Routine Eye Exams Help Find Glaucoma Early

New Medications Offer Early Treatment Options

It is called the silent thief of sight, and for good reason.

Glaucoma has few if any early symptoms. And when they do appear, the disease has already robbed its victims of some sight. About 3 million Americans have glaucoma, but many do not know it yet.

Regular, routine eye exams, including special tests, can improve the odds of early detection, experts say. And, once detected, the disease can be controlled - and remaining vision preserved - with improved medications and surgery techniques.

"The key is to get checked before the disease becomes symptomatic, " says Dr. Andrew Iwach, an ophthalmologist at the University of California San Francisco.

Since glaucoma risk rises with age, eyes should be tested at about age 35 and 40, then every two to four years after age 40 and every one to two years after age 60, suggests the Glaucoma Research Foundation. Those at high risk due to family history should be examined every one to two years after age 35.

Glaucoma Causes Vision Loss

Glaucoma is actually a group of eye diseases, but all types damage the optic nerve, causing vision loss and, sometimes, blindness. The optic nerve connects the retina to the brain and it houses more than 1 million nerve fibers.

For good vision, a person needs a healthy optic nerve.
What goes wrong in glaucoma? In the front of the eye, clear fluid flows in and out of a space called the anterior chamber.

When the fluid passes out too slowly and builds up, pressure can increase and this intraocular pressure can rise to the point where it damages the optic nerve. This form of the disease, the most common, is called open angle glaucoma.

It is so named because the fluid leaves the anterior chamber at the open angle where the cornea and the iris meet.

Some people have glaucoma, and optic nerve damage, even without the pressure within the eye rising - a type called low-tension or normal-tension glaucoma.

And, in recent years, Dr. Iwach says, experts have discovered the thickness of the cornea somehow plays a role in who gets glaucoma.

"We may have a patient who has a higher than normal pressure, but the optic nerve looks fine," he says. Odds are the patient has a thick cornea, somehow possibly protecting against damage to the nerve.

During an exam for glaucoma, physicians will also look at the optic nerve, measure the intraocular pressure and evaluate peripheral vision - often affected first in glaucoma. To lower the pressure inside the eye, drops are commonly prescribed.

Newer Treatments Give Hope

"Twenty years ago, in order to control glaucoma, we needed to use drops four times a day," says Dr. Michael Berlin, a professor of clinical ophthalmology at the Jules Stein Eye Institute at the UCLA David Geffen School of Medicine.

Some of the newer eyedrop medications only need to be taken once or twice a day. Drops work either by causing the eye to make less fluid or helping the fluid drain.

If surgery is deemed the best treatment, a physician may perform a procedure called a laser trabeculoplasty. This procedure involves a laser aimed at the lens of the eye and makes several evenly spaced burns, stretching the drainage holes inside the eye and allowing the fluid to drain more effectively.

While the traditional approach has been to use medications first, then surgery if the glaucoma still progresses, Dr. Iwach says the latest thinking has it that some patients may benefit most from having surgery first.

Compliance with medication is a problem among patients, Drs. Berlin and Iwach agree.

"Most patients are not compliant," Dr. Berlin says. Part of the reason, he suspects, is the patient can tell little difference in vision during the short term, whether he takes the medicine or not.

Good patient-physician communication is the key. All the latest information - whether medication or laser therapy is best; which eye drops are preferred - "has to be customized to the individual patient," Dr. Iwach says.

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Academy of Ophthalmology

Centers for Disease Control and Prevention (CDC)

Glaucoma Research Foundation

National Eye Institute

National Institutes of Health (NIH)

Prevent Blindness America

US Department of Heath and Human Services

February 2004

Routine Eye Exams Help Find Glaucoma Early

Newer Treatments Give Hope

Facts About Glaucoma

Online Resources

Facts About Glaucoma

According to the National Eye Institute, glaucoma is detected through a comprehensive eye exam that includes:

Visual acuity test. This eye chart test measures how well you see at various distances.

Visual field test. This test measures your side (peripheral) vision. It helps your eye care professional tell if you have lost side vision, a sign of glaucoma.

Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems.

Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Pachymetry. A numbing drop is applied to your eye. Your eye care professional uses an ultrasonic wave instrument to measure the thickness of your cornea.

There is no cure for glaucoma. Vision lost from the disease cannot be restored.

However, immediate treatment for early stage, open-angle glaucoma can delay progression of the disease. That is why early diagnosis is very important. Treatment may include:

Medications. Medications in the form of eyedrops or pills, are the most common early treatment for glaucoma. Some medications cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.

Glaucoma medications may be taken several times a day. Most people have no problems. However, some medications can cause headaches or other side effects. For example, drops may cause stinging, burning, and redness in the eyes.

Because glaucoma often has no symptoms, people may be tempted to stop taking, or may forget to take, their medications. You need to use the drops or pills as long as they help control your eye pressure. Regular use is very important.

Laser trabeculoplasty. Laser trabeculoplasty helps fluid drain out of the eye. Your physician may suggest this step at any time. In many cases, you need to keep taking glaucoma medications after this procedure.

Laser trabeculoplasty is performed in your physician's office or eye clinic. Before the surgery, numbing drops will be applied to your eye. As you sit facing the laser machine, your physician will hold a special lens to your eye.

A high-intensity beam of light is aimed at the lens and reflected onto the meshwork inside your eye. The laser makes several evenly spaced burns that stretch the drainage holes in the meshwork. This allows the fluid to drain better.

Your physician may give you some drops to take home for any soreness or inflammation inside the eye. You need to make several followup visits to have your eye pressure monitored.

Conventional surgery. Conventional surgery makes a new opening for the fluid to leave the eye. Your physician may suggest this treatment at any time. Conventional surgery often is done after medications and laser surgery have failed to control pressure.

A small piece of tissue is removed to create a new channel for the fluid to drain from the eye.

For several weeks after the surgery, you must put drops in the eye to fight infection and inflammation. These drops will be different from those you may have been using before surgery.

Always consult your physician for more information.