Glaucoma: The Silent Thief

Recently a gentleman came in to see me for an eye examination since he hadn’t done so in a number of years. He wasn’t aware of any problems.

During the examination, I found that his eye pressure was very elevated in both eyes, his optic nerves had sustained some damage and his peripheral vision was partially decreased as a result. We discussed options for management of the condition and decided upon a medication in the form of eye drops to lower the eye pressure.

Fortunately, his glaucoma, which is degeneration of the optic nerve, was caught in a stage that was not too advanced. He was surprised but grateful to find out that he had the condition and could have treatment for it.

Glaucoma is often called the “silent thief.” On any given day, three million Americans are struggling with glaucoma, an eye disease that often goes undetected until a person’s eyesight is already seriously damaged. More than 120,000 Americans have lost their sight to the silent thief.

What is disturbing is that the disease doesn’t show any symptoms at first. In most cases, the patient will likely have lost 30 percent or more of his or her vision before he or she notes a change. Any damage, even early damage is irreversible. Therefore, the earlier glaucoma is detected, even when it is not symptomatic, the better as treatment can be started to prevent further degeneration.

Age, family history of glaucoma, race, certain medications and near sightedness are risk factors for glaucoma. People 70 and older are four to seven times more likely to develop glaucoma than people 40 to 50 years old. Also, glaucoma varies significantly among different ethnic groups. For example, African-Americans are four times more likely than Caucasians to develop glaucoma and the disease tends to be more severe.

Researchers aren’t certain what causes glaucoma. In most cases, but not all, pressure increases inside the eye. Increased pressure can come from genetic or environmental factors that cause creation or retention of excess aqueous humor, a watery fluid that fills the front part of the eye. One theory is that high eye pressure causes reduced blood flow to the optic nerve, which carries images from the eye’s retina to the brain. The nerve is slowly damaged, resulting in “silent” loss of vision. This theory accounts for the increased risk of glaucoma for people

Although there is no cure for glaucoma, we now have powerful weapons to inhibit the progression of the disease. Among the most effective of these weapons are eye drops and oral medications that reduce aqueous humor or boost it flow out of the eye. The eye drops can decrease eye pressure by as much as 30 percent. Another treatment is surgery-whether by laser or scalpel. The laser surgical techniques are quick and virtually painless, lasting no longer than 10 or 20 minutes. During scalpel surgery, the surgeon creates a small opening that allows excess fluid to drain out.

The most effective weapon is early detection-which is why every patient 30 and older who has a family history of glaucoma, or other risk factors such as diabetes or high blood pressure, or is African-American should have an annual examination. Otherwise examination should be done every two or three years in the 40s, every two years in the 50s and every year for people 60 and older.