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Glaucoma is a loss of vision from damage to the optic nerve, the major nerve from the eye to the brain. In most cases, the damage is by excessive fluid pressure within the anterior area of the eye; however, glaucoma can damage the eye even when such intraocular fluid pressure is normal.
In primary open-angle form of glaucoma which is more prevalent, pressure rises gradually with vision fading over time. A less common form, acute or angle-closure glaucoma develops quickly and usually painfully from blockage of normal fluid flow within the drainage channels in the eye. Other, rarer forms may relate to eye defects that develop before birth such as congenital glaucoma, eye injuries, tumors, or secondary effects of diabetes. Corticosteroid medications have precipitated cases of glaucoma.
Glaucoma is life-long but with proper treatment can prevent loss of vision. As many as 2.5 million Americans suffer from glaucoma, many of them unaware of it. Glaucoma tends to afflict families. It is five times more common in blacks than in whites. The risk of glaucoma also increases with age in people of all racial and ethnic backgrounds.
Both open-angle and angle-closure forms of glaucoma can cause blindness, but they present different symptoms:
Routine examinations of the back of the eye can discover changes in the appearance of the optic nerve suggesting open-angle glaucoma. If suspected, the examiner can confirm the suspicion by applying one or more tests:
There is no diagnosis of open-angle glaucoma without evidence of optic nerve damage. Some cases display elevated intraocular pressure but no optic nerve damage. Not everyone with elevated pressure develops glaucoma, nor does everyone with glaucoma have elevated eye pressure.
Glaucoma cannot be prevented; however, glaucoma screening & treatment may identify early stages of glaucoma or elevated eye pressures. There is no medical consensus about who should be screened. African Americans over 40 years old seem to be most at risk. The family history of glaucoma and advanced age also increase the risk. Medicare covers glaucoma screening for diabetics, patients with family histories of glaucoma, or blacks aged 50 and older.
In the United States, treatment of open-angle glaucoma ordinarily begins with prescription eye drops to lower pressure inside the eye. An alternative to medication or when medication is ineffective, trabeculoplasty, laser surgery, is available. Eye surgeons aim a high-intensity light beam at the eye drainage openings to widen them for faster fluid drainage.
If medication and laser surgery both fail, conventional eye surgery by which surgeons create new openings for fluid drainage is the next procedure. Both types of glaucoma surgery, laser and conventional, usually succeed in decreasing pressure but not always low enough, and repeat surgery may be needed.
Many patients fail to continue treatment because they are in no pain and do not notice the gradual loss of vision. They should remember that glaucoma treatment prevents additional eye damage but cannot restore vision already lost.
Closed-angle glaucoma patients must receive treatment as soon as possible to prevent loss of vision. Treatment usually starts with laser surgery to create a new opening in the iris to allow fluid drainage. If done soon enough, this surgery often proves to be a cure, but it may be temporary with the necessity of further surgery or long-term use of eye drops.
The prognosis depends on the form of glaucoma: