Glaucoma Treatment
If your doctor recently told you that you have glaucoma, you may be wondering what that means, what glaucoma treatment entails and how it can affect your sight. Glaucoma is a serious disease, but in most cases it can be diagnosed and controlled. The following information can help you learn more about glaucoma and what you can do in order to prevent further loss of vision and lead a normal life.
What is Glaucoma?
Fluid always flows through the inside of your eye but if you have glaucoma, the outflow is abnormal, or your eye produces too much fluid. As a result, the pressure inside your eye rises and it slowly destroys the delicate fibres in the optic nerve that send visual messages to the brain. As nerve fibres die, the optic disc changes. Nerve fibres that control side vision are damaged first. If your pressure remains high, it can eventually cause blindness.
OPEN ANGLE GLAUCOMA is the most common kind of glaucoma. Pressure inside the eye rises slowly and destroys vision gradually, starting with side vision. This usually causes no pain and there are no other warning signs. In some cases vision may be lost, even though pressure stays within a normal range.
CLOSED ANGLE GLAUCOMA is less common. Pressure inside the eye rises suddenly and must be lowered right away to prevent blindness. Severe pain and blurred vision can occur with an acute attack. A chronic form of closed angle glaucoma occurs more slowly and often without any symptoms.
OTHER KINDS OF GLAUCOMA can be linked to an injury or inflammation of the eye, a cataract (clouding of the lens of the eye), an eye tumour, advanced diabetes (high blood sugar), uveitis, or other genetic causes.
Who is affected by Glaucoma?
The major risk factor is age. Chronic Open Angle Glaucoma most often affects people over 40, but everyone over 35 should be tested at least every two years. You also have a higher risk of developing glaucoma if a close family member has had the disease or if you have high blood pressure or high blood sugar (diabetes). People who are very short-sighted are also at higher risk of developing glaucoma. If you are at risk for glaucoma, or if you have had an eye operation, you should have your eyes checked at least once a year.
How is Glaucoma diagnosed?
By taking your medical history
Because glaucoma is often hereditary, your eye doctor needs to know if other members of your family have the disease. You also need to tell your doctor about any medication you take and any medical conditions you have that could affect your eye pressure such as high blood sugar, high blood pressure, irregular heartbeat or lung disease.
By measuring your eye pressure:
An instrument called a tonometer, measures the pressure inside your eyes. Your doctor lightly touches a plastic prism to your eyeball while your eye is numbed with drops, so this should be painless. Sometimes your pressure may be measured by a tonometer that sends a puff of air onto the cornea.
By examining your optic disc
The inside of your eye is examined for changes in your optic disc. An enlarged optic disc or changes in the eye blood vessels indicate damage from pressure. An ophthalmoscope, which magnifies the back of your eye, is used to look through each pupil. Your pupils may also be dilated and pictures (fundus photographs) taken to record changes in your optic disc. The Heidelberg Retinal Tomograph is the most advanced way of scanning and documenting the optic nerve. This enables the ophthalmologist to pick up even very small changes in the optic nerve, and takes very accurate measurements of the cup/disc ratio, the cup depth and size, as well as other important data to monitor any changes of the optic nerve. It is necessary to have this test at least once a year.
By checking your drainage angle
The angle between the iris and cornea, where the drainage holes lie is examined. First you are given drops to numb your eyes. A lens (gonioscope), which contains a mirror to enable the doctor to see whether the drainage angle is open or closed, is placed onto your eye.
By testing your field of vision
A visual field test, called perimetry, tells whether you have lost any side, or peripheral, vision. You sit in front of a dome-shaped screen. One eye is covered while you look straight ahead with the other eye into the dome. Small lights flash inside this dome, and you have to respond by pressing a button every time you see a light flash. A printout map then shows your field of vision, and where any loss of visual field may be. It is necessary to have this test at least once a year.
By measuring your corneal thickness (Pachymetry)
The latest studies have shown that corneal thickness (pachymetry) is a special risk factor for developing optic nerve damage due to increased intra-ocular pressure. Corneal thickness determines the risk and prognosis of the glaucoma. A thin cornea (less than 500 microns) together with high pressure is a high risk factor.
How can vision loss be prevented?
An ophthalmologist (a medical doctor trained to treat eye diseases) treats your glaucoma. Your eye doctor can’t restore vision that has already been lost, but in most cases eye pressure can be lowered to prevent further loss of sight. Your glaucoma treatment depends on the kind of glaucoma you have and how it responds to medication. In some cases, your doctor may do glaucoma laser surgery or glaucoma eye surgery.
Glaucoma treatment goals
The only way to control pressure and prevent loss of vision is to either decrease production of fluid or increase drainage of fluid. To decrease production of fluid, eye drops or pills may be prescribed.
To increase drainage, eye drops, eye laser treatment, or surgery may be advised. The eye pressure must be lowered as quickly as possible to prevent any further loss of vision.
Caution
Once your eye pressure is under control, you still need to take medication. If you stop using your medication, your eye pressure will rise and may result in damage of the optic nerve and loss of vision.
How is Glaucoma treated?
Eye drops and pills are the most commonly used glaucoma treatments. Both go into your bloodstream, so they can cause side effects. Discuss the possible side effects of your medication with your doctor and be sure to report any symptoms right away (such as depression, redness of the eyes or itchiness of the eyes).
1. Eyedrops
Most people can use this glaucoma treatment without any side effects, but eye drops can cause headaches, eye irritation, blurred or dimmed vision, and other symptoms.
How to use eye drops:
- Sit down and tilt your head back, or lie down with your head flat and look at the ceiling.
- Make a pocket in your lower lid by pulling it down with your index finger, or pull your lower lid out gently between your thumb and your index finger.
- Look up and squeeze one drop into your lower lid. Then close your eye. Do not blink or wipe your eye or touch the tip of the bottle to your eye or face.
- Keep your eye closed for two to three minutes to ensure good absorption.
- Press on the lower lid tear duct (against the nose bridge) for two minutes.
2. Pills
Sometimes pills are used along with other eye drops as Glaucoma treatment. It is usually taken two to four times a day. Most people can take pills without any side effects, but some people suffer from tingling in their fingers and toes, nausea, loss of appetite, drowsiness, and bowel problems.
3. Laser Treatment
Sometimes eye pressure can't be controlled with eye drops and pills, or these medications cause side effects. In such cases glaucoma laser surgery (called a trabeculoplasty) is recommended. In some cases, laser treatment may be used even before eye drops or pills are tried.
Opening the drainage holes:
During a trabeculoplasty, the clogged drainage holes are opened with a laser. The laser is a beam of energy that can be focused to a tiny point. Your eye doctor aims the laser at precise spots around the outer edge of your iris. Each burst of laser energy stretches the tissue to open the clogged holes and allow fluid to drain freely.
Your Laser experience:
First your eye is numbed with drops. From a sitting position you rest your chin on a stand in front of the laser, and a special lens is placed on your eye. You need to remain very still while the laser is aimed through the lens. The glaucoma laser procedures takes only a few minutes. Your vision may be slightly blurred at first, but you should be able to get back to your normal routine within a few hours. After glaucoma laser treatment, you may need eye drops or pills to help control your pressure.
4. Surgery
Sometimes medication and laser treatment can't control your pressure, or laser treatment isn't recommended for you. In such a case a glaucoma procedure called a trabeculectomy is suggested. It is also recommended if your disease is progressive, if you have too many medications to take, or if you have too many side effects from medication. You’re awake, but your eye is numbed so you shouldn't feel any pain during surgery.
Making a new drain:
During glaucoma eye surgery, a new drain is made in your eye so that fluid can bypass the clogged drainage holes. Your doctor looks through a powerful microscope placed several inches above your eye. Using very small instruments, the doctor makes a flap in the sclera, or white part of the eye. Then a tiny hole is made under this flap. This new opening allows fluid to drain freely.
Your experience during surgery:
During glaucoma eye surgery your eye is numbed with drops. Then you lie down under the microscope. The surgery usually takes about an hour. You can go home shortly afterward, but you should plan to rest that day. You'll have medication and a patch over the eye to keep it clean and dry, and you'll need to come back the next day to have your eye checked. Once your eye heals you may need eye drops or pills to help control your pressure.
Collagen drainage implant:
A new form of glaucoma eye surgery which has proven to be highly successful is the implantation of a collagen implant underneath the trabeculectomy flap. The eye is not entered. This means you can already see fairly well directly after the operation. Other implants include the Ahmed valve and Mini Xpress implant. Dr. Krüger has a lot of experience in this field and has been doing this type of surgery since 1989.
Your role is to
1. Use medication exactly as directed, even after your pressure is under control.
2. Make, and keep regular appointments with your eye doctor.
- Once you have been diagnosed with Glaucoma, or if you are considered a Glaucoma suspect, it is important to have your intra-ocular pressure measured every four months.
- A visual field test must be performed at least once a year, to monitor any changes in your peripheral vision.
- A Heidelberg Retinal Tomography must be performed at least once a year to document any changes of the optic nerve.
3. Tell your doctor if you have any side effects, notice any change in your vision, or forget to take your glaucoma treatment medication.
4. Ask family members or friends for help. Talk to others who have glaucoma. Do not let yourself feel alone.
Your doctor's role is to
1. Recommend the best glaucoma treatment that best suits your requirements and adjust your treatment as your condition changes or new treatments become available.
2. Diagnose your glaucoma and detect any damage to your optic nerve.
3. Continue to check your eye pressure, your optic nerve, your vision, and your drainage angle.
Tips to help you
1. Make sure you understand exactly how and when to take your medication. Learn the name and dosage of each eye drop or pill and what it does.
2. If you forget to take any glaucoma medication, take it as soon as you remember. Do not wait until the next regular time.
3. Wherever you go, always carry your glaucoma medication with you. Take an extra supply when you travel.
4. Tell all your doctors that you have glaucoma and give them a list of your glaucoma medications. This can help prevent interactions with other medications you take.
5. When you buy over-the-counter drugs, read the label. Check with your eye doctor if the label says that anyone with glaucoma shouldn't take this medication.
Looking ahead
Although Glaucoma can't yet be prevented or cured, new medication and treatments are continuously being tested. Right now, you can help save your sight and continue to do the things you enjoy by taking your medication and seeing your eye doctor regularly.
Summary
- Once you have been diagnosed with Glaucoma, or if you are considered to be a Glaucoma suspect, it is important to have the intra-ocular pressure checked every four months.
- A visual fields test must be performed at least once a year to monitor any field loss or changes in your peripheral vision.
- A Heidelberg Retinal Tomography must be performed at least once a year to document any changes of the optic nerve.
- It is very important to use your eye drops exactly as prescribed by your ophthalmologist to prevent any further deterioration in your vision or peripheral visual field loss.
