Preventing Vision Loss from Glaucoma (Part One)

Out of all the major eye diseases, glaucoma is as harmful as any, and it can certainly take you by surprise. To put it in perspective, think of glaucoma like a heart attack. You can go a long time without thinking or feeling anything is wrong, then one day it hits you. And when it does, it’s too late to reverse the damage.

As an eye care provider, my personal experience in treating glaucoma has been nothing short of an eye opener. Some of my hardest days at work were early in my career. Since I’m only human, it would break my heart to meet older patients caught in glaucoma’s grip. Some would often fall down, others would miss the curbs when walking, almost all would tell me they didn’t feel safe while driving a car. Other complications were much worse.

After finishing an exam and going over the findings, many of these patients were extremely surprised to hear the diagnosis of advanced glaucoma. Even worse, some would tell me it was their very first eye exam, which would nearly bring me to tears (again, I’m only human). From my standpoint, I could’ve helped to slow the disease if I’d seen some of these patients earlier. But now there was nothing I could do. When glaucoma reaches advanced stages, it’s too late. This is why early detection is so important. After a few of these experiences, I began to understand the need for more public awareness.

What is Glaucoma?

According to the Glaucoma Research Foundation, “Glaucoma is a complicated disease in which damage to the optic nerve leads to progressive, irreversible vision loss. There are typically no early warning signs or painful symptoms of open-angle glaucoma. It develops slowly and sometimes without noticeable sight loss for many years.”

In my opinion, glaucoma is “complicated” because most people never see it coming. On top of that, it’s hard to give a reasonable explanation when glaucoma takes effect. Furthermore, I’m sure it’s quite painful to experience the reality of permanent vision loss from a patient standpoint. Just like most good things in life, we don’t know what we’ve lost until it’s gone.

The main types of glaucoma can be categorized as follows:

• Open-angle glaucoma
• Low-tension or normal-tension glaucoma
• Angle-closure glaucoma
• Congenital glaucoma
• Traumatic glaucoma
• Neovascular glaucoma
• Pigmentary glaucoma
• Pseudoexfoliation glaucoma

In most glaucoma cases, the damage to the optic nerve is a result of fluid build-up, which increases the pressure of the eye. If enough damage is done, vision loss is the result.

Facts & Statistics:

The following facts and statistics have been compiled by the Glaucoma Research Foundation:

• Glaucoma is the second leading cause of blindness in the world, according to the World Health Organization
• It accounts for over 10 million visits to physicians each year
• It is estimated that over 3 million Americans have glaucoma, but only half of those know they have it
• In the U.S., more than 120,000 are blind from glaucoma, which accounts for 9 to 12 percent of all cases of blindness
• In terms of Social Security benefits, lost income tax revenues, and health care expenditures, the cost to the United States government is estimated to be over $1.5 billion annually

Even though the end result of glaucoma is permanent vision loss, the worst case scenario doesn’t always have to manifest itself. If caught early enough through routine eye examinations, the bulk of major complications can be avoided. That said, it pays to take your eye doctor’s advice seriously. If a particular plan of action is recommended by your eye doctor, it should be followed to the tee.

Risk Factors & Symptoms:

When vision loss from glaucoma starts, it’s usually in the far peripheral field of vision. Narrow-angle glaucoma is diagnosed if an angle closure attack takes place. This is a very painful red-eye situation which triggers an immediate visit to the eye doctor. Angle-closure glaucoma, which is a result of acutely increased eye pressure, also must be treated immediately to prevent permanent vision loss.

Because there are few symptoms that warrant a trip to the doctor’s office in its early stages, glaucoma is known as a “silent eye disease.” However, there are several warning signs that I monitor. The goal is to diagnose and start treatment for the disease before any vision loss can occur. These warning signs include the following:

• Increased eye pressure
• Increased optic nerve size in either eye
• Significant difference between the optic nerve size in either eye
• Thinner than average corneal thickness
• History of trauma to the eye(s)

I also take age, family history, and certain medications into account.

In part two of my series on preventing vision loss from glaucoma, I’ll talk about diagnosis, treatment options, and prevention tips.