Glaucoma
Glaucoma is often referred to as the "silent thief of sight," and is the second most common cause of blindness in the United States. Glaucoma causes vision loss by affecting the optic nerve, the part of the eye which receives images collected by the retina and sends them to the brain. Every eye maintains a certain amount of internal pressure, called intraocular pressure. When this pressure rises to abnormal levels, it can put extra stress on the optic nerve, causing significant damage. Optic nerve damage results in loss of vision, and ultimately blindness.
Glaucoma can occur suddenly, or be present for a long period of time. If you are noticing vision changes or have a family history of glaucoma, request an appointment or call (928) 782-1980 to speak with one of our eye care professionals about glaucoma surgery in Yuma, Arizona.
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What causes glaucoma?
Glaucoma is a group of eye conditions which lead to damage to the optic nerve, which carries visual information from the eye to the brain. In many cases, but not always, the damage is caused by increased pressure of the fluid in the eye, also called intraocular pressure (IOP). A healthy eye will continually produce small amounts of this fluid to ensure consistent pressure within the eye. When normal drainage becomes slowed or blocked, the fluid in the eye builds up and that pressure can cause damage to the optic nerve.
What are the different types of glaucoma?
The two main types of glaucoma are open-angle glaucoma and closed-angle glaucoma.
Open-angle glaucoma accounts for 90% of the glaucoma cases in the United States. It occurs most often with an increase in eye pressure over a period of time. It is painless and there are normally no symptoms in the early stages. As the disease progresses, however, some may experience deteriorating peripheral vision or blank spots. If untreated, open-angle glaucoma can cause blindness.
Closed-angle glaucoma accounts for the other 10% of cases, occurs suddenly, and is accompanied by pain. This condition occurs when the exit channels for the fluid in the eyes are suddenly blocked, causing an immediate rise in the pressure of the eye. Fortunately the discomfort usually causes the affected person to seek prompt medical attention and treatment may be obtained before permanent damage can occur.
How is glaucoma diagnosed?
Checking eye pressure is not enough to diagnose glaucoma because the eye pressure changes. In fact, about 25% of people who have glaucoma have normal eye pressure. A diagnosis is made by an eye care specialist, who will look into the back of the eye at the optic nerve. In addition, there are many diagnostic tests that aid in the diagnosis of glaucoma. It is important to note that your eye doctor can detect changes in the optic nerve before problematic symptoms arise.
Am I at risk?
Risks for open angle glaucoma include:
- Advanced age
- Family history of the disease
- Higher-than-normal intraocular pressure
- Certain ethnicities, particularly those of African or Hispanic descent
- Certain diseases or conditions, especially diabetes, farsightedness or nearsightedness, or previous eye trauma or surgery.
Closed-angle glaucoma is less prevalent, but occurs rapidly and should be treated as an emergency. Symptoms of closed-angle glaucoma include:
- Severe eye pain
- Headache
- Blurred vision
- Nausea or vomiting
- Rainbow halos around lights
High risk factors for closed-angle glaucoma include:
- Extreme farsightedness
- An iris that is abnormally large or far back in the eye
- Advanced age
- Heredity
- Certain ethnic races, especially Asian
What treatments are available?
Various types of surgery are available for glaucoma. For acute-angle-closure glaucoma, emergency medical and surgical treatment is required to prevent immediate loss of sight. For chronic glaucoma, treatments range from various medications to laser treatment or traditional surgery.
Medications
Many people successfully manage their glaucoma through medication. One option is medication such as prescription eye drops which help to reduce intraocular pressure. There are also pills called carbonic anhydrase inhibitors which slow down fluid production within the eye.
Laser Treatments
- Argon Laser Trabeculoplasty (ALT)
A laser is used to treat the trabecular meshwork, the natural drainage apparatus of the eye. This is done in the office using topical anesthesia and takes only several minutes. This procedure typically gives a 25% reduction in intraocular pressure in approximately 80% of people treated. The procedure is not permanent in most cases, having lost effectiveness in 50% of patients after 5 years.
- Selective Laser Trabeculoplasty
The procedure is done in nearly the same way as argon laser trabeculoplasty, but only very specific wavelengths are used for treatment. Proponents contend that this treatment may be repeated an indefinite number of times, but this has yet to be proven. The effects are approximate to ALT.
- Peripheral Iridectomy
This laser treatment involves placing a tiny hole in the peripheral iris. This is done to treat or prevent angle-closure glaucoma.
Surgical Options
- Trabeculectomy
This is considered the "gold standard" of glaucoma surgery by most glaucoma surgeons. Trabeculectomy involves creation of a drainage canal from inside the eye to the surrounding structures. It is effective in up to 90% of cases in reducing eye pressure to normal values. Unfortunately there are significant risks of infection and other complications with this surgery.
- Glaucoma Valve
This procedure uses an external drainage valve to shunt fluid from the inside of the eye to the external structures. The success rates and complications of glaucoma valve are very similar to that of trabeculectomy.
- Trabectome
Trabectome is one of the newest innovations in glaucoma surgery and involves creating an opening in the natural drainage canal, the trabecular meshwork, to normalize pressure in the eye. This is a minimally invasive procedure and has a very high success rate with minimal complications. The Aiello Eye Institute is one of the few places in the country where this procedure is offered. Dr. Aiello is one of the country's most experienced trabectome surgeons.
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