National Glaucoma Month - Tacoma, WA

What Is Glaucoma?

Glaucoma is a group of eye diseases that gradually steal sight without warning. In the early stages of the disease, there may be no symptoms. Experts estimate that half of the people affected by glaucoma may not know they have it.

Vision loss is caused by damage to the optic nerve. This nerve acts like an electric cable with over a million wires. It is responsible for carrying images from the eye to the brain.

There is no cure for glaucoma—yet. However, medication or surgery can slow or prevent further vision loss. The appropriate treatment depends upon the type of glaucoma among other factors. Early detection is vital to stopping the progress of the disease.

It was once thought that high pressure within the eye, also known as intraocular pressure or IOP, is the main cause of this optic nerve damage. Although IOP is clearly a risk factor, we now know that other factors must also be involved because even people with “normal” levels of pressure can experience vision loss from glaucoma.

Are You At Risk For Glaucoma?

Everyone is at risk for glaucoma. However, certain groups are at higher risk than others.

People at high risk for glaucoma should get a complete eye exam, including eye dilation, every one or two years.

The following are groups at higher risk for developing glaucoma.

African-Americans

Glaucoma is the leading cause of blindness among African-Americans. It is six to eight times more common in African-Americans than in Caucasians.

People Over 60

Glaucoma is much more common among older people. You are six times more likely to get glaucoma if you are over 60 years old.

Family Members with Glaucoma

The most common type of glaucoma, primary open angle glaucoma, is hereditary. If members of your immediate family have glaucoma, you are at a much higher risk than the rest of the population.

Family history increases risk of glaucoma four to nine times.

Hispanics in Older Age Groups

Recent studies indicate that the risk for Hispanic populations is greater than those of predominantly European ancestry, and that the risk increases among Hispanics over age 60.

Asians

People of Asian descent appear to be at some risk for angle closure glaucoma. Angle closure glaucoma accounts for less than 10% of all diagnosed cases of glaucoma. Otherwise there is no known increased risk in Asian populations.

Steroid Users

Some evidence links steroid use to glaucoma. A study reported in the Journal of American Medical Association, March 5, 1997, demonstrated a 40% increase in the incidence of ocular hypertension and open angle glaucoma in adults who require approximately 14 to 35 puffs of steroid inhaler to control asthma. This is a very high dose, only required in cases of severe asthma.

Eye Injury

Injury to the eye may cause secondary open angle glaucoma. This type of glaucoma can occur immediately after the injury or years later.

Blunt injuries that “bruise” the eye (called blunt trauma) or injuries that penetrate the eye can damage the eye’s drainage system, leading to traumatic glaucoma.

The most common cause is sports-related injuries such as baseball or boxing.

Other Risk Factors

Other possible risk factors include:

• high myopia (nearsightedness)

• diabetes

• hypertension

• Central corneal thickness less than .5 mm.

Types Of Glaucoma:

• Primary Open Angle Glaucoma

• Angle Closure Glaucoma

• Normal Tension Glaucoma (NTG)

• Secondary Glaucoma

• Pediatric Glaucoma

• Overview

• All

The two main types of glaucoma are primary open angle glaucoma (POAG), and angle closure glaucoma. These are marked by an increase of intraocular pressure (IOP), or pressure inside the eye. When optic nerve damage has occurred despite a normal IOP, this is called normal tension glaucoma. Secondary glaucoma refers to any case in which another disease causes or contributes to increased eye pressure, resulting in optic nerve damage and vision loss.

Early detection, through regular and complete eye exams, is the key to protecting your vision from damage caused by glaucoma.

It is important to have your eyes examined regularly. Your eyes should be tested:

• before age 40, every two to four years

• from age 40 to age 54, every one to three years

• from age 55 to 64, every one to two years

• after age 65, every six to 12 months

Anyone with high risk factors, should be tested every year or two after age 35.

Four Common Tests for Glaucoma

Regular glaucoma check-ups include two routine eye tests: tonometry and ophthalmoscopy.

TONOMETRY

The tonometry test measures the inner pressure of the eye. Usually drops are used to numb the eye. Then the doctor or technician will use a special device that measures the eye’s pressure.

OPHTHALMOSCOPY

Ophthalmoscopy is used to examine the inside of the eye, especially the optic nerve. In a darkened room, the doctor will magnify your eye by using an ophthalmoscope (an instrument with a small light on the end). This helps the doctor look at the shape and color of the optic nerve.

If the pressure in the eye is not in the normal range, or if the optic nerve looks unusual, then one or two special glaucoma tests will be done. These two tests are called perimetry and gonioscopy.

PERIMETRY

The perimetry test is also called a visual field test. During this test, you will be asked to look straight ahead and then indicate when a moving light passes your peripheral (or side) vision. This helps draw a “map” of your vision.

GONIOSCOPY

Gonioscopy is a painless eye test that checks if the angle where the iris meets the cornea is open or closed, showing if either open angle or closed angle glaucoma is present.

Optic Nerve Computer Imaging

In recent years three new techniques of optic nerve imaging have become widely available. These are scanning laser polarimetry (GDx), confocal laser ophthalmoscopy (Heidelberg Retinal Tomography or HRT), and optical coherence tomography (OCT).

The GDx machine does not actually image the optic nerve but rather it measures the thickness of the nerve fiber layer on the retinal surface just before the fibers pass over the optic nerve margin to form the optic nerve. The HRT scans the retinal surface and optic nerve with a laser. It then constructs a topographic (3-D) image of the optic nerve including a contour outline of the optic cup. The nerve fiber layer thickness is also measured. The OCT instrument utilizes a technique called optical coherence tomography which creates images by use of special beams of light. The OCT machine can create a contour map of the optic nerve, optic cup and measure the retinal nerve fiber thickness. Over time all three of these machines can detect loss of optic nerve fibers.

Your intraocular eye pressure (IOP) is important to determining your risk for glaucoma. If you have high IOP, careful management of your eye pressure with medications can help prevent vision loss. Recent discoveries about the cornea, the clear part of the eye’s protective covering, are showing that corneal thickness is an important factor in accurately diagnosing eye pressure. In response to these findings, the Glaucoma Research Foundation has put together this brief guide to help you understand how your corneal thickness affects your risk for glaucoma, and what you can do to make sure your diagnosis is accurate.

Corneal Thickness

In 2002, the five-year report of the Ocular Hypertension Study (OHTS) was released. The study’s goal was to determine if early intervention with pressure lowering medications could reduce the number of ocular hypertensive (OHT) patients that develop glaucoma. During the study, a critical discovery was made regarding corneal thickness and its role in intraocular eye pressure and glaucoma development.

WHY IS CORNEAL THICKNESS IMPORTANT?

Corneal thickness is important because it can mask an accurate reading of eye pressure, causing doctors to treat you for a condition that may not really exist or to treat you unnecessarily when are normal. Actual IOP may be underestimated in patients with thinner CCT, and overestimated in patients with thicker CCT. This may be important to your diagnosis; some people originally diagnosed with normal tension glaucoma may in fact be more accurately treated as having regular glaucoma; others diagnosed with ocular hypertension may be better treated as normal based on accurate CCT measurement. In light of this discovery, it is important to have your eyes checked regularly and to make sure your doctor takes your CCT into account for diagnosis.

A THIN CORNEA—THE DANGER OF MISREADING EYE PRESSURE

Many times, patients with thin corneas (less than 555 µm) show artificially low IOP readings. This is dangerous because if your actual IOP is higher than your reading shows, you may be at risk for developing glaucoma and your doctor may not know it. Left untreated, high IOP can lead to glaucoma and vision loss. It is important that your doctor have an accurate IOP reading to diagnose your risk and decide upon a treatment plan.

A THICKER CORNEA MAY MEAN LESS REASON TO WORRY ABOUT GLAUCOMA

Those patients with thicker CCT may show a higher reading of IOP than actually exists. This means their eye pressure is lower than thought, a lower IOP means that risk for developing glaucoma is lowered. However, it is still important to have regular eye exams to monitor eye pressure and stay aware of changes.

PACHYMETRY—A SIMPLE TEST TO DETERMINE CORNEAL THICKNESS

A pachymetry test is a simple, quick, painless test to measure the thickness of your cornea. With this measurement, your doctor can better understand your IOP reading, and develop a treatment plan that is right for your condition. The procedure takes only about a minute to measure both eyes.