spaced burns. These burns stretch the drainage
holes in the meshwork. This helps to open the holes and lets
fluid drain better through them.
Your eye care professional will
check your eye pressure shortly afterward. He or she may also
give you some drops to take home for any soreness or swelling
inside the eye. You will need to make several follow up visits
to have your pressure monitored.
Once
you have had laser surgery, over the entire meshwork, further
laser treatment may not help. Studies show that laser surgery is
very good at getting the pressure down. But its effects
sometimes wear off over time. Two years after laser surgery, the
pressure increases again in more than half of all patients.
Conventional
surgery: The purpose of
surgery is to make a new opening for the fluid to leave the eye.
Although your eye care professional may suggest it at any time,
this surgery is often done after medicine and laser surgery have
failed to control your pressure.
Surgery
is performed in a clinic or hospital. Before the surgery, your
eye care professional gives you medicine to help you relax and
then small injections around the eye to make it numb.
 The
eye care professional removes a small piece of tissue from the
white (sclera) of the eye. This creates a new channel for fluid
to drain from the eye. But surgery does not leave an open hole
in the eye. The white of the eye is covered by a thin, clear
tissue called the conjunctiva. The fluid flows through the new
opening, under the conjunctiva, and drains from the eye.
 You
must put drops in the eye for several weeks after the operation
to fight infection and swelling. (The drops will be different
than the eye drops you were using before surgery.) You will also
need to make frequent visits to your eye care professional. This
is very important, especially in the first few weeks after
surgery.
In some
patients, surgery is about 80 to 90 percent effective at
lowering pressure. However, if the new drainage opening closes,
a second operation may be needed. 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.
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What are
some other forms of glaucoma?
Although
open-angle glaucoma is the most common form, some people have
otherforms 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
closed-angle glaucoma, the fluid at the front of the eye
cannot reach the angle and leave the eye because the angle gets
blocked by part of the iris.
People
with this type of glaucoma have a sudden increase in pressure.
Symptoms include severe pain and nausea as well as redness of
the eye and blurred vision. This is a medical emergency.
The patient needs immediate treatment to improve the flow of
fluid. Without treatment, the eye can become blind in as little
as one or two days. Usually, prompt laser surgery can clear the
blockage and protect sight.
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.
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