Eyes on eye disease: Glaucoma

Glaucoma (or “gloocoma” as many of my patients like to pronounce it) is one of the leading causes of irreversible vision loss in the world. In most cases, it produces no noticeable symptoms until the advanced stage when you suddenly realise you can’t see anything other than what’s right in front of you. This is essentially what we call tunnel vision, or in some cases, “my husband’s vision”. mansaysnotthere

In a nutshell, glaucoma is a disease of the optic nerves (the bit that sends neural information from the eyeball to the visual cortex of your brain) that is brought on by the pressure inside the eye being at a level too high to maintain healthy optic nerve function. The optic nerve fibres become damaged and the peripheral vision deteriorates. If you think about too much pressure being applied on anything – for example, Asian parents on their kids’ studies – then you can imagine the risk of crumpling under this pressure, never to fully recover, living the remainder of your days as but a miserable shell of a person. Was that a bit dramatic? Maybe.

In most cases glaucoma is easily diagnosed and treated. How is it diagnosed, you may ask? Well, number 1 – by having regular eye tests. Your optometrist will be able to assess your risk of glaucoma by using a few different procedures, such as:

  • assessing the physical appearance of your optic nerves using fundoscopy or retinal photography
  • measuring the intraocular pressure in your eyeballs using tonometry
  • analysing the thickness of your nerve fibre layer using optical coherence tomography (aka “retinal scan”)
  • boring you out of your brains by making you do a visual field test (aka click button whenever you see a spot or flicker out of your peripheral vision)

Note that some of these tests may not be performed routinely but only if there is a reasonable suspicion of glaucoma. You will not be able to diagnose yourself with glaucoma just by looking in a mirror, therefore, keeping up with optometric exams is important. For other things you can’t diagnose with a mirror, have a look at Do I Really Need an Eye Test?

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Here is a picture of an eye with no glaucoma
old-eye-detail-46174447
Here is a picture of an eye with glaucoma

 

 

 

 

 

 

It is also important to be aware of any family history of glaucoma (or any other eye disease, for that matter), as there can be a genetic predisposition. Other risk factors include Asian ethnicity, long-sightedness, female gender (lucky me on all three counts), as well as other things like borderline intraocular pressures, increasing age, and conditions such as pseudoexfoliation and pigment dispersion syndrome.

There is a type of glaucoma known as “angle closure glaucoma”. This type of glaucoma will often present as redness of the eye, blurriness of the vision and haloes around lights, and pain in the eye that is sometimes so intense it can cause vomiting. In these instances the pressure in the eye has shot up to an extremely high level, and this becomes an ocular emergency so take yourself straight to hospital!

Treatment of glaucoma is usually quite straightforward with the aim of lowering the intraocular pressure to protect the optic nerve. This is most commonly achieved by using either daily eye drops or a longer-lasting laser procedure. Treating glaucoma doesn’t recover sight that has already been lost but it will prevent or slow the progression of any further sight loss.

silent_thief
An artist’s impression of peripheral vision loss from glaucoma (image credit: http://www.goyaleye.com/glaucoma.html

 

If your optometrist diagnoses you with glaucoma or has a high suspicion, he/she may refer you onwards to an ophthalmologist (eye doctor) if further assessment or treatment is required. Some therapeutically endorsed optometrists are even able to initiate glaucoma medication treatment themselves, which is particularly useful for those living in rural areas where ophthalmology appointments are hard to come by. Further information can be found at http://www.glaucoma.org.au/index.html.

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