Understanding Glaucoma |Causes, Symptoms, and Treatment

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Glaucoma

Glaucoma is a common eye condition and is a major cause of blindness globally. It encompasses a range of eye conditions where there is progressive damage to the optic nerve and permanent impairment of vision. Glaucoma is commonly associated with an elevated intraocular pressure and signs of optic nerve damage. These signs can be detected with an eye examination but may not cause symptoms until the Glaucoma is severe. Regular eye examinations play a crucial role in early detection and long-term monitoring of Glaucoma, allowing early treatment and prevention of potential vision loss.

What Causes Glaucoma?

In most people with glaucoma there is no underlying cause.

There are factors that can increase your risk of developing Glaucoma. These include:

High eye pressure
Increasing age
Family history of Glaucoma
Myopia (short sightedness)
Previous eye trauma
Certain medications (including steroids)
Some underlying eye conditions, including inflammation and increased cataract development

What are the Types of Glaucoma?

There are many types of Glaucoma. The most common types include:

Primary open-angle Glaucoma

This is the most common type of Glaucoma, where the drainage canals in the eye become less efficient over time, leading to increased intraocular pressure

Closed-angle Glaucoma (including emergency acute closed-angle Glaucoma)

This occurs when the iris blocks the drainage canal in the eye, resulting in a sudden increase in intraocular pressure. This can be chronic or acute and require urgent medical treatment.

Normal tension Glaucoma (NTG)

In NTG damage to the optic nerve and loss of vision occurs, even though the intraocular pressure is within a normal range.

Other less common types of Glaucoma include, Congenital Glaucoma, Pigmentary Glaucoma, Secondary Glaucoma and Pseudoexfoliative Glaucoma.

Glaucoma Diagnosis

Glaucoma often has no symptoms in the early stages and regular eye examinations are crucial for early detection. High eye pressure and optic nerve damage can be detected during a routine eye examination. Other diagnostic tests for Glaucoma may include scans to evaluate the optic nerve and performing visual field tests to assess peripheral vision. Early diagnosis allows for timely intervention and better preservation of vision. At Nexus Eyecare, we pride ourselves on having the latest technologies to optimise early detection of Glaucoma.

What are the Symptoms of Glaucoma?

In most cases, Glaucoma has no symptoms until the disease is severe. This is why Glaucoma is often referred to as the ‘sneak thief of sight’. There is usually no eye pain. The peripheral vision is affected first and central vision loss causing noticeable visual impairment occurs later. This vision loss is permanent and will not improve with treatment, hence the need for early detection and treatment to slow down the rate of progression.

Less commonly, if the eye pressure increases rapidly in cases such as acute angle-closure Glaucoma, symptoms may include blurred vision, haloes, eye pain, eye redness and headache. This is an emergency and an eye assessment is required urgently.

Who is at Risk of Glaucoma?

There are various factors that can increase your risk of developing Glaucoma these include:

High eye pressure
Increasing age
Family history of Glaucoma
Being very long or short sighted
Having Diabetes, high blood pressure or other health conditions
Being of African or Asian heritage
Previous eye trauma
Certain medications (including steroids)
Some underlying eye conditions, including inflammation and increased cataract development

Having multiple risk factors increases the chance of developing Glaucoma.

Glaucoma Treatment

The treatment for Glaucoma involves lowering eye pressure to slow down the rate of vision loss. Treatment cannot reverse vision loss that has already occurred. Your surgeon at Nexus Eyecare will discuss numerous treatment options including eye drops, laser, and surgery.

Eye Drops

Eye drops are one of the initial Glaucoma treatment options, particularly in the early stages. These medicated eye drops help to lower intraocular pressure by either reducing the production of fluid in the eye or improving its drainage. It is essential to use the prescribed eye drops regularly and as directed by your ophthalmologist. Some eye drops may have side effects and interact with your other medications. Your Eye Specialist at Nexus Eyecare will discuss these with you.

Selective Laser Trabeculoplasty (SLT)

Glaucoma laser trabeculoplasty is an alternative initial treatment to lower eye pressure. SLT is a minimally invasive procedure used to treat some types of Glaucoma. It involves using a laser to heat the drainage angle in the eye’s trabecular meshwork, increasing the outflow of fluid and reducing intraocular pressure. This procedure can be performed in the clinic at all Nexus Eyecare locations. There is usually minimal discomfort and normal activities can be resumed a few hours after the procedure. If successful, it can lower eye pressure for several years. SLT can be used in patients who find eye drops too difficult to put in (e.g. due to arthritis or dementia) or patients who cannot tolerate eye drops.

Minimally Invasive Glaucoma Surgery or MIGS

Minimally Invasive Glaucoma Surgery (MIGS) is an advanced surgical option that involves inserting micro stents into the eye’s drainage angle. This can be performed in combination with cataract surgery or as a standalone procedure. These devices improve the outflow of fluid and help lower intraocular pressure. MIGS procedures are considered safe and have shown effectiveness in reducing eye pressure and reducing reliance on pressure-lowering eye drops. Sometimes MIGS is performed when medication or Glaucoma laser treatment is insufficient but more invasive surgeries are not yet necessary. At Nexus Eyecare, we have surgeons who are skilled in the implantation of these devices.

Trabeculectomy

Trabeculectomy is the gold standard surgical option for managing Glaucoma, especially in cases where the condition is more advanced or uncontrolled with less invasive measures. This operation aims to establish a new drainage pathway within the eye to reduce the intraocular pressures. It involves creating a small flap valve in the eye to slowly release excess fluid produced by the eye. The fluid drains into a small blister (drainage bleb) that forms on the surface of the eyeball underneath the upper eyelid. The appearance of the eye after the operation is usually relatively unaltered. If successful, progressive vision loss from severe Glaucoma can be prevented. This procedure can only be performed by specially trained eye surgeons at Nexus Eyecare.

Tube Shunt

Tube shunt surgery is the best Glaucoma treatment method that can be considered when other surgical options for managing the condition are not suitable or effective. This operation involves the insertion of a small tube, typically made of silicone, into the eye to redirect the flow of fluid and establish an alternate drainage pathway. To facilitate this, a small plate or reservoir is placed on the surface of the eye, connecting to the tube. By regulating the drainage of fluid, intraocular pressure can be controlled. If successful, progressive vision loss from severe Glaucoma can be prevented. This procedure can only be performed by specially trained eye surgeons at Nexus Eyecare.

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