Glaucoma is the leading cause of blindness in people over the age of 60. But blindness from glaucoma can often be prevented with early detection and treatment.

Your eye is constantly creating the liquid "aqueous humor". As new aqueous humor flows into your eye, the same amount should drain. Fluid drains through an area called the drainage angle. This process keeps the pressure in the eye (called intraocular pressure or IOP) stable. But if the drain angle is not working properly, liquid accumulates. The pressure inside the eye increases, damaging the optic nerve.

The optic nerve consists of more than a million tiny nerve fibers. It is like an electrical cable made up of many small wires. As these nerve fibers die, you will develop blind spots in your vision. You may not notice these blind spots until most of your optic nerve fibers have died. If all the fibers die, you will go blind.

The damage caused by glaucoma is permanent - it cannot be reversed. But medicine and surgery help stop further damage. 

How is glaucoma treated?

There are two main types of glaucoma:

Primary open-angle glaucoma

This is the most common type of glaucoma. This happens gradually, where the eye doesn't drain fluid the way it should (like a blocked drain). As a result, eye pressure rises and begins to damage the optic nerve. This type of glaucoma is painless and does not cause vision changes at first. Some people may have optic nerves that are sensitive to normal eye pressure. This means that their risk of getting glaucoma is higher than normal. Regular eye examinations are important for detecting early signs of optic nerve damage.

Angle-closure glaucoma (also called “angle-closure glaucoma” or “narrow-angle glaucoma”)

This type occurs when a person's iris is very close to the corner of the eye's drainage. The hose can block the corner of the drain. You can think of it as a piece of paper sliding down the sink drain. When the drainage angle is completely blocked, eye pressure rises very quickly. This is called an acute attack. It is a real eye emergency and you need to seek immediate help or else it can lead to blindness.

Signs of an acute angle-closure glaucoma attack:

• Your vision suddenly blurs
• You have severe eye pain
• You have a headache
• You feel sick to your stomach (nausea)
• You throw up 
• You see rainbow-colored rings or halos around the light

Many people with angle-closure glaucoma develop it slowly. This is called chronic angle-closure glaucoma. At first there are no symptoms, so they don't know they have it until the damage is severe or until they have an attack.

Angle-closure glaucoma can cause blindness if not treated immediately.

Symptoms of open angle glaucoma

In open-angle glaucoma, there are no warning signs or obvious symptoms in the early stages. As the disease progresses, blind spots develop in your peripheral (side) vision.

Most people with open-angle glaucoma do not notice any change in vision until the damage is quite severe. This is why glaucoma is called the "silent thief of vision". Regular eye exams can help your eye doctor detect this disease before you lose your vision. Your ophthalmologist can tell you how often you should have an examination.

Symptoms of angle-closure glaucoma

People at risk of angle-closure glaucoma usually show no symptoms before an attack. Some early symptoms of an attack may include blurred vision, halos, mild headaches or eye pain. People with these symptoms should see an ophthalmologist as soon as possible. An attack of angle-closure glaucoma includes the following:

• severe pain in the eye or forehead
• eye redness
• reduced vision or blurred vision
• see rainbows or halos
• headache
• nausea
• vomit

Symptoms of normal tension glaucoma

People with "normal tension glaucoma" have eye pressure that is within normal limits, but show signs of glaucoma, such as blind spots in the visual field and damage to the optic nerve.

Who is at risk of glaucoma?

Some people have a higher than normal risk of getting glaucoma. This includes people who:

• are older than 40 years
• have family members with glaucoma
• are of African, Latin American or Asian origin
• have high eye pressure
• are farsighted or shortsighted
• had an eye injury
• use long-term steroid drugs
• they have corneas that are thin in the middle
• have thinning of the optic nerve
• have diabetes, migraines, high blood pressure, poor blood circulation or other health problems that affect the whole body

Talk to your eye doctor about your risk of developing glaucoma. People with more than one of these risk factors have an even higher risk of glaucoma.

Glaucoma is the silent thief of sight

Glaucoma has no symptoms in its early stages. In fact, half of people with glaucoma don't know they have it! Regular eye exams can help your eye doctor detect this disease before you lose your vision. Your ophthalmologist can tell you how often you should have an examination.

Medicines

Glaucoma is usually controlled with medication in the form of drops. Used daily, these eye drops lower eye pressure. Some do this by reducing the amount of aqueous fluid that the eye produces. Others reduce pressure by helping better fluid flow through the drain angle. Glaucoma medications can help you keep your vision, but they can also cause side effects. Some eye drops can cause:

• burning or itching sensation
• red eyes or red skin around the eyes
• changes in pulse and heartbeat
• changes in your energy level
• changes in breathing (especially if you have asthma or breathing problems)
• dry mouth
• blurred vision
• eyelash growth
• changes in the color of the eyes, the skin around the eyes or the appearance of the eyelid

All medicines can have side effects. Some medicines can cause problems if taken with other medicines. It is important to give the doctor a list of all the medicines you take regularly. Be sure to talk to our medical team if you think you may be experiencing side effects from your glaucoma medication.

Never change or stop your glaucoma medications without talking to our ophthalmologist. If you will soon run out of medication, send us an inquiry as to whether you need a pharmacy prescription filled.

Laser surgery

There are two main types of glaucoma laser surgery to help clear the water from the eye. These procedures are usually done in an ophthalmologist's office or in an outpatient surgery center.

Trabeculoplastica. 

This surgery is for people who have open-angle glaucoma. The surgeon uses a laser to make the drainage angle work better. In this way, the liquid flows out properly and the eye pressure is reduced.

Iridotomy. 

This is for people who have angle-closure glaucoma. An ophthalmologist uses a laser to create a small hole in the iris. This hole helps the fluid flow to the drainage angle.

Operative interventions

Trabeculectomy. 

In this case, the eye surgeon creates a tiny flap in the sclera. It will create a bubble (like a pocket) in the conjunctiva called a filtration bubble. It is usually hidden under the upper eyelid and cannot be seen. Aqueous fluid will be able to leak out of the eye through the flap and into the spot. In the macular, the fluid is absorbed by the tissue around your eye, reducing eye pressure

Drainage implant. 

Our doctor can also install a tiny drainage implant in the eye. A glaucoma drainage implant sends fluid to a collection area (called a reservoir) under the conjunctiva. The fluid is then absorbed into nearby blood vessels.

Cataract surgery. 

In some cases, removing the eye's natural lens can lower eye pressure. This is most often done for people with narrow angles who have high eye pressure, signs of glaucoma, or both. With narrow angles, the iris and cornea are too close. If the angle is so narrow that the iris touches the cornea, it will also cover (block) the drainage canal of the eye. Cataract surgery creates more space between the iris and cornea, so more fluid leaves the eye. This can reduce eye pressure.

Your role in glaucoma treatment

Successful glaucoma treatment is a team effort between you and your doctor. Your ophthalmologist will prescribe glaucoma treatment. It is up to you to follow your doctor's instructions in detail.

It is recommended that you visit your ophthalmologist approximately every 3-6 months. However, this may vary depending on your treatment needs. If you have any questions about your eyes or treatment, talk openly with your ophthalmologist.