Grappling with Glaucoma

Your vision is cloudy and you can’t see things on the side. You may have some light sensitivity and your eyes tear like nobody’s business. You could be looking at glaucoma.

Glaucoma is a group of eye disorders that can lead to progressive damage to the optic nerve. People who experience glaucoma can lose nerve tissue and eventually suffer vision loss. In most cases, fluid builds up in the front part of the eye. The extra fluid puts pressure on the eye, gradually damaging the optic nerve. Often the condition can be hard for the average person to detect until it becomes more severe.

Glaucoma is the second leading cause of blindness worldwide, according to the Centers for Disease Control and Prevention. While vision loss can’t be recovered with this condition, further loss can be slowed down with early detection. About 3 million Americans have glaucoma. Glaucoma occurs at a higher rate among blacks compared with whites. Glaucoma tends to run in families.

There are several types of glaucoma. Open-angle glaucoma is the most common. The drainage angle formed by the cornea and iris remains open, but the trabecular meshwork (a tissue at the angle where the iris and cornea meet) is partially blocked. This causes pressure in the eye to gradually increase. The pressure damages the optic nerve.

Angle-closure glaucoma happens when the iris bulges forward to narrow or block the drainage angle formed by the cornea and iris. As a result, fluid can’t circulate through the eye and pressure increases. Some people have narrow drainage angles, which puts them at risk for this type of glaucoma. Angle-closure glaucoma can happen suddenly (acute angle-closure glaucoma) or gradually (chronic angle-closure glaucoma). Acute angle-closure glaucoma is serious and requires medical intervention.

Symptoms with angle-closure glaucoma include eye pain or pressure, headaches, seeing rainbow colored halos around lights, low vision or blurred vision or tunnel vision, nausea and vomiting, and red eyes.

With normal-tension glaucoma, your optic nerve becomes damaged, even though your eye pressure is in the normal range. No one knows the cause of this particular type of glaucoma. This limited blood flow to the optic nerve could be caused by atherosclerosis which is the buildup of fatty deposits (plaque) in the arteries or other conditions that impair circulation.

Even children can get glaucoma. It may be present at birth or develop within the first few years of life. The optic nerve damage may be caused by drainage blockages or an underlying medical condition.

In pigmentary glaucoma, pigment granules from your iris build up in the drainage channels, blocking fluid leaving your eye. Activities such as running or jogging sometimes stir up the pigment granules, depositing them on the trabecular meshwork and causing intermittent pressure elevations.  

Risk factors for glaucoma include having high internal eye pressure (intraocular pressure); being over age 60; being black, Asian, or Hispanic; having a family history of glaucoma; having certain medical conditions such as diabetes, heart disease, high blood pressure, or sickle cell anemia; having corneas that are thin in the center; being extremely nearsighted or farsighted; having had an eye injury or certain types of eye surgery; and taking corticosteroid medication, especially eye drops for a long time.

To diagnose glaucoma, your doctor will run several types of tests like a tonometry which measures intraocular pressure and a test for optic nerve damage through a dilated eye examination and imaging tests. A visual field test will check for areas of vision loss. A pachymetry measures corneal thickness. A gonioscopy inspects the drainage angle.

Glaucoma is treated by lowering the eye pressure or intraocular pressure. Depending on your diagnosis, you can have a choice of prescription eyedrops, oral medications, laser treatment, surgery or a combination of any of these.

Prescription eyedrops can help decrease eye pressure by improving how fluid drains from the eye or by decreasing the amount of fluid your eye makes. Prescription eyedrops include prostaglandins (work by increasing the outflow of the fluid in your eye and relieve eye pressure) like latanoprost (Xalatan) and beta blockers (reduces the production of fluid in your eye and lowering the pressure) like timolol (Betimol).

Alpha-adrenergic agonists reduce the production of aqueous humor and increase the outflow of fluid in your eye. Carbonic anhydrase inhibitors, rho kinase inhibitors, and miotic or cholinergic agents are some other types of eyedrops that may be recommended by your doctor. Please note that some of these eyedrops carry potential side effects such as irregular heart rate, high blood pressure, fatigue, red or itchy eyes, and dry mouth.

If eyedrops are not enough to bring down the eye pressure, your doctor may suggest oral medication such as carbonic anhydrase inhibitor. Possible side effects may include frequent urination, tingling in the fingers and toes, depression, stomach upset, and kidney stones.

Then there is surgery as an option if needed like laser surgery or other kinds of procedures. Laser trabeculoplasty is a choice for those with open-angle glaucoma. Filtering surgery, installing drainage tubes, and minimally invasive glaucoma surgery are some examples of procedures that may be recommended.

Some lifestyle recommendations may be necessary to heal successfully from glaucoma. Eating a healthy diet, exercising regularly, limiting your caffeine, sipping fluids frequently, sleeping with your head elevated, and taking prescribed medicine are just some ways to improve your condition.

A natural remedy that has been tried for glaucoma is bilberry extract but results are inconclusive whether it actually works or not. Relaxation techniques are highly suggested especially for those who suffer from acute angle-closure glaucoma where it is important to keep stress at bay. Some research shows that marijuana may be useful in lowering eye pressure for those with glaucoma but only for a limited time like three to four hours. But the American Academy of Ophthalmology doesn’t recommend marijuana for treating glaucoma.

The best way to combat glaucoma is to have scheduled eye exams at least once a year after age 40. Sooner if it runs in your family. Discuss with your doctor the best course of action for you.