ANSWERS TO YOUR - Kremer Eye Center

For Your Eyes Only:
ANSWERS TO YOUR
MOST COMMON
GLAUCOMA QUESTIONS
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Table of Contents
Introduction ......................................................... 3
Glaucoma Defined .............................................. 4
Symptoms of Glaucoma ..................................... 6
Treatment Options for Glaucoma ....................... 8
Conclusions ...................................................... 10
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Introduction
Receiving a diagnosis of glaucoma can leave you feeling scared or confused. If you’re wondering
about your treatment options and prognosis, this e-book is here to help by answering the most common
glaucoma questions.
Glaucoma is the second leading cause of blindness after cataracts, but prompt treatment can slow down
further vision loss. Vision lost from glaucoma cannot be restored, which is why it’s important to seek
treatment as soon as possible after being diagnosed.
This e-book will answer all your questions related to:
• The definition and causes of glaucoma
• The symptoms of glaucoma and what
you should do if you experience them
• Highly effective treatment options for
glaucoma
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Glaucoma Defined
Part 1: Glaucoma Defined
What is Glaucoma?
Glaucoma is a disease where the optic nerve becomes damaged over time, often due to elevated eye
pressure. When the optic nerve cannot tolerate the increased stress from elevated eye pressure, some
of the fibers that make up the optic nerve stop working. The most common reason eye pressure rises
is because the eye’s internal fluid is not draining well. The eye’s internal drain is called the trabecular
meshwork, which is located in the angle of the eye.
The picture on the left shows a healthy optic nerve. The photograph on the right shows an optic nerve
with damage caused by glaucoma.
Healthy Optic Nerve
Optic Nerve with Glaucoma
What are the Types of Glaucoma?
The most common type of glaucoma in the United States is open-angle glaucoma. In open-angle
glaucoma, there is nothing physically blocking the eye’s drainage canal. Even though nothing is blocking
the access of fluid to the trabecular meshwork, sometimes the fluid simply does not drain through the
meshwork as well as it should. This results in an increased eye pressure which can then damage the
optic nerve.
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Glaucoma Defined
There are some patients with glaucomatous damage to their optic nerve who never register a high eye
pressure reading when measured during normal eye exams. These patients have normal-pressure
glaucoma which is also known as normal-tension glaucoma or low-tension glaucoma. These patients
most likely develop optic nerve damage due to poor blood flow to the optic nerve. Whether patients
with open-angle glaucoma have an elevated eye pressure or a normal eye pressure, lowering the eye
pressure has been shown to be an effective treatment.
In patients with narrow angles of the eye, the eye pressure can become elevated if the trabecular
meshwork becomes blocked. Ideally, a patient with narrow angles is identified and treated prior to the
development of optic nerve damage. A sudden episode of angle closure is a medical emergency and can
cause permanent visual loss.
Congenital glaucoma appears at birth, often due to malformation of the trabecular meshwork. Surgery
is typically performed shortly after birth to correct this issue, but the patient will still require lifelong
monitoring.
Certain diseases, medications, and eye trauma can also lead to glaucoma.
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Symptoms of Glaucoma
What Factors Put Someone
at High Risk for Developing
Glaucoma?
•
•
•
•
•
•
Elevated eye pressure
African-American and Hispanic ethnicities
Chronic steroid use
Family history of glaucoma
Individuals over the age of 60
Eye trauma
Part 2: Symptoms of Glaucoma
The symptoms of glaucoma vary depending upon the severity of the disease. Glaucoma in the early
stages may have no symptoms. Patients with mild or moderate glaucoma often describe their vision as
blurred or missing parts. Patients do not often describe their vision as looking through a dark tunnel,
despite what is commonly depicted on the Internet. Severe glaucoma can cause blindness and significant
visual impairment.
“
Here are a few excerpts from a 2013 survey asking glaucoma patients to describe their vision:
“
...There’s no sort of blackness, not with me anyway... there are areas
of blur and then ordinary, it’s difficult to describe it sometimes...
...I don’t often do it because it frightens me to see what I’ve got
missing, but the other day, when I was sitting in the garden, I looked
down and I thought, oh gosh, there is a great chunk missing...
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...I get very much blurred, like a mist, and I keep
cleaning my glasses but it’s not there...
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Symptoms of Glaucoma
Patients with an attack of closed-angle glaucoma may have sudden symptoms including:
•
•
•
•
•
Blurred or hazy vision
Halos around lights
Eye pain or headaches (sometimes accompanied by nausea or vomiting)
Eye redness
Sudden loss of vision
What Should I Do If I Think I Have Glaucoma?
If you experience any of the above symptoms, or if you think you may have glaucoma for any reason,
schedule an appointment with one of the glaucoma specialists at Kremer Eye Center as soon as possible.
Your eye doctor can perform a number of tests to pinpoint a diagnosis. An examination may include
measuring the eye pressure, as well as assessing the angle of the eye and the optic nerve.
What are the Potential Complications of
Glaucoma and the Risks to Leaving Glaucoma
Untreated?
Left untreated, glaucoma can lead to total blindness. How quickly this happens depends on the type
of glaucoma, hereditary factors, severity upon diagnosis, and the patient’s lifestyle. When treated,
however, glaucoma can be managed and vision loss can often be slowed down before it progresses to a
substantial loss in quality of life. Read on to find out about the best treatment options for glaucoma.
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Treatment Options for Glaucoma
Part 3: Treatment Options for Glaucoma
Treatment for glaucoma involves lowering the eye pressure in various ways. At Kremer Eye Center,
your treatment strategy will be tailored to your specific type of glaucoma. Reducing eye pressure can be
accomplished by eye drops, laser procedures, or surgery.
Eye Drops
There are several types of glaucoma eye drops. They work by either causing the eye to produce less fluid
or enhancing the eye’s ability to drain fluid. Modern glaucoma eye drops are often prescribed to be used
once-daily, twice-daily, or three-times-daily, depending on the type of medication. Of course, no eye drop
can be effective if not taken as prescribed. Intermittent use of eye drops is not an effective way to prevent
vision loss from glaucoma.
The following are the more common potential side effects of the different classes of glaucoma drops:
• Prostaglandin analogues – change in iris color,
eye redness, dry eye
• Beta blockers – low blood pressure or heart rate,
fatigue, shortness of breath, depression
• Alpha agonists – burning, stinging, fatigue,
drowsiness, allergy to the eye drop
• Carbonic anhydrase inhibitors – burning, stinging, eye discomfort
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Treatment Options for Glaucoma
Laser Procedures
With open-angle glaucoma, selective laser trabeculoplasty (SLT) may be recommended to lower the eye
pressure. SLT is the most common form of glaucoma surgery and is successful for 80% of patients. This
procedure works by applying laser energy directly to the pigment in the trabecular meshwork, causing
the eye to drain fluid better. SLT can lower eye pressure by as much as 30%, which is comparable to
glaucoma eye drops. It can be used as an initial treatment of glaucoma or as a supplement to eye drops.
The effects of SLT typically last for multiple years and can be repeated if your eye pressure begins to rise.
If you have a narrow or closed-angle glaucoma, a laser peripheral iridotomy (LPI) may be recommended.
During this procedure, a small hole is created in the iris to improve your eye’s angle anatomy.
Side effects of glaucoma laser procedures are not common, but a temporary elevation in eye pressure
can occur. This transient rise in eye pressure happens in about 5% of patients and can be managed by
glaucoma eye drops.
LPI and SLT are FDA-approved treatments for glaucoma and are covered by most insurance plans, as
well as Medicare and Medicaid. Insurance co-pays and prices for uninsured patients may vary.
LPI and SLT do not require general anesthesia or a hospital stay. In fact, they rarely have side effects and
are fast procedures. Both SLT and LPI procedures are performed on an outpatient basis at Kremer Eye
Center offices in Pennsylvania, New Jersey, and Delaware.
What are Microinvasive Glaucoma
Surgeries?
Microinvasive glaucoma surgeries (MIGS) are designed to have a modest reduction in eye
pressure with a good safety profile. They are often performed at the same time as cataract
surgery if a patient has mild or moderate glaucoma. Endoscopic cyclophotocoagulation (ECP)
and the iStent are currently available MIGS surgeries with multiple other devices under
investigation.
Endoscopic cyclophotocoagulation (ECP) uses a laser to shrink the eye’s ciliary body, which is
the part of the eye that produces fluid.
The iStent is a device only 1 millimeter in length that creates a permanent opening to allow fluid
to drain from inside the eye out through the trabecular meshwork.
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Conclusions
What if I Do Not Respond Appropriately
to Eye Drops, Lasers, or the Surgeries
Previously Listed?
For some patients, eye drops and lasers are not effective in lowering eye pressure enough.
A trabeculectomy is a surgery that creates a new drain to reduce eye pressure.
A tube shunt surgery places a small plastic tube into the eye to allow excess fluid to drain to the tissues
surrounding the eye.
These surgeries do carry more risk compared to the ones described above, but are recommended if the
benefits outweigh the risks.
Conclusions
The best way to find out more about glaucoma treatments is by
contacting a specialist at Kremer Eye Center. They will explain the best
treatment options available to you and answer any other questions
you may have about your glaucoma diagnosis. When you are ready
to schedule a consultation with a Kremer specialist, click here or call
1-800-649-EYES (3937).
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