Glaucoma is a group of diseases that damage the optic nerve, the essential link between the eye and the brain. They are one of the world’s leading causes of visual disability, which should be preventable with early diagnosis and effective treatment.
What are the main types of glaucoma and what are the symptoms?
Eye pressure is controlled by the fluid drain located in the “angle”, which can be open (but not functioning efficiently) or narrow with intermittent or permanent closure.
In Australia, open-angle glaucoma is the most common form. It provokes no symptoms. In many cases, it follows an increasing eye pressure over months or years – until the optic nerve and thus the vision become damaged enough to cause peripheral vision loss. It’s often called the Sneak Thief of Sight. This damage can also occur with “normal” eye pressures.
Angle closure glaucoma results from the coloured part of the eye (the iris) blocking the normal flow of fluid to the drain. If sudden, this is an emergency highlighted by severe pain, nausea, vomiting, blurred vision with a rainbow halo around lights. Immediate treatment is vital. More commonly, however, angle closure is a slow process in which physical damage to the drain leads to increasing eye pressures, which damage the optic nerve. It can be detected by careful clinical examination of the shape of the front parts of the eyes.
Congenital or juvenile glaucoma affects children from birth. Warning signs include excessive sensitivity to light, tearing and if undetected, a cloudy cornea (front window of the eye) and an increase in eye size. This last finding is easier to note if the condition affects one eye only, rather than both.
Secondary glaucomas result from detectable underlying eye or general conditions, or from the side effects of treatment of those conditions.
Glaucoma causes permanent damage to the optic nerve.
It can be caused by a build-up of pressure when fluid in the eye isn’t draining properly.
So, what’s the best way to check for glaucoma?
An eye check is the best way to discover all forms of glaucoma. This is straightforward if you have regular appointments with an optometrist every year or two. Several tests are part of this: check the eye pressure with a tonometer and inspect both the optic nerve for damage with an ophthalmoscope and the front of the eyes with a slit lamp. All these need to be done to exclude one of the glaucomas.
If you don’t have regular eye tests but are concerned, you could ask your doctor or a local optician or ophthalmologist. Please advise your eye doctor if you have a history in your family – especially a sibling or parent with glaucoma as this increases your life-time risk ten-fold.
It’s recommended that people over the age of 50 have a comprehensive test for glaucoma every two years (over 40 for people of African or Asian descent, over 35 if there’s a family history). Comprehensive tests are usually best performed by an ophthalmologist, and you’ll need a GP’s or an optometrist’s referral to see one.
Acute angle closure crisis glaucoma usually provokes pain, redness, visual blurring (see above). You should seek help immediately.
What treatments are available?
Damage caused by glaucoma can’t be repaired. Most treatments work to slow or stop further damage to the optic nerve and thus the vision.
Eye drops designed to reduce the pressure in the eye are used to treat the most common forms of glaucoma. Laser treatment and surgery are also used if eyes don’t respond to drops or require urgent action.
If you are taking eye drops for the disease, it’s crucial that you don’t become careless about them because of a lack of symptoms – stick to your treatment plan as damage is permanent and can lead to blindness.
Surgeries come in many forms, are usually performed with the patient awake and aware, and are rapidly changing as research continues.
Watch this short video – it has excellent information about glaucoma surgery at the Sydney Eye Hospital. Highly recommended if you or someone you know has been offered the surgery.
Congenital or juvenile glaucomas often need surgery: sometimes without delay. In most cases the outcomes are good, and vision can be protected. As with all surgeries, there are risks, including to eyesight, and the child will need to have regular eye checks throughout life.
Who is most at risk?
If you have:
- A family history of glaucoma
- High eye pressure
- Are over 50 years old
- African or Asian descent
- Short-sightedness or long sightedness
- Previous eye injury
- Past or present prolonged use of steroids
- A tendency to migraine or colds hands and feet in winter
- High or low blood pressure
However, even if you don’t have these factors, glaucoma can still happen to you.
Help us in our work against this disease.
Sydney Eye Hospital tests for the glaucomas, undertakes significant research into these diseases and is involved in developing new and safer forms of treatment.
The Sydney Eye Hospital Foundation supports the hospital’s programs through focused fund-raising aimed at saving sight, including the funding of a Glaucoma Fellowship. Glaucoma Fellows perform surgery under experienced supervision, do rounds of in-patients, conduct clinics and undertake research. They often come from overseas and take back their knowledge and skills to their homeland.
Join us in supporting this research and the Sydney Eye Hospital’s many other programs dedicated to eye health and cutting-edge solutions to eye disease.