Glaucoma is an umbrella term for eye diseases that make pressure build up inside your eyeball, which can damage delicate, critical parts at the back of your eye.
Most of these diseases are progressive, which means they gradually get worse. As they do, they can eventually cause permanent vision loss and blindness. In fact, glaucoma is the second-leading cause of blindness worldwide. Learning that you have glaucoma or that you’re at risk for it can be hard to process. For most people, vision is the sense they rely on most in their daily routine. It can feel scary to imagine trying to adapt to and live your life after you have severe vision loss.
But most forms of glaucoma are treatable, especially when diagnosed early. And with care and careful management, it’s possible to delay — or even prevent — permanent vision loss.
SYMPTOMS AND CAUSES
Glaucoma happens when high pressure in your eye presses on and damages your optic nerve and retina. Glaucoma happens when high pressure inside your eye damages your optic nerve and retina. In its early stages, glaucoma may not cause any symptoms. And symptoms may not appear until this condition causes irreversible damage.
Some of the more common Glaucoma symptoms include: Eye pain or pressure. Headaches. Red or bloodshot eyes. Double vision (diplopia). Blurred vision. Gradually developing low vision. Gradually developing blind spots (scotomas) or visual field defects like tunnel vision.
Some types of Claucoma, particularly angle closure glaucoma, can cause sudden, severe symptoms that need immediate medical attention to prevent permanent vision loss. Emergency glaucoma symptoms include: Blood gathering in front of your iris (hyphema). Bulging or enlarged eyeballs (buphthalmos). Nausea and vomiting that happen with eye pain/pressure. Rainbow-colored halos around lights. Sudden appearance or increase in floaters (myodesopsias). Sudden vision loss of any kind. Suddenly seeing flashing lights (photopsias) in your vision.
WHAT CAUSES GLAUCOMA?
Glaucoma is caused by damage to your optic nerve. It can occur without any cause, but many factors can affect the condition. The most important of these risk factors is intraocular eye pressure. Your eyes produce a fluid called aqueous humor that nourishes them. This liquid flows through your pupil to the front of your eye. In a healthy eye, the fluid drains through mesh-like canals (trabecular meshwork), which is where your iris and cornea come together at an angle. With glaucoma, the resistance increases in your drainage canals. The fluid has nowhere to go, so it builds up in your eye. This excess fluid puts pressure on your eye. Eventually, this elevated eye pressure can damage your optic nerve and lead to glaucoma. What makes the fluid build up can vary, depending on the specific overall type of glaucoma you have.
TYPES OF GLAUCOMA
There are many different types of Glaucoma, but they mainly fall under a few specific categories:
Primary open-angle glaucoma: “Open-angle” means that the drainage angle, where the inside of the sclera (the white of your eye) and the outer edge of your iris meet, is open wide. Aqueous humor flows into the drainage angle so it can drain out of the anterior chamber. This is the most common type of glaucoma.
Primary angle-closure glaucoma: Aqueous humor fluid is supposed to flow from the posterior chamber behind your iris, through your pupil, and into the anterior chamber. But sometimes, the lens of your eye presses too far forward, blocking fluid from flowing through the pupil opening. The extra fluid in the posterior chamber forces the iris forward, narrowing or closing off the drainage angle.
Secondary glaucoma: This is when another condition or event increases eye pressure, which leads to glaucoma. Conditions that can cause it include eye injuries, pigmentary dispersion syndrome, uveitis, certain medications (especially corticosteroids and cycloplegics), eye procedures and more.
Congenital glaucoma: This means you have glaucoma because of changes or differences that happened during fetal development. These include aniridia, Axenfeld-Rieger syndrome, Marfan syndrome, congenital rubella syndrome and neurofibromatosis type
WHAT ARE THE RISK FACTORS FOR GLAUCOMA?
Several risk factors can contribute to glaucoma. They include:
Age: Most types of glaucoma affect people age 40 and older (congenital types are the biggest exception to this). Experts estimate that 10% of people age 75 and older have Glaucoma.
Race: Black people have a much higher risk of developing primary open-angle glaucoma, especially people of Afro-Caribbean descent. People of African descent are 15 times more likely to have blindness from open-angle glaucoma. People of Asian and Inuit descent have a higher risk of angle-closure glaucoma.
Sex: People assigned female at birth (AFAB) have a higher risk of angle-closure glaucoma. Experts suspect this is mainly because of sex-linked differences in eye anatomy.
Refractive errors: People with nearsightedness (myopia) have a higher risk of open-angle glaucoma. People with farsightedness (hyperopia) have a higher risk of angle-closure glaucoma.
Family history: There’s evidence that a family history of glaucoma, especially a first-degree biological relative (a parent, child or sibling), means you also have a higher risk of developing it. And several conditions that cause secondary glaucoma are genetic, too.
Chronic conditions. Research links some conditions, like high blood pressure (hypertension) and diabetes, to much higher odds of developing glaucoma.
WHAT ARE THE COMPLICATIONS OF GLAUCOMA?
Without care to manage it and lower the pressure inside your eye, glaucoma damages your retina and optic nerve to the point where they stop working. That causes glaucoma’s main complication: vision loss and, eventually, total blindness. The end result is what experts call “absolute glaucoma.” That means you’re totally blind in the affected eye. The affected eye feels hard — and maybe even painful — when you touch it.
MANAGEMENT AND TREATMENT
The top priority for treating glaucoma is to keep it from getting worse by lowering the pressure inside your eye (intraocular pressure).
Some of the most likely treatments for this include:
Medications: This mainly involves medications that lower pressure inside your eye. They can prevent glaucoma from developing if you have higher-than-normal intraocular pressure (ocular hypertension) or keep it from worsening enough to cause damage and symptoms.
Glaucoma surgeries: These mainly focus on improving the drainage of aqueous humor fluid to lower pressure inside your eye. Surgery options include trabeculectomy, tube shunts, laser therapy and minimally invasive glaucoma surgeries (MIGS).
Other treatments are possible, depending on what type of glaucoma you have, how it’s affecting your eye and other factors. Your eye care specialist can tell you more about your treatment options and help you choose one that fits your needs best.
PREVENTION
Glaucoma isn’t preventable, but early detection and treatment can manage pressure inside your eye and help prevent or delay vision loss. There are a few main ways that can happen:
Regular eye exams: Pressure increases in your eyes are often detectable before they can cause glaucoma and its symptoms. Early detection lets you and your eye specialist try to prevent glaucoma from worsening or, at least, slow down its progress.
Managing ocular hypertension: If you have higher-than-normal pressure in your eyes, your eye care specialist can offer treatment options. Following their guidance can be crucial and help you avoid — or at least delay — vision loss.
Knowing and managing your risk factorsl Some of the conditions that you can try to manage or prevent include high blood pressure and diabetes. Using protective items like safety glasses and goggles can help prevent eye injuries.
Without treatment, glaucoma inevitably causes permanent vision loss and blindness. With treatment, it’s possible to slow the progress of the disease or stop it entirely. But because the range of possibilities can vary so widely, your eye specialist is the best person to talk to about this. They can tell you the likely outlook for your specific case and what you can do to help tilt the scales in your favor.
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