Glaucoma Treatment

glaucomaGlaucoma is a group of diseases that are generally distinguished by an increase in pressure inside the eye, which causes damage to the optic nerve. Interestingly, elevated eye pressure is not always noted however.

To understand glaucoma, one must first understand the normal circulation of the eye. The eye receives its nourishment from a clear fluid called “aqueous fluid” which is continually produced inside the eye. The aqueous is returned to the blood stream through the eye’s drainage “angle” between the cornea (the clear window of the eye) and the iris (the colored part of the eye). When the fluid cannot drain fast enough, pressure inside the eye begins to build. This excess fluid pressure pushes against the delicate optic nerve that connects the eye to the brain. If the pressure remains too high for too long, irreversible damage to the nerve and subsequent vision loss can occur.

Open Angle Glaucoma

Open angle glaucoma is the most common type of glaucoma, affecting 70 percent to 80 percent of those who suffer from the disorder.

Open angle glaucoma is the leading cause of blindness among adults in the United States and is particularly dangerous because it can progress gradually and go unnoticed for years. The disease usually affects both eyes. The only way to detect glaucoma before it becomes a serious problem is with regular eye examinations. These examinations will often include a simple, painless pressure test.

Open angle glaucoma typically occurs in patients over the age of 50, and the risk increases with age. African-Americans are at higher risk of developing the condition than Caucasians and, if there is a family history of glaucoma, the risk is up to six times higher than for the general population. Also, patients who are highly myopic (nearsighted), are at increased risk.

Another form of open angle glaucoma is called low-tension or normal-tension glaucoma. It is not known why, but patients with this condition are found to have normal eye pressures. Nonetheless, they go on to develop optic nerve damage and vision loss just like patients who have high eye pressures.

Open angle glaucoma cannot be cured, but it can be controlled by lowering the pressure in the eye, with the use of eyedrops, laser or surgery.

In most cases, if medications are successful in controlling the eye pressure, they will be continued for the rest of the patient’s life, and regular use according to a physician’s instructions is absolutely necessary to maintain control of the disease.

Narrow Angle Glaucoma

Narrow angle glaucoma is another form of glaucoma independent from open angle glaucoma and it presents quite differently.

A “narrow angle” is an eye condition where the iris (colored part of the eye) is too close to the drainage angle of the eye. The iris is at risk for being drawn into the angle, totally blocking any drainage and resulting in angle closure glaucoma. In contrast to open angle glaucoma where the visual loss is often quite gradual (generally occurs over months to years) and the eye pressure elevation is generally mild, angle closure glaucoma can result in vision loss over minutes to hours due to the exceedingly high pressures that occur. This excess fluid pressure damages the delicate optic nerve that connects the eye to the brain. Rapid and irreversible vision loss can occur if treatment is delayed.

Symptoms of angle closure glaucoma include the onset of severe eye pain, eye redness, blurry vision with halos around lights, nausea and sometimes vomiting.

Because drainage from the eye occurs normally up to the point when the drainage angle becomes blocked, most patients who are at risk for angle closure glaucoma (i.e. those with narrow angles) have normal eye pressures and no symptoms prior to an attack.

Patients at risk for angle closure include those who are farsighted, those with small eyes, and some patients with cataracts. Patients found to have narrow angles should avoid cold remedies which contain Pseudoephedrine, Phenylephrine or Neo-Synephrine; anti-histamines like Chlorpheniramine, Diphenhydramine or Benadryl and overactive bladder remedies such as Detrol. These medications can narrow the angle further and lead to an attack of angle closure.

Angle closure glaucoma is a true medical emergency. Fortunately, it is often preventable if patients at risk are identified and treated prior to an acute attack. An eye examination is necessary to establish the diagnosis and determine one’s risk for this condition. Should you experience any of the symptoms of angle closure as described above, it is imperative that you see your Eye MD (ophthalmologist) immediately to prevent/limit vision loss from this potentially blinding condition.

Glaucoma DiagnosisAt the East West Eye Institute we are specialists in the diagnosis and management of all forms of glaucoma. Because no single test exists that can diagnose glaucoma in all affected individuals, we have a multitude of state of the art advanced diagnostic devices to assist our doctors in accurately assessing your risk of glaucoma.

Ocular Coherence Tomography (OCT) - This instrument can be thought of as a high-resolution computer generated picture of the back of the eye, namely the optic nerve and retina. The OCT is used to detect changes in these structures that are caused by glaucoma. It can often detect these changes at their earliest stages, long before any clinically measurable vision loss occurs.

Humphrey visual field – This instrument measures one’s “side” or “peripheral” vision. Loss of peripheral vision is asymptomatic and can occur early in the disease process. Once any vision is lost in glaucoma, it generally can not be recovered. The purpose of this test is twofold: First, it serves as a baseline measurement to detect if any peripheral vision loss has occurred prior to an initial evaluation for glaucoma. Second, it is repeated periodically to see if any progression in the disease process has occurred between visits. Most commonly, each eye is tested once per year, more often if necessary.

Corneal pachymetry – This important test measures the thickness of the cornea, the clear window that makes up the front surface of the eye.  The thickness of the cornea relates directly to the accuracy of the eye pressure measurement. If one has a thick cornea, the pressure reading taken directly from the machine will be falsely elevated, i.e. it will read higher than it actually is. For example, if a patient has a thick cornea and the pressure reading from the machine is 22 (normal for most people is generally between 10 to 20), the “true” pressure will be less, maybe 17 or 18, depending on how thick the cornea is. In this case, what initially looks to be a high pressure, in reality is likely to be a normal pressure. The converse is also true. If one has a thin cornea, the intraocular pressure measurement shown by the machine will be less than it actually is. This test is generally performed once per eye at or around the time of the first visit to calibrate our measurements accordingly. Without this test, we cannot be sure of the accuracy of the intraocular pressure measurements.

Digital stereoscopic photography – Characteristic changes called “cupping” can be seen in the optic nerve head as the damage from glaucoma progresses. This cupping usually occurs early in the disease process, well before a patient has noticeable vision loss. Baseline photographs are an excellent way to document this cupping. During subsequent visits, the appearance of the optic nerve cupping can be compared to the baseline photographs. Any increase in cupping is a sign that glaucoma is progressing. Optic nerve head photos are usually taken every 1 to 5 years, depending on the severity of the disease.

Open Angle Glaucoma

Open angle glaucoma cannot be cured, but it can be controlled by lowering the pressure in the eye, with the use of eyedrops, laser or surgery.

In most cases, if medications are successful in controlling the eye pressure, they will be continued for the rest of the patient’s life, and regular use according to your physician’s instructions is absolutely necessary to maintain control of the disease.

An argon laser trabeculoplasty is an effective treatment that can often help to lower eye pressures for several years when eyedrops are not enough. The offices of the East West Eye Institute are equipped with in-house argon lasers so necessary treatment is quick, effective and relatively painless. Most patients return to full activity with no restrictions immediately after their treatment.

If medications and/or laser do not provide adequate control of the condition, a surgical procedure known as a trabeculectomy may be necessary. You can be assured that our doctors have performed thousands of such operations, and we will put this vast experience to use to help you should the need arise.

Narrow Angle Glaucoma

Fortunately, most eyes with narrow angles that are at risk for angle closure can be identified by an eye examination. To prevent an attack of angle closure, a laser peripheral iridotomy may be recommended. With this procedure, a laser is used to create a tiny hole in your iris near the drainage angle, effectively preventing any chance for blockage of the angle from occurring. This eliminates the risk of angle closure glaucoma for most narrow angle patients. The procedure is relatively painless and can be done in the office, and usually takes just a few minutes to perform.

Side effects of a laser peripheral iridotomy are generally mild but may include increased glare and rarely double vision. A pressure “spike” can sometimes occur immediately after the procedure. This can usually be controlled in the office by the use of eyedrops. On rare occasions, the iridotomy created by the laser may close, requiring a repeat laser procedure to reopen this tiny hole.

Glaucoma Doctors in West Los Angeles

The eye doctors at the East West Eye Institute want you to know that glaucoma is a potentially serious eye disease and that we have the expertise to diagnose and manage all forms of this potentially sight threatening condition.


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