Glaucoma

What is glaucoma?

Glaucoma is a progressive eye disease generally associated with aging that is very treatable; especially when diagnosed early. Glaucoma often runs in families, and affects 20-30% of the population. People diagnosed with glaucoma often choose laser treatment (SLT) or eye drops for treatment and undergo frequent diagnostic tests to determine if there is progression of the eye disease. There are two different types of glaucoma, open-angle glaucoma and closed-angle glaucoma.

Open-angle glaucoma is the most common type. Patients are usually unaware of any symptoms until it is very advanced. The loss of vision cannot be reversed and is permanent, so early detection and treatment is essential to preserve your vision.

Closed-angle glaucoma is less common than open-angle glaucoma, although more common in the Asian population. Your eye care professional can tell if you have the eye structure that leads to this problem and can recommend laser therapy to prevent it. The symptoms of acute closed-angle glaucoma include sudden, dull, aching pain over one eye, a change in your vision, and experiencing blurring or halos around lights. If this happens, you should see an eye doctor immediately or go to emergency.

Routine eye examinations once a year are essential to diagnose, monitor or rule out glaucoma.

What causes glaucoma?

Glaucoma is an eye disorder characterized by a specific type of optic nerve damage. It is the damage to the optic nerve that, slowly over time, steals your vision. Glaucoma is often associated with an elevation of pressure in the eye. There are many classifications and subtypes of glaucoma, which may require very different treatments. In many cases, the primary symptom is a gradual loss of vision, that unfortunately most people don't notice until they have severe disease. In about 10% of cases, glaucoma symptoms might include sudden ocular pain, seeing halos around lights, red eye and a sudden decrease in vision, please contact us or go to your nearest emergency room as soon as possible, if this occurs.

How do I know if I have glaucoma?

The only way to find out if you have glaucoma is to see your eye doctor for a check-up. Damage to the optic nerve usually happens slowly, so it is difficult to notice the onset of symptoms. Your doctor will perform specialized tests for glaucoma to check your eye pressure, peripheral vision and the health of your optic nerve to determine if you have glaucoma or if you are at risk for developing it.

How is glaucoma diagnosed?

Tests for glaucoma are quick and painless. The doctor measures your intraocular pressure (IOP) with a special instrument called a tonometer and views the optic nerve. Depending on the results, you may need more testing to determine the diagnosis and best treatment.

What can I do to protect my vision if I have glaucoma?

The most important thing you can do to protect your vision is to follow your doctor’s instructions, take medications as prescribed and return for eye check-ups. Follow-up eye examinations are important so your doctor can monitor the health of your optic nerve, peripheral vision as well as your eye pressure, to see if any changes to your treatment are necessary. It is a disease we can not cure but we can usually manage it so you will have good vision for the rest of your life.

What are my treatment options?

Some people with glaucoma only require a simple laser procedure to cure their problem, while others need a lifetime of therapeutic eye drops, which can be expensive, burdensome and sometimes ineffective. At VLEC, our goal is to offer you the latest in eye laser technologies to reduce your dependence on such ocular therapies.

iStents

Inserted at the time of cataract surgery or refractive lensectomy in patients with glaucoma. May significantly reduce the intraocular pressure(IOP) and reduce the need for topical glaucoma eye drops.

Eye drops

There are a variety of different types of eye drops to treat glaucoma. Your eye doctor will help find the right medication(s) that will lower your IOP to the desired range and control it over time.

Prostaglandin analogues

Prostaglandin analogues are the newest class of glaucoma drugs, which includes Travatan Z, Xalatan and Lumigan. They work by increasing the flow of aqueous humor out of the eye, lowering your IOP. Prostaglandin analogues are administered once a day and effectively control your IOP for many years.
One of the more common side effects of prostaglandin analogues is redness of the eye. If the redness occurs it is usually mild. In a very small number of patients, prostaglandin analogues may gradually darken eye colour, increasing the amount of brown colour in the iris. Although these changes occur slowly, they may be permanent.

Beta blockers

Beta blockers have been used for decades to treat glaucoma. The most common is Timolol. Beta blockers work by decreasing production of the aqueous humor, which lowers your IOP. They are administered once or twice a day. Some of the side effects include low blood pressure, slow heart rate, and general fatigue.

Alpha agonists

Brimonidine is the most common alpha agonist. Alpha agonists work by creating an increase in outflow, as well as decreasing the production of aqueous humor, to lower your IOP. They are administered three times a day.
Side effects may include ocular allergic reactions and drowsiness.

Carbonic anhydrase inhibitors

Brinzolamide and Dorzolamide are the most common carbonic anhydrase inhibitors. Carbonic anhydrase inhibitors lower IOP by decreasing production of aqueous humor. They are administered two or three times a day. Carbonic anhydrase inhibitors are also available as an oral medication.
The severe side effects, such as nausea and diarrhea, common with the oral forms, are largely avoided with eye drops. The eye drops are fairly well-tolerated, but may cause a minor ocular stinging or burning sensation.

Miotics

Pilocarpine is the most common miotic and has been around for decades. Miotics decrease IOP by increasing outflow of the aqueous humor. They are usually administered three to four times a day.
Side effects may include blurred vision, brow ache, and small pupil size.