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Glaucoma refers to a group of eye conditions that damage the optic nerve, which is the nerve that connects your eye to the brain. This damage is usually caused due to abnormally high pressure in your eye (intraocular pressure). If the damage worsens, glaucoma can cause permanent vision loss within a few years. According to the Centers for Disease Control and Prevention (CDC), glaucoma is the second leading cause of blindness worldwide. And about three million Americans have glaucoma.

Most forms of glaucoma come with no warning signs, so you may not notice a change in vision until the condition has reached an advanced stage. Since vision loss due to glaucoma is irreversible, it is crucial to have regular eye exams to diagnose the condition early and protect against loss of vision.  

Causes of Glaucoma

Glaucoma can occur at any age but is most common among adults in their 70s and 80s. As mentioned above, glaucoma is caused by optic nerve damage that gradually leads to blind spots in your visual field. For reasons experts don’t completely understand, this nerve damage is often related to increased pressure in the eye. 

A healthy eye constantly produces aqueous humor, a clear, water-like fluid inside the front part of your eye. As new aqueous fluid flows into your eye, the same amount has to drain out. This fluid drains out through the trabecular meshwork tissue that helps keep eye pressure stable. But if the fluid is overproduced or the drainage system doesn’t work properly, the fluid builds up in the eye, increasing intraocular pressure and damaging the optic nerve. 

Developmental Glaucoma 

Glaucoma in babies, young children, and teenagers is referred to as developmental glaucoma. It can be primary or secondary, meaning it develops independently or as a result of another disease or abnormality. Like adult glaucoma, this diagnosis implies that some degree of optic nerve damage has already occurred. However, the degree is not always severe, and early detection and treatment can often halt the progression and maintain visual acuity.

Unlike adult glaucoma, children’s glaucoma generally has noticeable symptoms, making it easier to detect. However, developmental glaucoma usually worsens much faster and does not react well to nonsurgical treatment. Also known as childhood or pediatric glaucoma, this condition can be divided into two types: congenital glaucoma and juvenile glaucoma.

Congenital or infantile glaucoma is glaucoma that affects babies and children under three. When glaucoma strikes a child after the age of three, it is called juvenile glaucoma. When glaucoma occurs in older children or young adults, it is known as early-onset glaucoma.

The number of children with primary congenital glaucoma varies by country. However, it is not as common as primary open-angle glaucoma in adults. According to the Glaucoma Research Foundation (GRF), around one out of every 10,000 children are born with this condition in the United States. And juvenile or early-onset glaucoma is even more uncommon. According to recent data released by the American Academy of Ophthalmology (AAO), the prevalence of this condition in people between the ages four and 20 ranges from 0.38 to 2 in 100,000.

Types of Glaucoma in Adults

There are many types of glaucoma, but the most common is primary open-angle glaucoma and angle-closure glaucoma. 

• Primary open-angle glaucoma (wide-angle glaucoma) – The most common type of glaucoma in adults. This condition is caused by the drainage angle formed by the cornea and iris remaining open, but the trabecular meshwork is partially blocked. This blockage then causes a buildup of pressure in the eye, damaging the optic nerve. Open-angle glaucoma occurs so gradually that you may lose vision even before you’re aware of the problem.
  

• Angle-closure glaucoma (closed-angle glaucoma) – This type of glaucoma occurs when the iris swells forward and blocks the drainage angle, interrupting fluid circulation throughout the eye and increasing eye pressure. Angle-closure glaucoma can occur suddenly (acute angle-closure glaucoma) or gradually (chronic angle-closure glaucoma). Acute angle-closure glaucoma can result in total blindness without immediate medical care.
  

Less common types of glaucoma include:

• Normal-tension glaucoma – People with normal-tension glaucoma have normal eye pressure but still show signs of glaucoma, including blind spots in their field of vision and optic nerve damage. The exact cause for this type of glaucoma remains unknown, but research shows that reducing eye pressure can help slow down the disease and prevent vision loss.
  

• Pigmentary glaucoma – This form of secondary glaucoma occurs when tiny bits of pigment from your iris flakes off and clogs the drainage canals. Activities such as jogging can sometimes stir up the pigment granules, depositing them on the trabecular meshwork and causing elevated eye pressure.
  

Symptoms of Glaucoma 

Glaucoma doesn’t usually have any noticeable symptoms during the initial stage. It tends to develop over many years gradually and affects your peripheral vision first. And this is why most people do not realize they have glaucoma until it is detected during a routine eye exam. 

The most noticeable symptoms of glaucoma include blurry vision or halos around lights. Although these symptoms generally affect both eyes, they can be much worse in one eye. 

Open-angle glaucoma may produce symptoms such as:

• Patchy blind spots in your peripheral or central vision, frequently in both eyes
• Tunnel vision in the advanced stages

Acute angle-closure glaucoma can occur suddenly and cause symptoms such as:

• Headache 
• Severe eye pain 
• Nausea and vomiting 
• Eye redness 
• Haloes around bright light 
• Blurred vision
• Tenderness around the eyes 

People exhibiting the above symptoms of an acute angle-closure glaucoma attack should immediately be checked by their ophthalmologist. 

Risk Factors for Glaucoma 

Anyone can develop glaucoma, but some are more likely than others. Because chronic glaucoma can cause vision loss before any symptoms or signs appear, be aware of the following risk factors:

• Having high internal eye pressure 
• Being over the age of 60
• African American, Irish, Hispanic or Asian descent 
• Have a family history of glaucoma 
• Are severely nearsighted or farsighted
• Have poor vision 
• Have certain medical conditions, such as heart disease, diabetes, high blood pressure, and sickle cell anemia
• Long-term use of steroid medications 
• Have previously had an eye injury or any eye surgery
• Have corneas that are thin in the center 

Talk to an ophthalmologist about your risk for glaucoma and ask how often you need to get checked. People with a high risk of developing glaucoma need to get a comprehensive eye examination every one to two years. 

Glaucoma Diagnosis 

The only foolproof way to diagnose glaucoma is through a complete eye exam. A glaucoma screening that only checks eye pressure is usually not enough to detect glaucoma. Glaucoma tests are simple and painless. Your doctor will administer some eye drops to dilate your pupils and check your eyes for glaucoma or any other eye issues. In addition, your doctor will also:

• Measure your eye pressure
• Inspect your eye’s drainage angle 
• Examine your optic nerve for any signs of damage 
• Assess your peripheral vision 
• Take a picture or digital measurement of your optic nerve 
• Assess your cornea’s thickness 

If the glaucoma test suggests you have an eye disease, you will be asked to consult a  glaucoma specialist to discuss treatment. 

Glaucoma Treatment 

Glaucoma damage is permanent, and no treatment can undo any loss of vision that occurred before the eye condition was diagnosed. And while there isn’t a cure for glaucoma, treatment can help prevent further damage to vision.

To treat glaucoma, doctors may use one or more of the following treatments:

• Eye drops – Prescription eye drops are the most common form of treatment for glaucoma. These eye drops lower intraocular pressure by either reducing aqueous fluid production in your eye or increasing its flow out. Glaucoma medications can help keep your vision, but they may also cause a few side effects, including:
• Allergies
• Red eyes
• Stinging sensation in the eye
• Blurred vision 
• Irritated eyes 

Some medications can also interact with other substances and cause adverse reactions. Thus, ensure to inform your doctor about any other medical condition you have or medications you take. 

Inform your doctor if you experience any side effects from glaucoma medicines. 

• Laser treatment – To lower eye pressure, doctors can use lasers to help drain out the aqueous humor from the eye. These laser procedures are usually simple and can be performed in your doctor’s office or outpatient surgery center. The two main types of laser surgery to treat glaucoma include:
  

• • Trabeculoplasty – This laser surgery is for people who have primary glaucoma and can be used instead of or in conjuncture with glaucoma medications. The eye surgeon uses a laser to improve the function of the drainage angle, easing proper fluid flow out and reducing intraocular pressure.
  • Iridotomy – This invasive glaucoma surgery is for people with acute glaucoma. The eye surgeon uses a laser to create a small hole in the iris to help fluids flow to the drainage angle without disturbance and ease fluid pressure.

• Surgery – If medicines and laser treatment don’t work, your doctor may suggest surgery. Glaucoma surgery helps create a new drainage channel for the fluid to drain out of the eye and ease the ocular pressure. There are several types of glaucoma surgery, including:

• • Trabeculectomy – During this surgery, your doctor may create a tiny flap in the sclera and a bubble (filtration bleb) in the conjunctiva to allow aqueous humor to drain out of the eye through the flap and into the bleb. The fluid is then absorbed by the tissue around the eye in the bleb, lowering eye pressure.
  • Glaucoma implant surgery – Your ophthalmologist may implant a tiny drainage tube or shunt into the white part of your eye to help excess fluid drain out of the eye. The glaucoma drainage implant sends this excess fluid to a collection area called a reservoir, created by your eye surgeon beneath the conjunctiva, to be absorbed into nearby blood vessels.
  • Cataract surgery – For some people with narrow angles, removing the eye’s natural lens can help lower eye pressure. Since the iris and cornea are too close together with narrow angles and can block the eye’s drainage channel, removing the eye’s natural lens with cataract surgery can create more space for fluid to drain out from the eye.

Glaucoma Prevention 

Although glaucoma cannot be prevented, early detection and medical treatment can lower the risk of irreversible damage to the eye. Here are a few steps that may help protect your field of vision: 

• Get regular dilated eye exams – Regular eye examinations can help detect glaucoma early before any significant damage occurs. The American Academy of Ophthalmology (AAO) recommends having a comprehensive eye exam every five to ten years if you’re under 40; every two to four years if you’re between 40 and 54; every one to three years if you’re between 55 and 64; and every one to two years if you’re older than 65. And if you’re at a high risk of glaucoma, you may need more frequent screening. Ask your doctor for the right screening schedule if you are at risk of primary or secondary glaucoma.
  

• Follow your doctor’s instructions – If you exhibit high eye pressure readings during glaucoma exams, your doctor may prescribe you some eye drops or recommend other forms of treatment to prevent further damage from glaucoma.
  

• Exercise – Regular, moderate exercise can help prevent glaucoma by reducing eye pressure. Talk to your doctor about an appropriate exercise program.
  

• Wear eye protection – Serious eye injuries can lead to glaucoma. Wearing eye protection when using power tools or playing sports in enclosed settings is highly recommended.
  

Scientists are studying other possible glaucoma causes to detect and treat the condition better. The National Eye Institute (NEI) is also funding research on new treatment options for glaucoma patients. But in the meantime, people with glaucoma should commit to regular eye exams and follow advice from their health care provider to prevent the condition from leading to irreversible vision loss. 

Here at OOMC, our patient’s well-being is our priority. Our dedicated team of surgeons and staff always makes an effort to create a safe and secure environment where you can easily access care comfortably and confidently.

Contact one of our centers nearest to you for further information.

Phillips Eye Specialists

Corneal Associates of New Jersey

Kremer Eye Center

Omni Eye Services

Ludwick Eye Center