Glaucoma is an eye disease in which the optic nerve is damaged in a characteristic pattern. This can permanently damage vision in the affected eye(s) and lead to blindness if left untreated. It is normally associated with increased fluid pressure in the eye (aqueous humour). The term “ocular hypertension” is used for people with consistently raised intraocular pressure (IOP) without any associated optic nerve damage. Conversely, the term ‘normal tension’ or ‘low tension’ glaucoma is used for those with optic nerve damage and associated visual field loss, but normal or low IOP.
The optic nerve is made up of over 1.2 million axons (individual nerve fibers). It serves as a relay between the retina and the brain. The retina absorbs the external light waves and transmits them via the optic nerve to the brain.
Primary Open Angle Glaucoma is the 2nd leading cause of blindness in the US.
The most common form of glaucoma is primary open-angle glaucoma. However there are other types including congential glaucoma,low tension glaucoma, angle closure glaucoma, and the broad category of secondary glaucomas. Secondary glaucoma includes for example: pigmentary glaucoma, neovascular glaucoma and steroid induced glaucoma.
How does glaucoma cause vision loss?
glaucoma initially causes no symptoms, but loss of side vision (peripheral vision)
Gender Acute angle closure glaucoma has been reported more often in women than men. Studies have shown that women have more shallow anterior chambers than men.
Age The anterior chamber decreases in depth and volume with age. These changes predispose to papillary block.
Inheritance (Genetics) Congenital (CYP1B1 gene); positive Family history (TIGR/myocilin gene (MYOC) on chromosome 1)
Increased Cup to Disc Ratio
Thinner Central Corneal Thickness (< 550um)
Other factors may include
diabetes mellitus Type 2, myopia, hypertension, migranes, trauma, sickle cell disease, uveitis, corticosteroid use, post retinal detachment, intraocular tumors, retinal or ocular ischemia(i.e. vein occlusions)
Important to have a complete eye examination for early detection and thus optimize and preserve vision.
Recommend: An annual eye examination every two years prior to age 40 and annual after age 40.
The American Academy of Ophthalmology (AAO) recommends screening for glaucoma as part of the comprehensive adult medical eye evaluation, starting at the age of 20, with a frequency depending on an individual’s age and other risk factors for glaucoma.
Primary treatment is surgical and may also require topical medications
Primary treatment: Pharmacologic (Medications:Topical Eye Drops)
Laser Treatment (i.e. Selective Laser Trabeculoplasty, Laser Iridotomy)
Cyclophotocoagulation: laser treatment of the ciliary body
Surgery: Surgical Iridectomy,Trabeculetomy/Drainage Implants(Setons/Tubes)
At the Massachusetts Eye Research and Surgery Institution (MERSI) we are using the latest and most sensitive technology to monitor the optic nerve in an effort to preserve vision as well as cutting edge treatment modalities.
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