Dr. Bhavnani's Practice  
     
     
Frequently Asked Questions
Frequently Asked Questions

What is Glaucoma? Information, Types, & Myths


What is glaucoma?

Glaucoma is a group of diseases where the fluid inside the eyeball gradually builds up and causes damage to the optic nerve. The optic nerve is a bundle of more than 1 million nerve fibers. It connects the retina, the light-sensitive layer of tissue at the back of the eye to the brain. A healthy optic nerve is necessary for good vision.

In glaucoma, the eye is like a sink that is filling up with water with a closed drain and if you were to place a flexible cover over the sink, the cover will start to bulge outward as it filled with water. Likewise, this is what happens to the inside of the eyeball with glaucoma.

The eye normally drains this buildup of fluid through a network of tissues called the drainage channels, which are located between the iris and the cornea. But in glaucoma these channels do not function properly and the pressures continue to build up in the eyeball. This build up of pressure will reduce the blood flow to the retina and the optic nerve. Without suitable blood supply, the fibers of the optic nerve will die and vision loss will result.

Glaucoma is called the "sneak thief of sight," which means that it steals sight without warning and without symptoms. If it is left untreated it can lead to permanently impaired vision or blindness. It is an irreversible disease that can strike at anytime, and when symptoms are finally detected, it may be too late for some.


What are the types of glaucoma and their symptoms?

There are two categories of glaucoma--acute and chronic. The chronic form is the most common and treatment is normally in the form of eye drops. The acute form is rare, but it does occur and immediate treatment should be sought to prevent permanent loss of vision.

The chronic form does not have any symptoms until it is in an advanced stage, which is why it is important to have your eyes checked regularly. But in the acute form the early symptoms to watch out for are blurred vision, loss of peripheral vision, teary eyes, and headaches. In the more serious forms there can be sudden eye pain, blurred vision, halos of lights, nausea and vomiting.

The acute form is sometimes treated through the use of a laser, by creating a small opening in the iris to relieve the pressure, or by making a drain in the eye to relieve the pressure called a Trabeculectomy.

There are many types of glaucoma within these two categories. Such as; Primary Open Angle Glaucoma, Chronic Angle Closure Glaucoma, Normal Tension Glaucoma, Pseudoexfoliative Glaucoma, Pigmentary Glaucoma, Neovascular Glaucoma, Secondary Glaucoma, Traumatic Glaucoma, Congenital Glaucoma, and Mixed Mechanism Glaucoma.


What Causes Glaucoma?

The most common type of glaucoma (Primary Open Angle Glaucoma) occurs when the channels draining the fluid in the eye become clogged and do not work correctly. This blockage can gradually increases pressure within the eye to damaging levels. Generally there is no pain occurs so a person is usually unaware that anything is happening. There are no signs or symptoms initially, but over the years if it is left untreated, the vision will slowly be lost; starting in the periphery and moving toward the central vision.

With early treatment, you can help protect your eyes against serious vision loss and or blindness. Regular eye examinations from your doctor are the best way to detect glaucoma. Glaucoma affects about 3 million Americans - half of whom don't know they have anything wrong.

When eye pressure builds up rapidly, it is called Acute Angle Closure Glaucoma. This type of glaucoma commonly occurs in individuals who have narrow drainage channels in their eyes, also called narrow angles. If an attack of this type of glaucoma happens, the fluid behind the iris cannot pass through the pupil thus pushing the iris forward, preventing any drainage through the angles of the eye.

It is as though a piece of plastic is floating near a drain and suddenly drops over the opening and blocks the flow out of the sink. In cases of Acute Angle Closure Glaucoma, a person may have blurred vision, halos around lights, deep pain behind the eye, nausea, and vomiting. If you have any combination of these symptoms, call your eye doctor immediately. If pressure within the eye is not immediately relieved, blindness may result in a matter of hours.


How is glaucoma detected?

A glaucoma diagnosis is based upon several factors, such as what the optic nerve looks like, what the pressure is, and whether there is damage to the vision. A common misconception about glaucoma is that if a person has high pressures in the eyes, then they have glaucoma. This is not always true. The high pressure is a risk factor for glaucoma, but does not mean that you have it.

Whether or not you get or have glaucoma depends on the level of pressure that your optic nerve can tolerate without being damaged. This level is different for each person.

Although normal pressure is usually between 10-21 mm Hg, a person might have glaucoma even if the pressure is in this range. That is why an eye examination is very important.

To detect glaucoma, your eye doctor will perform various tests, such as; visual acuity testing, pressure checks, visual field testing, dilated exams, optic nerve scans, and drainage channel tests.

Glaucoma is a treatable disease. It is important to have regular eye examinations so that early detection can be made and treatment started. With proper treatment glaucoma can be controlled and your eyesight can last a long time.


Myths About Glaucoma

There are four major myths about glaucoma. Many people have misunderstood what the disease is, how severe it can be, and who can be affected.

Myth #1
There is a cure for glaucoma.

Truth #1
Glaucoma is a treatable disease, not a curable one at the present time. It is most often treated with medication and can be treated with surgery. The goal of treatment is to stall or slow down the disease. Life long treatment is necessary once diagnosed with glaucoma because it is a chronic condition, which needs to be monitored.

Myth #2
Only older people will get glaucoma.

Truth #2
No one is exempt from the risk of developing glaucoma. Seniors to infants can develop this disease. Seniors have are at higher risk for getting glaucoma but infants can be born with it. A recent statistic shows that roughly 1 in 10,000 babies in America are born with it. Adolescents and young adults can also develop glaucoma, but people of African-American descent are vulnerable at a younger age than those of Caucasian descent.

Myth #3
You can't go blind from glaucoma.

Truth #3
If glaucoma is left untreated it can result in blindness. Even with suitable treatment an estimated 10% of glaucoma patients go on to lose their vision. Treatment decreases the risk of blindness.

Myth #4
Glaucoma has many symptoms.

Truth #4
With the most common types of glaucoma there are nearly no symptoms. With the higher eye pressures in these forms of glaucoma, there is generally no pain but there is a gradual loss of the side vision, which is generally not noticed because a person uses their central vision a majority of the time. When a person notices a loss of vision from glaucoma a considerable amount of their vision will have been lost from the disease and glaucoma is irreversible.

Myth #5
If you have high pressures, then you have glaucoma.

Truth #5
This is not always the case. Some people have higher pressures and yet have no damage to their optic nerves. This means that their eyes are able to withstand a higher pressure than normal and this condition is called ocular hypertension. The high pressure is a risk factor for glaucoma, but does not mean that you have it. When a person has this condition, they still need to have regular eye examinations because this condition may lead to glaucoma in the future.


Facts & Terminology


Facts & Terminology

Statistics

* 3 million Americans have glaucoma but only half of those know they have it.

* Approximately 120,000 are blind from glaucoma, which accounts for approximately 10% of all cases of blindness in the U.S.

* About 2% of the population ages 40-50 and 8% over 70 have elevated eye pressures.

* Glaucoma is the second leading cause of blindness in the U.S. and the first leading cause of preventable blindness.

* Glaucoma is the leading cause of blindness among African-Americans.

* Glaucoma is about 7 times more common in African-Americans than Caucasians.

* African-Americans ages 45-65 are approximately 15 times more likely to go blind from glaucoma than Caucasians with glaucoma in the same age group.

* The most common form, Open Angle Glaucoma, accounts for 19% of all blindness among African-Americans compared to 6% in Caucasians.

* Other high-risk groups include: people over 60, family members of those already diagnosed, diabetics, and people who are severely nearsighted.

* Estimates put the total number of suspected cases of glaucoma at around 65 million worldwide.


Public Awareness and Attitudes

A recent survey, done for the Glaucoma Research Foundation by ICR, Inc. in Media, PA, found that:

* 74% of over 1,000 people interviewed said they have their eyes examined at least every two years.

* 61% of those are receiving a dilated eye exam (the best and most effective way to detect glaucoma).

* 16.1% of African-Americans were unfamiliar with glaucoma.

* 8.8% of Caucasians do not know anything about glaucoma.

A Prevent Blindness America Survey Found

* Blindness ranked third as people's major fear, after cancer and heart disease.

* 20% of people knew that glaucoma was related to elevated pressure within the eye. Most of them mistakenly thought people could tell if they had glaucoma due to symptoms, or that it was easily cured, or that it did not lead to blindness.

* 50% had heard of glaucoma, but were not sure what it was.

* 30% had never heard of glaucoma.


Economic Impact

* Glaucoma accounts for over 7 million visits to physicians each year.

* In terms of Social Security benefits, lost income tax revenues, and health care expenditures, the cost to the U.S. government is estimated to be over $1.5 billion annually.


Risk Factors

People with these risk factors should have their eyes examined on a regular basis to look for the disease.

* Having increaed introcular pressure
* Being over 50
* Being over 40 and African American
* Having a family history of glaucoma
* Having a history of serious eye injury
* Taking steroid medications
* Having diabetes
* Being nearsighted
* Having high blood pressure


Remember

* The best way to protect yourself from a loss of vision due to glaucoma is with regular, thorough eye exams. You can't treat a disease you don't know you have.

* Loss of vision from glaucoma is irreversible.

* Glaucoma usually has no signs or symptoms until serious loss of vision occurs.

* Most cases of glaucoma are controlled with medication or surgery.


Terminology

Angle closure glaucoma: A type of glaucoma caused by a sudden and severe rise in eye pressure. Occurs when the pupil enlarges too much or too quickly, and the outer edge of the iris blocks the eye's drainage canals. Can be either acute or chronic.

Aqueous humor: The fluid made in the front part of the eye.

Bleb: A bubble in the eye tissue that lies over the new drainage opening created during surgery.

Central vision: What is seen when you look straight ahead or when you read.

Ciliary body: Tissues that are located around the lens of the eye that supply fluid to nourish the eye.

Congenital glaucoma: A rare form of glaucoma that occurs in babies and young children. This condition can be inherited. It is usually the result of incorrect or incomplete development of the eye's drainage canals during the prenatal period.

Conjunctiva: A thin, clear membrane that lines the inner surface of the eyelids and the outer surface of the eyeball, except for the cornea.

Cornea: The clear part of the eye located in front of the iris. Part of the eye's protective covering.

Drainage canals: Small openings around the outer edge of the iris. These canals provide the final pathway for fluid to leave the inside of the eye. Sometimes referred to as the trabecular meshwork or Schlemm's canal.

Glaucoma suspect: A person may be considered a glaucoma suspect on the basis of high intraocular pressure, an unusual appearance of the optic disc or visual field, a family history of glaucoma, or narrow angles between the iris and cornea.

Gonioscopy: In this test, a contact lens that contains a mirror is gently placed on the eye. The mirror lets the doctor look sideways into the eye to check whether the angle where the iris meets the cornea is open or closed. This helps the doctor decide whether open angle or angle closure glaucoma is present.

Intraocular pressure (IOP): The inner pressure of the eye. Normal intraocular pressure usually ranges from 10-21 mm Hg, although people with relatively low pressures can still have glaucoma (see normal tension glaucoma).

Iris: The colored part of the eye that can expand or contract to allow the right amount of light to enter the eye.

Laser surgery: A type of surgery in which a tiny, powerful beam of light is used to solve problems in the eye. There are two common forms of laser surgery for glaucoma:

Laser peripheral Iridotomy: Creates a new drainage hole in the iris, allowing the iris to fall away from the outflow channel so fluid can drain out of the eye.

Laser Trabeculoplasty: In this procedure, the laser is aimed toward the normal drainage channels of the eye, in an attempt to open those channels so fluid can leave the eye more efficiently.


Lens: Located behind the iris, this helps light focus onto the retina.

mm Hg: An abbreviation for "millimeters of mercury," which is a scale for recording intraocular pressure.

Normal tension glaucoma: Also called low-tension glaucoma. A rare form of glaucoma in which intraocular pressure stays within the normal range (10-21 mm Hg), but damage still occurs to the optic nerve and visual fields.

Primary open angle glaucoma: The most common form of glaucoma in the western world. This form of glaucoma usually develops very slowly as the eye's drainage canals gradually become clogged. There are no early warning signs for open angle glaucoma, which is why it is often called the "sneak thief of sight."

Optic nerve: The nerve in the back of the eye that carries visual images to the brain.

Perimetery: Also known as the visual field test. A test that produces a map of the complete field of vision, to check whether there is damage to any area of vision.

Peripheral vision: The top, sides, and bottom areas of vision. These are usually the first areas of vision affected by glaucoma. Sometimes referred to as side vision.

Pupil: The opening that monitors how much light enters the inner part of the eye.

Retina: The part of the eye that carries light and images to the brain through the optic nerve.

Sclera: The tough, white, protective outer covering of the eye.

Secondary glaucoma: A form of glaucoma that can occur as the result of an eye injury, inflammation, or tumor. Includes forms such as pigmentary glaucoma and steroid-induced glaucoma.

Selective laser Trabeculoplasty (SLT): A type of laser surgery that uses a combination of frequencies allowing the laser to work at very low levels. It treats specific cells "selectively" and leaves untreated portions of the trabecular meshwork (the mesh-like drainage canals surrounding the iris) intact.

Tonometry: The use of a device to measure the pressure in the eye. There are two types of tonometry:

Air Puff: This is the only type of tonometry that does not touch the surface of the eye. The patient sits facing the instrument, and a warm puff of air is directed at the eye.

Applanation: The patient's eye is first treated with numbing drops and a stain called fluorescein. The tonometer is then placed gently on the cornea, and a very small amount of pressure is applied to the cornea. The patient may sit in front of the tonometer or a hand-held tonometer may be used.

Trabecular meshwork: The formal name of the mesh-like drainage canals surrounding the iris.

How is Glaucoma treated?


How is glaucoma treated?

Glaucoma is treated with medications, laser surgery, and invasive surgery in the operating room.

Eye drops

There are various types of medications that can be used, which work in one of two ways. One type decreases the amount of fluid that is produced inside the eye and the other type helps the drainage channels in the eyes to function better. Glaucoma eye drops may be taken once or several times a day.

If the drops are not efficient enough to control the pressure, the doctor may suggest a surgery.

Surgery

There are many different types of surgery for glaucoma. The two most common are a Trabeculoplasty and a Trabeculectomy.

There is the laser surgery, also called a Trabeculoplasty; this surgery increases the outflow of fluid from the eye to decrease eye pressure. This surgery is done most often in conjunction with taking medications and is an alternative to adding another eye drop.

The doctor performs this surgery in his office. The following is what to expect when undergoing a laser procedure.

One of the doctor's assistants will be there to instill some topical anesthetic drops, which will numb your eye. When the doctor performs the laser, you will be sitting in the exam chair with your chin placed in the chin rest and your head firmly against the headrest. The doctor will need to place a special lens upon your eye, which helps to focus the laser light.

The laser light is a high-energy beam that when aimed into the lens, it reflects into the drainage channels inside the eye. Normally there are 50-100 laser spots made inside the drainage channels during the procedure. These spots help to stretch open the drainage channels and help the fluid within your to move through them more efficiently.

During the laser you may see flashes of bright lights and it might sting a little, but this is normal.

After the procedure the doctor will provide you with some eye drops to help control any inflammation that may be caused by the laser. These drops are generally taken four times a day only for four days.

A few days following the procedure the doctor will call you back to the office to check your eye pressure and make sure that you are doing well.

Typically only one half of the drainage channels in the eye are done at a time. The laser works very well to decrease the pressure inside your eye, however after several months or years the effect may wear off and other options may need to be pursued.

With today's lasers that are available, the laser surgery may be repeated several times if the need arises.

More sophisticated surgeries in the operating room may need to be done in the event that the eye drops and laser surgeries are not effective in controlling the pressure. The most common surgery done to control the pressure is to make a drain in the eye, also called a Trabeculectomy. This surgery allows for a new opening to be made inside the eye into which fluid can drain out. The surgery will create a "bubble" under your eyelid, which will act like a trap door to let the fluid escape into the drain and then evaporate to the outside of the eye.

This surgery is preformed at an outpatient surgery center and the anesthetist will be there to sedate you and keep you comfortable. Small injections around the eye socket are given to numb the eye and surrounding area.

In the procedure the doctor will remove a tiny piece of tissue in the sclera (or white portion of the eye) under your eyelid. By doing so it creates a new passageway for fluid to leave the eye, but it does not leave a hole in the eye. This area is covered by the conjunctiva, which is the clear tissue covering the outside of the eye.

After the surgery you will be instructed to use two or three different eye drops to protect against infection and inflammation, these will be used for several weeks following the surgery. Also after the surgery the old eye drops you have will not be used in that eye unless the doctor specifically instructs you to use them. You will also need to make a trip to the doctor's office roughly once a week for four to six weeks so that the doctor can monitor your eye. This is especially important in the first few weeks.

This surgery is about 90% effective at lowering the pressure in the eye. However, the body does have a tendency to scar shut any opening that is made in the body and if it succeeds in closing the drain, a second surgery may be required.

It is important to remember that this type of surgery is only meant to control the pressure and not to improve you vision.

It is important to realize that this is a surgery like any other and you may have a complication. Some of these complications can include: inflammation, infection, swelling in the eye, retina detachment, and possible loss of vision. This is why it is so important to keep your appointments after the surgery, so that the doctor can start treatment if you do have a complication.

Frequently Asked Questions


FAQ's (Frequently Asked Questions)

Q. What is Glaucoma?

A. Glaucoma is a group of eye diseases that gradually steals sight without warning and often without symptoms. Vision loss is caused by damage to the optic nerve, which is the nerve that connects the eye to the brain. It was once thought that high intraocular pressures (IOP's) were the main cause of this damage. We now know that other factors also are involved since people with "normal" IOP's can experience vision loss from glaucoma. Glaucoma is a chronic disease. It must be treated for life.

Q. What are the symptoms of glaucoma?

A. There are no symptoms of glaucoma in the initial stages. The vision stays normal and there is no pain. But when the glaucoma progresses to an advanced stage, symptoms will begin. These generally include not seeing objects or even people to the side even though they may see things clearly in front of them. At this stage blurry or worsening vision may occur, it may be difficult to adjust to lighting changes, and the vision may appear to be tunnel-like.

Q. Can anything be done to prevent glaucoma?

A. No. There is nothing that can stop a person from getting glaucoma, although by starting treatment early the disease can be slowed down. This is why regular eye exams are important. To detect glaucoma the doctor will perform different tests, these include; checking the pressures in your eyes, dilating your eyes, visual field tests, checking the drainage channels inside the eyes, and doing scans on the optic nerve. These tests will detect any change in your condition. If you are diagnosed early, then the glaucoma is most likely to be controlled with medication or simple laser surgery.

Q. Will I go blind if I have glaucoma?

A. Glaucoma can cause blindness if left untreated, which is why it is so important to have regular eye check ups. If you use your medication correctly and do not skip doses, then it is possible to stall or slow down the disease. In fact, your eyesight may outlive you.

Q. If my family members have glaucoma, will I get it?

A. It does not mean that you will get it, but it means that your risk of getting it is increased.

Q. What are the risks factors for glaucoma?

A. If a family member has it, being over 50 years old, being over 40 years old and of African American decent, having a history of a serious eye injury, taking steroid medications, having diabetes, being highly nearsighted, and having high blood pressure. If anyone has these risk factors they should have their eyes checked regularly with an emphasis on looking for glaucoma.

Q. Can glaucoma be treated?

A. Yes it can. Presently there is no cure for glaucoma but it can be controlled with proper treatment. Glaucoma treatments include: medications, laser surgeries, and surgeries in the operating room.

Q. Are treatments for glaucoma effective?

A. Yes. There are various types of medications that can be used, which work in one of two ways. One type decreases the amount of fluid that is produced inside the eye and the other type helps the drainage channels in the eyes to function better. Glaucoma eye drops may be taken once or several times a day.

Most people have no problems using the medications, but something to remember about medications, even eye drops, is that they can affect the entire body, not just the eye. So if you notice any side effects, be sure to alert your doctor. In addition, tell your doctor about any other medications you may be taking before you begin glaucoma treatment.

The treatments for people in whom the medications do not work to sufficiently control the pressure in, are surgeries. The first type of surgery is done in people who are not in an advance stage of the disease. It is a laser surgery, called a Trabeculoplasty, which helps the drainage channels in the eyes to work better. This is usually done in the doctor's office.

The next surgery is done in the operating room and is the most common invasive surgery done for glaucoma. It is called a Trabeculectomy, in which the doctor makes a drain in your eye to decrease the pressure. After both of these procedures, patients may still need to take eye drops to keep the pressure low.

Q. Is marijuana an effective and legal treatment?

A. In the 1970's some studies were done which showed that smoking marijuana could lower a person?s eye pressure. The National Eye Institute and the Institute of Medicine have done some more recent studies that show there is no scientific evidence that marijuana works better than the current medication which are available.

As for legality, there have been political battles to legalize marijuana for medicinal purposes, including treatment of glaucoma. There have been a few states that have legalized marijuana for medicinal purposes, but is it against the federal law to any doctors to prescribe it.

Q. Will I still be able to drive if I have glaucoma?

A. As long as a person can pass the DMV's tests, most people can still drive. It will depend on how much vision has been affected by the disease. Some people who have advance glaucoma can still drive legally but with restrictions on their license.

Q. Can I still wear contact lenses?

A. Most likely yes. It depends on what treatment you will need. If only eye drops are needed then you can wear contact lenses, although you will need to remove them to put your drops in and then wait 15 minutes before putting your lenses back in. If you do not remove your contact lenses the eye drops will rapidly decrease the life of your contacts.

Q. How can I help my parent(s) if they have glaucoma?

A. Many times when a person grows older they are dealing with a lot of health problems that come with age and learning that they could lose their sight is scary. Many people are afraid of becoming a burden to their family if they go blind. One thing to do to help them is to encourage them that many people have kept their vision with the proper care and treatment. Next you can ask if there is something that you can do to help them with their medications or even help them with transportation to their appointments. The most important thing you can do though is to support and reassure them.

For further information about glaucoma, you may wish to contact:

Glaucoma & Cataract Eye Institute, Inc.
9371-15 Cypress Lake Dr.
Fort Myers, Fl. 33919
(239) 437-8118
http://www.bhavnani.eyemd.org

American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94109-7424
(415) 561-8500
http://www.aao.org

(The) Glaucoma Foundation
116 John Street, Suite 1605
New York, NY 10038
1-800-452-8266
(212) 285-0080
http://www.glaucoma-foundation.org/info

Glaucoma Research Foundation
200 Pine Street, Suite 200
San Francisco, CA 94104
1-800-826-6693
(415) 986-3162
http://www.glaucoma.org

National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
(301) 496-5248
2020@nei.nih.gov
http://ww.nei.nih.gov

Living with Glaucoma


Living with Glaucoma

When making the adjustment of having glaucoma, it is important to remember that most glaucoma cases are controlled and managed with the use of medications and/or surgery.

It's important to take good care of your eyes by remembering to take your glaucoma medications daily and it is also essential to be aware that there is another side of glaucoma, which is the emotional and psychological effect that it can have on you.

It is important to talk about how you feel. When you are initially diagnosed with this disease, it can be beneficial to voice your concerns to someone you trust. You can talk to your spouse, children, siblings, friends, or clergy members. It is also beneficial to speak with others who have glaucoma and share your experience with them about living with this disease. It can be very useful and reassuring.

With proper treatment, glaucoma doesn't have to become a limiting condition. You can still enjoy living life as you did before you were diagnosed and continue to look forward to whatever is next.

Find a specialist you trust and be assured that there are people out there who are working to develop a cure and who keep searching for a better way to care for you as a glaucoma patient.