Risks, Diagnosis & Treatment
Glaucoma is a complex eye disease that is most commonly associated with an elevated pressure inside the eye-Intraocular Pressure (IOP)-that damages the optic nerve and causes loss of vision. Glaucoma is a leading cause of blindness and visual impairment in people above age 40. More than three million Americans are living with glaucoma, 2.7 million of whom-aged 40 and older-are affected by its most common form, Primary Open Angle Glaucoma (POAG) which begins without any symptoms or obvious loss of vision. It is critical to diagnose and treat glaucoma as early as possible through regular eye exams in order to prevent vision loss. With early detection, diagnosis & treatment, in the vast majority of cases, glaucoma vision loss can be controlled or prevented.
Glaucoma Risk Factors
- High Intraocular Pressure
- Age-Risk increases after the age of 40 and is 6 times greater if you are over 60.
- Race-African-Americans have a six to eight fold increased risk for glaucoma.
- Myopia-Severely nearsighted people have a higher risk of developing glaucoma.
- Hypertension or High Blood Pressure
- Family History-Any family history of glaucoma is considered a very significant risk factor.
- Steroids-Taking steroid medication for allergies, asthma or arthritis
- Early Menopause
- Sleep Apnea
- Thin Corneal Tissue
- Eye Trauma
During your eye exam please tell us if you think that you have any of these glaucoma risk factors!
Types of Glaucoma
There are two main types of glaucoma which are called Primary Open Angle Glaucoma (POAG) and Angle Closure Glaucoma. Primary Open Angle Glaucoma is the most common type of glaucoma whereby the production and/or drainage of fluid inside the front of the eye-called aqueous humor-is imbalanced, resulting in an elevation in eye pressure (IOP). This pressure deprives the optic nerve of oxygen and nutrients causing irreversible changes and damage, which if left untreated results in vision loss and ultimately blindness. Angle Closure Glaucoma accounts for about 10% of all cases of glaucoma and about 2/3 of these produce no symptoms for patients. Acute Angle Closure Glaucoma is one of the only types of glaucoma that produces distinct symptoms that include pain, light sensitivity, redness, blurry vision, colored haloes around lights and nausea or vomiting. Acute Angle Closure Glaucoma is considered a medical emergency. If you experience a sudden onset of pain, redness, blurred vision, light sensitivity, haloes around lights, nausea and vomiting, please call Coastal Jersey Eye Center at 609-465-7926 and relay these symptoms to the Patient Services Representative so that you can be given an appointment immediately. In the event that you are at risk for Angle Closure Glaucoma or in the event that you have Acute Angle Closure Glaucoma we may initially prescribe some medication to begin to lower the pressure but will also perform a type of glaucoma laser procedure called Laser Iridotomy to produce a small opening or hole in the Iris so that Aqueous Humor can drain from the eye more effectively.
Eye Exams & Diagnosis of Glaucoma
During your routine eye exam or as part of a special glaucoma testing visit, we may perform a number of tests in order to be able to provide early detection and make the most accurate diagnosis of glaucoma. These may include the following:
- Tonometry-Intraocular Pressure (IOP) measurement.
- Ophthalmoscopy-Examination of the optic nerve through a dilated pupil which may be performed using special instruments or a high magnification lens at the Slit Lamp Biomicroscope.
- Visual Field Perimetry-A computerized examination to plot an actual map of the field of your vision.
- Gonioscopy-Direct examination of the drainage structures of your eye called “trabecular meshwork”-using a specialized contact lens at the Slit Lamp Biomicroscope.
- Computerized Imaging of Optic Nerve & Fibers-OCT uses a method called “optical coherence tomography” to create digital images with beams of light to examine the optic nerve and measure the retinal nerve fiber thickness.
- Pachymetry Measurement of Corneal Thickness
From this testing our doctors will be able to make a diagnosis and recommendations for additional visits and treatment as required. They will be sure to answer all questions you may have and help you understand how we will work together to help maintain your eye health & vision.
Medical, Laser & Surgical Glaucoma Treatment
The goal of glaucoma treatment is to stabilize and control your eye pressure in order to provide the best chance of preserving your vision. The three main glaucoma treatments are medical-using eye drops, glaucoma laser treatment & glaucoma surgery, most often minimally invasive glaucoma surgery (MIGS).
Medical Treatment of Glaucoma
Primary Open Angle Glaucoma has most often been treated with eye drops. By using one or two types of glaucoma eye drops most patients are able to achieve a stable and lowered eye pressure. Some patients are unable to achieve adequate control with eye drops alone, or may experience intolerable side effects from the eye drops, and do better with a glaucoma laser treatment to maintain control as a first choice of treatment.
Laser Treatment of Glaucoma
Selective Laser Trabeculoplasty (SLT) is a type of glaucoma laser treatment for Primary Open Angle Glaucoma that helps to reduce the Intraocular Pressure (IOP) by creating more effective drainage of fluid through the trabecular meshwork. This is a quick painless procedure Dr. Uretsky performs to help patients obtain good stability and also reduce the number or frequency of eye drops they need to use.
Laser Peripheral Iridotomy (LPI) is a type of glaucoma laser treatment for Angle Closure Glaucoma that creates a hole on the outer edge, or rim, of the iris, the colored part of the eye which allows the aqueous humor fluid to easily flow between the anterior chamber, the front part of the eye, and the area behind the iris, the posterior chamber. This is performed for patients with narrow chamber angles or those patients experiencing angle closure to prevent sudden buildup of pressure within the eye, which occurs during an episode of acute closed-angle glaucoma.
Surgical Treatment of Glaucoma
In more severe cases of glaucoma, maximum eye drop medical therapy and laser treatment may fail to provide stable control of glaucoma and stop further vision loss. While uncommon, surgical treatment may be required. Newer, less invasive glaucoma procedures called Minimally Invasive Glaucoma Surgery (MIGS) are indicated for use in patients with mild-to-moderate glaucoma. As the name implies, these procedures are much gentler to the eye, recovery times are much faster and often the number of eye drops required can be reduced and sometimes, eliminated altogether.
Many patients with glaucoma will eventually need cataract surgery. iStent® provides a once-in-a-lifetime opportunity to better control glaucoma and also restore vision during cataract surgery. Multiple studies show that about 80% of individuals undergoing cataract surgery and iStent® implantation can reduce the number of glaucoma medications they require for adequate control. Some can eliminate medication altogether. Given the inconvenience, expense and occasional side-effects of eye drops, this is a wonderful opportunity to better control the disease.