Jones Eye Clinic is recognized as a tertiary referral center for glaucoma services in the Siouxland region. For more than 40 years, we have had excellent outcomes for our glaucoma patients.
What is Glaucoma?
Glaucoma is a group of eye conditions that damage the optic nerve, which is the nerve that carries information from the eye to the brain. The most common type of glaucoma, known as primary open-angle glaucoma, is caused by increased pressure within the eye. This pressure can cause damage to the optic nerve, which can lead to vision loss and blindness. The pressure increase in the eye is caused by the build-up of a fluid called aqueous humor that does not drain properly from the eye.
Other types of glaucoma include angle-closure glaucoma (blockage in the drainage angle of the eye) and normal-tension glaucoma (optic nerve damage at a normal pressure).
Some common symptoms of glaucoma include peripheral vision loss, loss of night vision, and seeing halos around lights. However, most people with glaucoma do not experience any symptoms in the early stages of the disease. That’s why getting regular eye exams is important, especially if you are at risk for glaucoma.
Glaucoma risk factors include age, family history, African heritage, nearsightedness, diabetes, long-term steroid use, and other health conditions.
What are the signs and symptoms of glaucoma?
It can take months or years after nerve damage has occurred before symptoms are noticeable. The best way to identify glaucoma is through annual eye exams before symptoms begin, though some indications may present as the disease progresses:
- Suddenly blurry vision
- Severe eye pain
- Frequent or continuous headaches
- Unexplained nausea with or without vomiting
- Seeing rainbow-colored rings or halos around lights
How is Glaucoma Diagnosed?
There are several tests and procedures that can be used to diagnose glaucoma. Some of the most common include:
- Tonometry: This test measures the pressure inside the eye. A tonometer is used to gently touch the surface of the eye, which can determine the eye’s pressure.
- Visual field test: This test measures the extent of a person’s peripheral vision. The person will sit in front of a machine and press a button every time they see a light. This test can detect blind spots or areas of vision loss caused by glaucoma.
- Pachymetry: A measurement of the thickness of the cornea (clear front window of the eye). Thinner corneas have been associated with a higher risk of glaucoma.
- Gonioscopy: The doctor uses a special lens to examine the angle where the iris meets the cornea. This test can help determine if there is a blockage in the drainage angle of the eye.
- Optic nerve evaluation: A doctor will use a special microscope called an ophthalmoscope to examine the optic nerve at the back of the eye. The doctor will look for signs of damage to the nerve, such as cupping (a potential sign of nerve fiber loss) or hemorrhages (a sign of poor optic nerve blood flow).
- OCT (Optical Coherence Tomography): A non-invasive imaging technique that uses light waves to take cross-sectional images of the retina and optic nerve. It can be used to diagnose glaucoma and follow patients for changes.
In addition to these specific tests, the doctor will perform a complete eye exam, including visual acuity and a dilated retinal examination.
It’s important to note that some types of glaucoma, like normal-tension glaucoma, can occur even with normal intraocular pressure. All the above tests are important to rule out or confirm the diagnosis of glaucoma.
What are the treatments for Glaucoma?
There are several different treatment options for glaucoma. The type of treatment that is best for a particular individual will depend on their specific type of glaucoma, as well as other factors such as their overall health and the severity of their condition.
The primary goal of treatment for glaucoma is to lower the pressure in the eye and prevent further damage to the optic nerve. Some of the most common treatment options include:
- Eyedrops: The most prescribed medications are called prostaglandin analogs, which help to lower IOP by increasing the outflow of fluid from the eye. There are also drops that lower IOP by decreasing the production of fluid inside the eye. Sometimes medications will be used together for multiple mechanisms of action.
- Laser therapy: This type of treatment uses a special laser to make small adjustments to the eye’s natural internal drainage system, which helps to improve the outflow of fluid and lower IOP.
- Surgery: In some cases, surgery may be necessary to treat glaucoma. One of the most common types of surgery for glaucoma is called a trabeculectomy, which involves creating a new drainage channel in the eye to help lower IOP. Another is a glaucoma drainage device (GDD), an implant placed in the eye that allows the aqueous humor to flow out of the eye and decrease the IOP.
- Sustained drug-delivery devices: Devices that are implanted into the eye to release medication over time at a constant rate slowly. This type of drug delivery can help reduce the need for some eye drops.
- MIGS (Minimally Invasive Glaucoma Surgeries): Minimally invasive glaucoma surgeries are a group of procedures used to treat glaucoma. These procedures are designed to lower the eye’s intraocular pressure (IOP) by increasing the outflow of aqueous humor, the fluid that fills the front part of the eye. MIGS are less invasive than traditional glaucoma surgeries, such as trabeculectomy, and have a lower risk of complications.
Some examples of MIGS include:
Viscodilation: A small device is inserted into the Schlemm’s canal, which is part of the internal drainage mechanism in the eye, to widen it and increase the outflow of aqueous humor. The viscous fluid is pushed into Schlemm’s canal and adjacent channels to further open the drainage.
Hydrus Microstent: A small device is inserted into the Schlemm’s canal to expand the canal and increase the outflow of aqueous humor.
Goniotomy: A small incision is made in the trabecular meshwork to allow fluid to flow more easily into Schlemm’s canal.
MIGS are not suitable for all patients with glaucoma or high intraocular pressures. The decision to perform this type of procedure is made on a case-by-case basis, depending on the individual’s disease severity, age, and other factors.
It is important to keep in mind that glaucoma can be progressive and have no symptoms or very mild symptoms in the early stage, and once vision is lost, it is permanent. Hence, regular eye exams and close monitoring of IOP with the treatments discussed above can help preserve vision for a patient with glaucoma.
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