Glaucoma – The Nebraska Medical Center

Glaucoma – The Nebraska Medical Center


No one needs to go blind from this disease Glaucoma is a disease of the eye that affects
the optic nerve, which is the nerve that helps us to see better, and there are many kinds
of Glaucoma’s, so it’s a misconception that it’s just one disease and another thing
to know about the disease is it can affect people of all age groups, though it is far
more common as we get older. Here in the U.S. the open-angle kind of Glaucoma, is the more
common variety, and it is called the silent thief of sight, because it does not give any
symptoms early on. So by the time a person starts noticing any visual problems, the disease
is fairly advanced. It is a disease of aging, so anyone over the
age of 50 or 60, and if there’s a family history perhaps by the time they’re 45,
they should be getting a dilated eye exam and getting their eye pressure checked, and
that would give an indication if there’s any evidence of damage to the optic nerve
or if the eye pressure is high, that is a risk factor that can cause further damage
to the optic nerve. This disease is far more common in African-American’s and Hispanics
than in the Caucasian population. Also it is a worse form of the disease in African-American’s
and Hispanics. Even though it’s a disease of aging it can also be seen in a newborn
baby, also if someone has had trauma to an eye that puts them at a higher risk of Glaucoma,
that’s a different kind of Glaucoma, also someone who’s using steroids, whether it
is for Bronchial Asthma or Rheumatoid Arthritis or even a skin cream for Eczema, if they keep
using it for several years, that puts them at risk of having high eye pressure. Even though it’s not curable, it can be
well controlled, the crucial thing to know is, getting screened for it, so my advice
to my patients is, “if you have a sibling or a parent who hasn’t had an eye exam,
it’s a good time for them to get it checked out, especially if they are at 45 or older. There are many kinds of Glaucoma’s so the
more common kind is the open-angled Glaucoma, which is, most of the times there are no symptoms
early on, and as time goes by a person may have difficulty navigating objects. Even,
especially if they are in unfamiliar surroundings, they might have difficulty and they might
bounce into, bump into furniture, or while driving they may not notice a car changing
lanes from either side of them, so because it’s the peripheral vision, or the side
vision that is affected, that’s where they start noticing those problems. And the other
kind is the angle-closure or the closed-angle Glaucoma, where the drainage system is shut
down, and that’s the kind of Glaucoma where the patient will have symptoms. They may have
a bad headache, red-eye, pain in and around the eye, nausea, vomiting, reduced vision
– that is a serious condition and it is a true emergency, that’s the kind of patient
who needs to be seen within hours and they can be treated with laser, otherwise they
take the risk of losing their eyesight all together and going blind. Looking at it from the front, which is the
cornea, which is the clear part of the eye, and as you look all the way to the back that’s
the optic nerve which is running from the eye, eye, all the way to the brain. So if
you can imagine, it is like an electrical cable going from the eye to the brain, sending
signals whenever you see an object, it sends the image of that object to the brain and
the brain tells you what you are seeing. Right behind the cornea is your iris and the area
where the iris and the cornea meet is the drainage system, and that is what gets affected
in Glaucoma. So if that area is narrowed, it’s the narrow-angled Glaucoma; if it is
wide open, it is the open-angle Glaucoma. The drainage system runs around in a circular
fashion, all-around, right where the cornea meets the iris, and as aging occurs that drainage
system, if you can imagine it’s like a sive, so with passing of time that sive gets clogged
up, and as it gets clogged up, the eye which normally produces fluid 24 hours a day, there
is no way for the fluid to be draining outside, and that causes a pressure build up, that
gets transmitted to the back of the eye and through the nerve, which eventually gets effected
because of the high pressure. The least invasive is using eye-drops and
there are many different good eye drops available. Usually we start with one eye drop, it works
pretty good and after awhile as we get older it may not be enough, then I add a second
eye drop and then a third eye drop. Sometimes patients are not able to tolerate it because
they may have some allergy to the medication or it may not be adequate. Then we bump to
the next level, which would be a laser procedure, which is done in the office or it might be
an eye surgery which is done in the operating room. As far as the laser goes, it’s a short
procedure done in the office, painless, it takes a few minutes to do and the patient
can go home the very same day, get back to their routine life. As far as the surgery
goes there are many different kinds of options. There is a standard procedure called, a filter,
or a Trabelectome, there are tubes that can be placed, and then there is newer technology
called the Trabectome, which is a minimally invasive procedure. Also know that if it’s under good control,
there’s no reason why any, if not most patients can’t retain all there good eyesight for
all their lives. So I, it’s, it’s tragic that some people end up losing their eyesight
to Glaucoma, because of late diagnosis or not being adequately controlled with treatment.

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