Glaucoma

Glaucoma 2018-03-20T17:29:40+00:00

Protecting Your Vision with Glaucoma Diagnosis and Treatments

Glaucoma is a progressive disease that causes damage to the optic nerves. Without treatment, glaucoma can lead to complete vision loss. Because this disease may not exhibit symptoms until it has reached advanced stages, it is important to undergo regular eye exams. Contact us today to learn more.

Glaucoma is a group of eye conditions that damage the optic nerve, which transmits visual information from the eye to the brain. In most cases, glaucoma is caused by an increase of intraocular pressure within the eye. The most common type of glaucoma is open-angle glaucoma, which gradually develops as the thin channels in the eye become clogged with fluid. This form of glaucoma often results in minimal or no symptoms until the condition has advanced. In contrast, closed-angle glaucoma results in a sharp, sudden blockage within the eye, causing an acute, immediate increase in intraocular pressure. Closed-angle glaucoma typically causes more obvious symptoms and may require emergency treatment.

It is very common for patients who suffer from glaucoma to experience little or no symptoms in the early stages of the disease. Often, if symptoms are experienced, the disease has already progressed significantly. As eye pressure within the eye builds, patients may experience loss of peripheral vision, eye pain, blurry vision, and more. Any changes in vision should be reported to our doctors immediately, so that we can perform a comprehensive eye exam.

You may be at higher risk for glaucoma if:

  • You are older than 50 years of age
  • You are of African-American or Japanese descent
  • You suffer from heart disease, uncontrolled diabetes, thyroid problems, or hypertension
  • You take steroid medications
  • Your family members have had glaucoma
  • You have a history of eye trauma or other ocular diseases

If you are at a higher risk of developing glaucoma, you should be especially conscientious about attending regular eye exams and monitoring your eyes for the symptoms of glaucoma.

Open-angle Glaucoma

More than 90 percent of glaucoma patients suffer from open-angle glaucoma. Open-angle glaucoma occurs when the drains in the eye gradually become clogged, preventing fluid from circulating properly and creating a buildup of pressure. Open-angle glaucoma does not change the natural angle between the cornea and the iris. This condition can develop without any noticeable symptoms, so it’s important to undergo regular eye exams. Patients with open-angle glaucoma may experience subtle symptoms like slightly blurry vision or weakened peripheral vision.

Closed-angle Glaucoma

This type of glaucoma occurs suddenly. As the proper angle between the iris and the cornea narrows, the drainage channels of the eye quickly close, creating a sharp increase in intraocular pressure. Closed-angle glaucoma has much clearer symptoms than open-angle glaucoma, and it usually requires immediate care to prevent vision loss. Contact one of our Ophthalmologists for an emergency appointment if you experience any of the following symptoms:

  • Eye pain, especially in combination with nausea or vomiting
  • Blurry vision
  • Headache
  • Light sensitivity, which could result in rings, glare, or halos
  • Red eyes
  • Worsened night vision
  • Tunnel vision

Other Types of Glaucoma

  • Normal tension glaucoma, in which your intraocular pressure is normal, but the optic nerve becomes injured as though the intraocular pressure is too high.
  • Traumatic glaucoma, which results from eye injury.
  • Pigmentary glaucoma, which is caused by the breakdown of cells in the iris.
  • Secondary glaucoma, in which intraocular pressure rises due to a separate ocular condition such as cataracts.
  • Psuedoexfoliative glaucoma, in which tissues from the lens flake off and disrupt intraocular pressure.
  • Pediatric glaucoma, in which a baby’s ocular drains are improperly developed.
  • ICE, or Irido Corneal Endothelial Syndrome, in which corneal tissues separate and increase intraocular pressure.
  • Neovascular glaucoma, a type of open-angle glaucoma in which irregular blood vessels grow as a result of another condition such as uncontrolled diabetes.

Most patients suffer from progressive open-angle glaucoma and often have no symptoms of the disease until it threatens their eyesight. Attending regular eye exams allows our Ophthalmologists to identify the the early signs of glaucoma. To screen for glaucoma, our Ophthalmologists will review your medical history, since certain conditions like diabetes or medications like steroids can put you at higher risk for this disease. Then, they perform a wide range of diagnostic tests, which may include:

  • Optical Coherence Tomography (OCT): We use our Zeiss machine to perform optical coherence tomography, a technique that uses specific light wavelengths to map the structure of your eye, allowing our doctors to look for any abnormalities in the optic nerve.
  • Tonometry: During this exam, we use a small tool to calculate your intraocular pressure.
  • Snellen Chart Reading: Since glaucoma can affect your optometric prescription, we perform this visual acuity exam to look for any changes, especially to your distance vision.
  • Pachymetry: Each patient’s eyes are unique, so a high tonometry reading for you may be normal for another patient. We use pachymetry to measure the thickness of your cornea to help us better interpret the results of your other tests.
  • Ophthalmoscopy: Typically used as a follow-up test if your OCT or tonometry readings are abnormal, this exam allows the Ophthalmologist to take a closer look at your optic nerve. Your doctor will apply dilating drops and use a lighted tool to assess your eye.
  • Perimetry: In its early stages, glaucoma can interfere with your peripheral vision, so our doctors use this field of vision test to check your vision range.
  • Gonioscopy: If we suspect you may glaucoma, we will perfom gonioscopy, which involves numbing your eyes and using a mirrored contact lens to examine the space between your cornea and iris.

Like many other glaucoma treatments, glaucoma eye drops lower intraocular eye pressure (IOP) to protect the optic nerve. If left untreated, high IOP can damage the optic nerve, resulting in vision loss.

Some glaucoma eye drops lower eye pressure by aiding the drainage of fluid in the eye (intraocular fluid), while others decrease production of fluid. Some eye drops do both. Some enhance the effects of other eye drops, and are prescribed in combination.

Who is a Good Candidate? 

When medications are placed in the eye, a small percentage of the active ingredient makes its way into the bloodstream. Depending on your overall health and other medications you may be taking, glaucoma eye drops can aggravate existing medical conditions, such as asthma, and can also interact adversely with common medications, such as Digitalis taken for heart conditions. The doctors at Broberg Eye Care will carefully evaluate your candidacy for glaucoma eye drops.

Types of Glaucoma Eye Drops

Glaucoma medications are either oral or topical (eye drop form). We may change your prescription over time to manage side effects or improve effectiveness of your treatment. There are six types of glaucoma eye drops, each with different purposes:

  • Miotics: This medication reduces eye pressure by increasing drainage of fluid.
  • Epinephrine: This drug initially decreases the rate of fluid production and then increases its outflow from the eye. Later, it further increases the outflow.
  • Beta blockers: Used in a variety of glaucoma eye drops, this class of medication decreases production of intraocular fluid. It is often used in combination with prostaglandins.
  • Prostaglandins: These medications increase the outflow of fluid from the eye through a secondary drainage route. In general, these eye drops relax the interior muscles of the eye, which reduces the buildup of eye pressure.
  • Carbonic anhydrase inhibitors (CAIs): Available in both eye drop and pill form, these medications reduce eye pressure by decreasing the body’s production of intraocular fluid, and improving blood flow in the retina and optic nerve. They are often used in combination with other glaucoma eye drops, and when other medications are not working.
  • Alpha-adrenergic agonists: When used as the active ingredient in eye drops, these medications both reduce the production of eye fluid and increase its drainage.

Using Glaucoma Eye Drops

It is important to use glaucoma eye drops exactly as prescribed. Eye drops are fairly simple to administer, but some patients have trouble remembering to take them. If you are prescribed daily eye drops, it may be helpful to coordinate using them with a regular activity, such as brushing your teeth. You may also find it helpful to set an alarm on a watch, clock, or cell phone as a reminder.

Some patients find it difficult to use eye drops, because of unsteady hands or problems holding the bottle. There are a variety of ways to make using the drops easier, such as wrapping a paper towel around the bottle for better grip, or resting your hand on your face while putting the drops into the side of your eye. Our supportive staff can help if you are finding it difficult to use your eye drops.

At Broberg Eye Care, we typically recommend that our patients begin with conservative treatment for eye diseases. For patients suffering from glaucoma, medicated eye drops are often our first treatment option. However, if we feel that eye drops are not significantly lowering a patient’s intraocular pressure, or if a patient is suffering severe side effects of eye drop medication, we will consider selective laser trabeculoplasty, or SLT. SLT is one of the latest advancements in glaucoma treatment. This laser treatment can effectively lower eye pressure for patients suffering from open-angle glaucoma. Unfortunately, this is not a treatment option for patients experiencing angle-closure glaucoma. Our doctors can determine if you are a candidate for SLT treatment.

The Procedure

Selective laser trabeculoplasty begins with anesthetic eye drops. This serves to numb the eyes so that patients are free of pain throughout the procedure. With the eyes held open, a lens will be brought up to the eye. A laser will be directed at this lens and will reflect onto the meshwork in the eye. The laser creates a chemical change in the drainage tissue, allowing fluid to drain more effectively, lowering the intraocular pressure. SLT treatment is typically completed in less than half an hour.

Results

As the eye adjusts to these changes and as the fluid begins to flow from the eye, the intraocular pressure will gradually decrease. In most cases, it takes one to three months for the results of surgery to become apparent. While SLT can effectively reduce eye pressure, some patients will need to continue the use of medicated eye drops after treatment in order to prevent fluid buildup. The long-term effects of selective laser trabeculoplasty vary by patient. For some patients, the effects of SLT begin to wear off a year after treatment, while others benefit from the results for up to five years. The advantage of selective laser trabeculoplasty is that it can be repeated. If we notice the intraocular pressure begin to increase, we can perform the procedure again.

Each patient’s glaucoma treatment is unique, so costs can fluctuate considerably. Some of the most common cost factors are:

  • Diagnostic testing: We offer comprehensive screening exams for patients. If your initial tests are positive, we may need to perform additional assessments, which may come at an additional cost.
  • Your glaucoma type: Open-angle glaucoma, the most common type that advances gradually as the drainage channels in your eye become clogged, requires different treatment than closed-angle glaucoma, which usually occurs suddenly as the space between the iris and cornea narrows.
  • The severity of your condition: It is simpler and less expensive to treat glaucoma in its earlier stages, when it has caused less damage to the optic nerve and surrounding tissue.
  • The treatment(s) you choose: Typically, medicated eye drops are less costly than glaucoma surgeries. The complexity of your surgery will also influence its cost.
  • Anesthetic: Some treatments, such as SLT, require only local anesthetic, but more involved surgeries could be performed under general anesthesia or intravenous sedation, which increases their cost.
  • Repeated treatment: When budgeting for glaucoma treatment, remember that some procedures, like SLT, will likely need to be repeated within one to five years. Medicated eye drops are an ongoing cost, since they are typically used daily.
  • Your medical insurance coverage: Depending on your health insurance, your provider may be willing to cover a portion or even the entirety of your glaucoma treatment costs.

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