What is glaucoma?
Glaucoma, a leading cause of blindness in the United States, is a disease of the optic nerve - the part of the eye that carries images we see to the brain. Because it is usually painless, a person may not experience any symptoms until significant damage has occurred. With early detection through regular exams and early treatment, however, loss of sight from glaucoma can often be prevented.

To maintain a healthy level of pressure within the eye, a small amount of fluid is constantly produced in the eye while an equal amount flows out of the eye through a microscopic drainage system, called the angle of the eye, located between the cornea (the clear covering of the eye) and the iris (the colored part of the eye). This fluid is not part of the tears on the outer surface of the eye. If the fluid drainage is compromised, the fluid being produced cannot flow out of the eye, causing an increase of the pressure in the eye. This increased pressure pushes against the optic nerve, causing damage first to the peripheral vision and later to the central vision.

Types of Glaucoma
There are several types of glaucoma, but the 2 major ones are "open-angle" glaucoma and "narrow or closed angle" glaucoma.

In open angle glaucoma, the fluid reaches the angle but then has trouble percolating through it. Typically, open-angle glaucoma has no symptoms early on, but as the optic nerve becomes more damaged, the fibers die, creating blank spots in the field of vision. Typically, these spots are not noticed in the day-to-day activities until the optic nerve is significantly damaged and these spots enlarge. Once death occurs to the optic nerve fibers, the vision loss is permanent.

Narrow or closed angle glaucoma is where the angle becomes so narrow or closed that the fluid cannot even reach the layers of angle to drain. The fluid in the eye then builds up acutely (quickly). Symptoms may include:
  • Blurred vision
  • Severe eye pain
  • Headache
  • Rainbow-colored halos around lights
  • Nausea/vomiting
This is a true eye emergency and needs to be treated immediately to avoid blindness.

Risk Factors
Glaucoma can affect anyone; however, certain factors increase your risk for developing the disease:
  • Age
  • Elevated eye pressure
  • Family history of glaucoma
  • African or Spanish-American ancestry
  • Far-sightedness or near-sightedness
  • Past eye injuries
  • Thinner central cornea thickness
  • Health problems including diabetes, migraine headaches, and poor circulation
  • Steroid medication, including oral steroids and steroid nasal inhalers
Diagnosis and Treatment
During your exam, the pressure in the eye will be measured and the appearance of the optic nerve will be evaluated for signs of damage. If either of these is suspicious or if there are other risk factors, additional testing will be done. These include:
  • Central corneal thickness measurement using ultrasound
  • Visual field analysis
    Since glaucoma usually affects the peripheral vision first, proper glaucoma care involves periodic analysis of the peripheral vision. At Pleasant Valley Ophthalmology, we use the Zeiss/Humphrey visual field analyzer to determine the amount of any peripheral vision loss through computer analysis.
  • Digital optic nerve photos
    Baseline and serial photographs of the optic nerve also help to determine any changes in the optic nerve appearance from death to the optic nerve fibers. We use the latest technology consisting of a camera to take the photographs, which enables the use of computer data analysis to enhance our interpretation of the photos.
Glaucoma can be treated successfully in many ways. Initial treatment for open angle glaucoma typically consists of either drops or laser (see section below on SLT) to lower the intraocular pressure. Treatment for angle closure or impending angle closure glaucoma is surgical, using a different laser (YAG) to create a hole in the periphery of the iris to open up the angle, thereby allowing fluid to drain. For your convenience, we have both the SLT and YAG lasers in our office.

Selective Laser Trabeculoplasty (SLT)
In times past, laser therapy for glaucoma carried certain risks because of tissue damage caused by the laser. Because of this, most ophthalmologists first started with eye drops to lower pressure, reserving the laser for cases where the pressure could not be controlled with the drops. While drops are, for the most part effective, there are some distinct disadvantages to these medications: the drops must be used regularly, are inconvenient, can cause side effects, and often are expensive. Now, a new laser, selective laser trabeculoplasty (SLT) does not produce the thermal burn damage seen with the previous laser. It is a safe, effective way to lower pressure and may reduce or eliminate a patient's dependency on eye drops. The procedure, which is covered by most health insurance plans, is quick and typically painless and is performed right in our office. For more information, please click on www.glaucomaSLT.com.

The goal of treatment is to prevent loss of vision or loss of field of vision. Damage that has already occurred cannot be reversed, but further damage can be prevented. Since most people with glaucoma experience no symptoms, an eye exam for glaucoma including specialized testing is the MOST important tool in preventing vision loss from the disease. The key to controlling glaucoma is catching it early.

Pleasant Valley Ophthalmology    11825 Hinson Road, Suite 103    Little Rock, AR 72212-3404
Office  501-223-3937    Fax  501-223-8656    disclaimer

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