Open your eyes to glaucoma
Contents
1. What is Glaucoma?
2. Who is at Risk of Glaucoma?
3. How is Glaucoma Detected?
4. How is Glaucoma Treated?
5. What Can I Expect in the Years to Come? Will I Lose My Sight?
6. Having Glaucoma.
7. The Best Way to Put the Drops In.
8. Different Types of Glaucoma.
9. Frequently Asked Questions.
10. Associations and Contact Information.
40% of your optic nerve can be damaged before you notice any loss of vision.
1. What is Glaucoma?
Glaucoma is a general term used to describe damage to the optic nerve. The most common type is called Primary Open Angle Glaucoma (POAG). It is caused by an increase in pressure within the eye, referred to as Intraocular pressure (IOP). A certain amount of pressure inside the eye is important to keep the eye’s shape and size. The damage to the optic nerve in glaucoma is usually associated with excessive pressure within the eye.
The optic nerve is like a cable. It has many nerve fibers that send messages about what we see from the eye to the brain. When damage to the optic nerve fibers occurs, blind spots develop, leading to loss of visual.
If glaucoma is not treated, damage can progress, causing a loss of peripheral (side) vision. Glaucoma may eventually lead to complete visual loss.
Glaucoma cannot be cured but the disease progression can be controlled. Glaucoma can be prevented if it is diagnosed and treated early enough.
The eye produces a watery fluid, called aqueous humour. Normally the fluid produced is balanced by fluid draining out, but if it cannot escape, then your eye pressure will rise.
Too much pressure in the eye can damage the optic nerve which is then unable to send images to the brain.
2. Who is at Risk of Glaucoma?
Glaucoma is a leading cause of preventable blindness. Anyone can develop glaucoma, some are at a higher risk than others. Review the checklist that follows to learn if you are at risk.
Are you over 40?
Increasing age is a risk factor for glaucoma.
Do you have a family history of glaucoma?
If you have a parent, sibling or child with glaucoma, you have a 20% chance of developing the condition. An eye test is strongly recommended.
Are you shortsighted (Myopia)?
Are you Afro-caribbean?
Glaucoma is 3 to 8 times more common in Afro-caribbeans compared to people of European origin. The condition is more apparent at an earlier age and more severe. People of Asian origin are also at an increased risk.
Do you have other medical conditions?
Diabetes, poor circulation, migraine headaches, past eye injuries.
The more risk factors described, the more important it is to have your eyes tested regularly for the early symptoms of glaucoma.
How Frequently do I Need to be Tested for the Signs of Glaucoma?
If you have a Risk Factor
Ages 20-29: eye exam every 3-5 years.
Ages 30-39: eye exam every 2-4 years.
Ages 40-64: eye exam every 2 years.
Ages 65 or older: eye exam every 1–2 years.
If you have NO Risk Factors
Ages 20-29: at least one eye exam during this time.
Ages 30-39: at least two eye exams during this time.
Ages 40-64: eye exam every 2-4 years.
Ages 65 or older: eye exam every 2 years.
3. How is Glaucoma Detected?
In its early stages, glaucoma has no symptoms and blind spots usually go undetected until damage to the optic nerve is significant. Glaucoma is usually detected during a routine eye test for spectacles.
Get your eyes tested regularly even if you do not require spectacles.
Regular and complete eye examination by your optician/optometrist is the best way to detect glaucoma.
There are three important tests to detect glaucoma. These tests are simple and painless. The tests will give a good indication of whether further examination is necessary or not.
If you are found to have an abnormal test you may be referred to an eye specialist doctor who will make a diagnosis and if necessary, start treatment.
1. Ophthalmoscopy
An examination of the back of the eye and the appearance of the optic nerve to see if there are any signs of glaucoma damage.
2. Tonometry
Measures the level of intraocular pressure (IOP), which is usually done by blowing a puff of air into the eye. An eye specialist will use a different tonometer to determine your IOP.
It is essential that tests one and two are carried out every time you visit your optician or optometrist. If either of these two tests is abnormal, then you would require test three (visual field test).
3. Perimetry (visual field test)
This tests the peripheral field of vision, checking that there are no missing areas of vision. While watching a central light on a screen, you will be asked to click a button when other lights are flashed in different positions around it.
If you are found to have any suspicious signs of glaucoma, you should be referred to your local eye specialist or eye hospital.
Regular eye tests can help to prevent unnecessary vision loss.
4. How is Glaucoma Treated?
Damage caused by glaucoma is irreversible, but medications, laser or surgery are used to help prevent further loss of vision.
When you attend your local eye specialist or hospital, you will again have to be tested for glaucoma. A similar three tests will be carried out – examining the back of the eye; measuring your intraocular pressure; testing your peripheral field of vision.
The eye doctor will then make a diagnosis as to whether or not you have glaucoma and whether or not treatment is required.
The goal of treatment is to prevent further glaucoma damage.
The aim of glaucoma treatment is to lower eye pressure and for the great majority of people this is achieved with the use of eye drops. A small percentage of people may need laser or surgery.
Eye Drops
Glaucoma is usually controlled by taking eye drops every day. You may not notice an improvement in your vision, but the objective of lowering your eye pressure is to prevent further glaucoma damage.
It is important you take your drops regularly, as advised by your doctor.
Never change or stop taking your medications without consulting your eye specialist.
Eye drops are medications and all medications can have some side effects (please read the label) or interact with other medications. You should notify your eye doctor or eye clinic if you think you may be experiencing side effects. It is also important that you make a list of the medications you take regularly and share this list of information with each doctor you see as some eye drops may cause side effects.
Laser Surgery – may be recommended for different types of glaucoma. In open-angle glaucoma, the drainage system is treated. The laser is used to modify the drainage to help control eye pressure, this is called a trabeculoplasty.
During laser treatment a strong beam of light is focused on the drainage area of the eye, this can increase the outflow of fluid from the eye. However, in time the effect of laser treatment may wear off and it is likely that glaucoma medication will have to be continued.
In closed-angle glaucoma, the laser creates a hole in the iris to improve the flow of aqueous fluid to the drainage system. This is called iridotomy.
Surgery – is recommended if your eye specialist feels it is necessary to prevent further damage to the optic nerve. The operation, called
trabeculetomy creates a new drainage channel for the aqueous fluid to leave the eye, thereby reducing the pressure.
In its early stages, glaucoma has no symptoms and damage caused by glaucoma is irreversible.
5. What Can I Expect in the Years to Come? Will I Lose My Sight?
Glaucoma can be managed and controlled allowing you to go about your life as you did before.
The good news is that people with glaucoma rarely lose their sight, especially if it is detected early and if patients use their eyedrops regularly.
If glaucoma is left untreated, damage increases, which may eventually lead to loss of vision.
It is vitally important you continue to take your drops every day to avoid losing your sight permanently.
6. Having Glaucoma
Although you have glaucoma, the good news is that you can make a positive difference to your future health – simply by taking your eye drops exactly as your eye specialist prescribes.
The important thing to remember is that glaucoma treatment is not a course of treatment – such as courses of antibiotics that last for a few days. The treatment for glaucoma involves taking your eye drops every day, generally for the rest of your life.
To help you get the most out of your eye drops speak to your eye specialist or nurse for any information, hints and tips you may need.
7. The Best Way to Put the Drops In
The following is a recommended way to insert your drops, however there are several techniques in which eye drops may be put into the eye. The important thing is that you continue to use your drops!
- First, wash your hands.
- Use your index finger to gently pull down the bottom eyelid of the affected eye.
- Hold the bottle in your other hand and gently put one drop into the space between the lower lid and the eye.
- Lie back, close your eyes gently and then gently dry the closed eyelid.
- Using your thumb and forefinger, lightly push in on your nose where your two eyelids come together, for about three minutes.
To prevent infecting your other eye, make sure that the tip of the bottle does not touch your eye or anything else.
Although you might feel nervous or find your hands shake at first, keep trying as you will soon get used to putting the drops in.
If you are experiencing difficulty inserting your drops, speak to your doctor or nurse about a device that will assist with the administration of drops.
Clinic Appointments
At your clinic appointments, your eye specialist will be able to see how well your treatment has been working since your last appointment. Remember to put your drops in as usual before your visit.
Missing a Dose
Don’t panic! If you do forget a dose, just put your drops in as soon as possible and go back to your regular routine. Never double the dose. Please remember that taking your drops regularly is a vital part of your treatment, so make a special effort not to forget again.
8. Different Types of Glaucoma
A. Primary Open Angle Glaucoma (POAG)
This is the most common form of glaucoma. It is a slowly developing condition. The pressure in the eye rises slowly, without pain to warn of a problem, whilst the optic nerve is being damaged. If this fluid cannot escape or an excess is produced, the pressure in the eye will rise.
Some eyes may have moderately raised pressure, but no signs of vision loss or optic nerve damage, this is known as Ocular hypertension.
B. Normal Tension Glaucoma
In glaucoma, the eye pressure is not always high. Glaucoma can develop where eye pressure is within the statistically “normal” range but the optic nerve becomes damaged. This is known as normal or low tension glaucoma. In fact, about 20% of all glaucoma patients have this form of the disease.
C. Angle Closure Glaucoma
This is relatively uncommon type of glaucoma, which causes pain, blurring of vision and a red eye. Sometimes people may notice halos around street lights. This condition tends to occur over 24-48 hours, due to a very rapid rise in the eye pressure. Early treatment can reverse the problem and prevent long-term visual damage.
If you suffer from the symptoms above, you should contact your GP stating you have an eye emergency.
Things to Remember
- Put your eye drops in every day.
- Put your drops in before you have a clinic appointment.
- Go to all your appointments.
- Make sure you don’t run out of your medication.
9. Frequently Asked Questions
Will I Always have Glaucoma?
Damage caused by glaucoma is irreversible. It is important to prevent further glaucoma damage and progression of visual loss. This can be achieved by taking your eye drops. Surgery may make the subsequent treatment unnecessary although regular check-ups would be necessary.
Early detection is of the greatest importance.
Is there a Cure?
No, there is no cure, but the majority of people with glaucoma can be well managed with the use of eye drops. A small percentage might need laser or surgery.
Will I Go Blind?
If glaucoma is not treated, damage can progress, causing a loss of peripheral vision. Glaucoma may eventually lead to complete visual loss. It is important to have regular and comprehensive eye examinations to detect any early signs of glaucoma damage.
What Can I Do?
Get your eyes tested regularly by a local optician or as advised by your eye specialist. Find out if you have a history of glaucoma in the family. If you have been diagnosed with glaucoma, follow your eye specialist’s instructions and take your eye drops as prescribed.
10. Associations and Contact Information
International Glaucoma Association (IGA)
Woodcote House
15 Highpoint Business Village
Henwood, Ashford
Kent TN24 8DH
Telephone: +44 87 0609 1870
Email: info@iga.org.uk
www.glaucoma-association.com
NCBI (National Council for the Blind of Ireland
Whitworth Road
Drumcondra
Dublin 9
Telephone: 1850 334 353
Email: info@ncbi.ie
www.ncbi.ie
Fighting Blindness
Chapel Hill
Christchurch
Dublin 8
Telephone: 01 709 3050
www.fightingblindness.ie
Royal National Institute of the Blind (RNIB)
105 Judd Street
London WC1H 9NE
Telephone: +44 (0)20 7388 1266
Telephone: 01 467 6500
www.rnib.org.uk
Acknowledgements
- Mater Misericordiae University Hospital
- Royal Victoria Eye and Ear Hospital
- University College Hospital Galway