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Glaucoma

GlaucomaGlaucoma is an eye disease that is associated with hydraulic pressures within the eye that are too high for the long term health and function of the optic (seeing) nerve. The ability of the nerve to tolerate any given intraocular pressure (IOP) varies from person to person. Most people will show a pressure in the teens or very low 20s. Others might have a relatively higher pressure and still not have glaucoma. What this means is that there is no magic number above which you have glaucoma, and below which you don’t. The ability of the optic nerve to tolerate any given pressure depends on a variety of factors including age, effectiveness of the circulation to the optic nerve, a family history of glaucoma, diabetes, race, to list a few. There are some people who have normal or low IOP yet remain in danger of losing vision due to glaucomatous optic nerve damage. It is important to have a comprehensive eye examination by an ophthalmologist (a medical doctor who specializes in diseases and surgery of the eyes) to rule out the less obvious but equally threatening forms of glaucoma. When the IOP is lowered sufficiently, the risk of damage to the optic nerve is reduced, and the progression of the disease can be slowed or even arrested, thereby ensuring many years of useful vision.

The prevailing intraocular pressure is determined by the delicate balance between the rate of aqueous fluid production within the eye and the efficiency with which the drainage area permits the outflow of fluid. Abnormalities of the drainage structure can slow down the outflow of aqueous with consequent elevation of IOP.

There are different types of glaucoma.

Open angle glaucoma is the most common type of glaucoma, and is usually treated by lowering the eye pressure with eye drops. Laser treatments (Selective Laser Trabeculoplasty – SLT) improve the outflow of aqueous and lower the IOP by approximately the same amount as an effective eye drop. SLT is successful in approximately 85% of people and should be considered as an adjunct to the various treatment options rather than a replacement. Surgery to provide additional pressure reduction is performed when eye drops and laser treatments are inadequate.

Acute angle closure glaucoma is an eye emergency that can result in permanent blindness in a matter of hours or days. It is associated with age-related growth of the human lens, an anatomically crowded hyperopic (farsighted) eye, and a family history of angle closure. When an acute attack occurs, the iris (colored portion of the front of the eye) is bowed forward to the point where it makes contact with the cornea (clear front window of the eye) and blocks the flow of aqueous from reaching the drainage channels. IOP skyrockets to very painful levels and is accompanied by nausea, redness, halos around lights, and vision loss. Urgent treatment by an ophthalmologist is necessary to break the current attack, to prevent further episodes in the affected eye, and to protect the opposite eye from developing an initial attack.