Glaucoma is the second leading cause of blindness worldwide, and the leading cause of irreversible blindness in the United States. It is estimated that over three million Americans have glaucoma, but only half are aware that they suffer from this condition. Patients often remain asymptomatic until significant vision loss has already occurred.
Causes of Glaucoma
Though the exact cause of glaucoma is not known, it is usually associated with a high pressure inside the eye. However, some patients develop glaucoma even though their eye pressure is within the “normal range.”
Vision loss from glaucoma typically occurs first in the periphery. Left untreated, this peripheral vision loss progresses to complete blindness that is irreversible.
Types of Glaucoma
Glaucoma is characterized as “open angle” and “closed angle”, which refers to the status of the drainage system within the eye.
In closed angle glaucoma, the fluid inside the eye does not have access to the drainage system, and the pressure inside the eye can rise dramatically, resulting in significant eye pain and blurry vision. This is an acute attack, and patients who experience these symptoms should seek an eye care specialist or emergency room physician immediately.
Open angle glaucoma is much more prevalent than closed angle. In open angle glaucoma, though the fluid inside the eye does have access to the drainage system, the drainage system is clogged. Eye pressure rises gradually, reaching levels that cause damage to the optic nerve and subsequent vision loss, but without causing any noticeable pain or other symptoms.
Who is at Risk for Glaucoma
Certain patients are at a higher risk to develop glaucoma and should see an eye care provider on a regular basis. Everyone over 40 years old should have a screening exam for glaucoma, even in the absence of symptoms. Patients 65 years or older should be tested for glaucoma every 1 to 2 years as recommended by their eye care provider.
Some factors which increase the likelihood of developing glaucoma include:
- A family history of glaucoma.
- African American or Hispanic descent.
- History of an eye injury.
- Thin corneas.
- Diabetes, high blood pressure, migraine headaches, or issues with blood circulation.
- Severe nearsightedness.
Having more than one of the risk factors puts patients at an even higher risk for developing glaucoma.
Early Detection is Important
Because glaucoma is most often asymptomatic, early detection is key. A complete dilated eye exam is an excellent screening tool for glaucoma. If there is suspicion for glaucoma (high eye pressure or visible damage to the optic nerve), further testing will then be performed.
Glaucoma testing includes:
- Measurement of eye pressure
- Corneal thickness measurement (pachymetry)
- Direct visualization of the drainage angle in the eye using a specialized lens (gonioscopy)
- A detailed scan of the optic nerve (OCT)
- Formal testing for peripheral vision loss (Visual Field Test)
When a patient is diagnosed with glaucoma, these tests are performed routinely and in conjunction with regular eye exams to monitor for changes in the health of the optic nerve.
Treatments for Glaucoma
There is no cure for glaucoma. Progressive vision loss from glaucoma cannot be stopped, but it can be slowed down. This is achieved by lowering the pressure inside the eye.
Eye drops are considered the first line of treatment to lower eye pressure. Most of the eye drops currently available are well-tolerated, with minimal side effects. Patients are instructed to use eye drops daily.
Selective Laser Trabeculoplasty (SLT) is an additional option that is a safe and effective method for lowering eye pressure. This laser treatment is conveniently performed in our office as an out-patient procedure. It is safe and well-tolerated. Click HERE for more information about SLT and what can be expected during and after this treatment.
When medical and laser therapies are not sufficient to slow down the progression of glaucoma, eye surgery may be needed to create additional drainage systems in the eye.
Over the past few yers a number of minimially invasive surgical techniques, also known as MIGS, have been developed that are safer, faster, and have shorter recovery times than traditional surgeries.
Dr. Jeffrey Peterson was the first surgeon in Hawai`i to utilize two such minimally invasive devices – the Cypass micro stent and the Xen Gel Stent. Together these procedures provide alternative options for surgical eye pressure lowering for patients with glaucoma.
Cypass micro stent – is an FDA approved device for treatment of patients with mild to moderate primary open angle glaucoma. Watch a video below to see how Dr. Peterson has implemented this new device in his line of treatment for patients with glaucoma.
Xen Gel Stent – is another FDA approved device for lowering eye pressure. The Xen Gel Stent is the size of an eyelash and is an option for patients with open-angle glaucoma where previous surgical treatments have failed and/or medications alone were not sufficient. In July 2017, Dr. Peterson implanted the first Xen Gel Stent in Hawai’i. Click HERE for more information about the Xen Gel Stent.
Dr. Jeffrey Peterson, a member of the Jenkins Eye Care team, specializes in the care of patients with glaucoma. His expertise enables him to diagnose and manage this chronic disease using state-of-the-art techniques and surgical treatments. Dr. Peterson is committed to educating his patients about glaucoma and walking them through each step of the treatment process.