Glaucoma

Open-angle glaucoma is the most common type, accounting for about 90 percent of cases in the United States. The drainage angle looks normal and open, but the drainage system does not work properly. Pressure rises slowly over months or years, gradually damaging the optic nerve. This type is painless and causes no early symptoms, making regular eye exams essential.

Angle-closure glaucoma happens when the iris bulges forward and blocks the drainage angle, preventing fluid from leaving. This can develop slowly or suddenly as an emergency. Acute angle-closure glaucoma requires immediate medical attention. Symptoms include severe eye pain, headache, nausea, vomiting, blurred vision, and halos around lights.

Some people develop optic nerve damage even with normal eye pressure. This is called normal-tension glaucoma, and the exact cause is not fully understood. The optic nerve may be more sensitive to pressure or may not get adequate blood flow. People with migraines, sleep apnea, or poor circulation may be at higher risk.

Secondary glaucoma develops from another eye condition, injury, or medical problem. Eye inflammation, tumors, advanced cataracts, diabetes, and long-term steroid use can all lead to secondary glaucoma. Treating the underlying cause is important along with controlling eye pressure.

Babies and young children can be born with glaucoma or develop it early when the drainage system does not develop properly. Signs include unusually large eyes, cloudy corneas, excessive tearing, and light sensitivity. Early diagnosis and treatment are critical for preserving vision. Childhood glaucoma can also occur from injuries, surgery, or other eye diseases.

Every evaluation starts with a thorough examination. Our eye doctors ask about medical history, family history of glaucoma, and vision problems. We check vision at various distances and examine the front of the eyes. After dilating the pupils, we examine the inside of the eyes and the optic nerve.

Tonometry measures the pressure inside the eye, called intraocular pressure. The most accurate method is Goldmann applanation tonometry, which gently touches the eye surface after numbing drops. Pressure readings vary from person to person. Some people with higher pressures never develop glaucoma while others develop it with lower pressures, which is why we use multiple tests together.

Ophthalmoscopy allows direct examination of the optic nerve. After dilating the pupils, we use magnifying lenses and special lights to view the optic nerve. We check for signs of damage like cupping, where the center becomes hollowed out. We also compare color and shape to previous exams to detect changes.

Visual field testing maps peripheral vision to check for blind spots. During this test, the person looks straight ahead while small lights flash in different locations. A button is pressed when a light is seen, and the computer creates a map showing areas where vision is reduced. This helps detect early damage and track progression.

Optical coherence tomography, or OCT, takes detailed pictures of the optic nerve and nerve fiber layer. This painless test uses light waves to create images similar to an MRI. OCT can detect very early damage before vision changes are noticed and before damage appears on visual field testing. It helps track progression and treatment effectiveness.

Gonioscopy examines the drainage angle where fluid leaves the eye. Using a special contact lens and microscope after numbing, we see whether the angle is open, narrow, or closed. This determines what type of glaucoma is present and guides treatment decisions.

Pachymetry measures corneal thickness. A probe gently touches the eye after numbing drops, or newer devices measure without touching. Corneal thickness affects how eye pressure readings should be interpreted. Thinner corneas may indicate higher risk and need more careful monitoring.

There is currently no cure for glaucoma, and vision loss cannot be reversed. The optic nerve damage is permanent. However, treatment can stop or slow further damage and preserve remaining vision. With proper treatment and monitoring, most people diagnosed early keep good functional vision for life.

Most people diagnosed and treated early will not go completely blind. The key is catching the disease before significant damage occurs and following the treatment plan carefully. Without treatment, glaucoma can eventually lead to complete blindness, but this is preventable with proper care.

Glaucoma damages peripheral vision first, and the brain fills in missing areas so loss is not noticed. By the time vision problems are realized, significant permanent damage has occurred. Treatment prevents future damage, so starting before symptoms appear is critical.

Primary open-angle glaucoma is completely painless. However, acute angle-closure glaucoma causes severe eye pain and is a medical emergency. If sudden eye pain occurs with nausea, blurred vision, or halos around lights, seek immediate medical attention.

Most patients need exams every three to six months once treatment starts. Those with advanced disease or poorly controlled pressure need more frequent visits, while those with stable glaucoma might be seen less often. When treatment is first started or changed, more frequent monitoring is needed.

Many people with glaucoma can continue driving safely, especially if the disease is caught early. However, glaucoma affects peripheral vision, which is important for safe driving. Our eye doctors can assess vision and determine if driving is safe based on state requirements.

Occasional missed doses will not cause immediate harm, but regularly missing doses allows pressure to rise and causes more optic nerve damage. If a dose is forgotten, put in the drop when remembered unless it is almost time for the next dose. Never double up doses.

Both eye drops and laser treatment are safe and effective. Research shows selective laser trabeculoplasty can control pressure as well as drops for many people. Laser has the advantage of not requiring daily medication, but effects may wear off over time. The best choice depends on glaucoma type, pressure levels, and personal preferences.

Yes, glaucoma has a strong genetic component. If a parent or sibling has glaucoma, the risk is four to nine times higher. Family members should have regular comprehensive eye exams starting in their 30s or 40s and be screened more frequently.

While uncommon, children can develop glaucoma. Congenital glaucoma occurs when babies are born with drainage problems. Signs include unusually large eyes, corneal cloudiness, excessive tearing, and light sensitivity. Early diagnosis and treatment are critical for preserving vision in children.

Glaucoma often affects both eyes, though one may be more severely affected or develop disease earlier. Sometimes glaucoma starts in only one eye, but there is usually risk the other eye will develop it over time. We examine and monitor both eyes carefully at every visit.

Yes, and combining cataract surgery with glaucoma treatment is often beneficial. Many minimally invasive glaucoma procedures can be performed during cataract surgery. Cataract surgery alone sometimes lowers eye pressure slightly. Our ophthalmologists will evaluate both conditions and recommend the best approach.

Sudden, severe eye pain can be a sign of acute angle-closure glaucoma, which is a medical emergency. If sudden eye pain occurs with headache, nausea, blurred vision, or halos around lights, go to an emergency room immediately. This condition can cause permanent vision loss within hours if not treated promptly.

While stress does not directly cause glaucoma, chronic stress can affect overall health and may indirectly influence progression through effects on blood pressure, sleep quality, and blood flow. Managing stress through relaxation techniques, exercise, and healthy lifestyle habits is beneficial for general health and may help protect vision.

Ocular hypertension means having higher than average eye pressure without optic nerve damage or vision loss. Not everyone with ocular hypertension develops glaucoma, but they are at increased risk. Glaucoma involves actual damage to the optic nerve and vision loss. People with ocular hypertension need regular monitoring to watch for early signs of glaucoma.