By Nikhil Wagle, MD, Eye Surgeons Associates
In the
U.S., more than 2 million individuals are estimated to be living with
glaucoma, and that number is expected to increase by 50 percent, to more
than 3 million, by 2020. Glaucoma is an eye disease typically
characterized by elevated pressure in the eye that causes damage to the
optic nerve and defects in the field of vision. The increase in eye
pressure is caused by a reduction in the ability of fluid to drain from
the eye. The cause of this blockage is unknown. However, as eye pressure
increases, nerve cells, which carry the information we require to see,
are damaged and gradually begin to die. As these nerve fibers or cells
die, loss of vision begins. Usually, peripheral vision or “side” vision
is lost first. This often goes unnoticed. Ultimately, central or reading
vision is affected. Blindness caused by glaucoma occurs in thousands of
people every year and is the most common cause of blindness in
African-Americans.
Glaucoma can develop at any age in life from
infancy through late life. However, it most often affects those 45 years
of age or older. Groups at increased risk include: people who have a
family history of glaucoma, African and Hispanic Americans, people who
have diabetes, hypertension, myopia (nearsightedness), poor ocular
circulation, a previous eye injury, people who have used
steroid/cortisone medications on a long-term basis and especially people
with elevated intraocular pressure.
Regular dilated eye
examinations are required for early detection of glaucoma. When detected
early, treatment can generally control glaucoma and prevent loss of
vision. During the exam, a painless test to measure eye pressure is
performed. The structures of the eye are examined including the optic
nerve. Additionally, tests can be done to detect damage to the field of
vision. Visual field tests measure light sensitivity of your eye. Damage
to the optic nerve caused by glaucoma produces a distinct pattern of
visual field loss. Doctors can use the visual field to detect and follow
the course of glaucoma over time.
Some patients can develop
glaucoma without ever having a high pressure. In other cases,
individuals with elevated eye pressures may never develop glaucoma.
Clearly, there are other factors than eye pressure that play a part in
the development of disease. The only way to determine if your eye
pressure is “normal” for you is by a thorough eye examination and
monitoring.
Because glaucoma is a painless disease in most cases,
patients are frequently unaware that they have a problem until
significant visual loss has already occurred. It has been estimated that
fully half of all those with glaucoma are unaware of their diagnosis.
Unfortunately, visual loss caused by glaucoma is irreversible.
Current
treatments include topical and/or oral medications, laser surgery, or
conventional surgery. The newest treatment for mild to moderate open
angle glaucoma is the iStent Trabecular Micro-Bypass. Inserted in
conjunction with cataract surgery, the iStent works like stents to
prevent heart attacks and strokes. It creates a permanent opening
through the blockage to improve the eye’s natural outflow. Based on the
discretion of your doctor, this may reduce the number of glaucoma
medications needed. The goal is to lower the eye pressure to help
prevent further damage. Research is looking at the genetics of glaucoma,
as well as examining certain neurotransmitters to determine the cause.
Hopefully, this research will help identify the cause of glaucoma and
improve methods of detection and treatment of this insidious and
devastating disease.
Nikhil Wagle, MD, with Eye Surgeons
Associates, is board-certified with a fellowship in Glaucoma. He sees
patients in our Silvis, Rock Island, Muscatine, and Bettendorf offices.
For more information, visit www.esaeyecare.com.