Get Treatment for Glaucoma to Prevent Blindness

Glaucoma is an eye disease in which elevated intraocular pressure (IOP)— the pressure inside your eye—damages the optic nerve. If glaucoma goes undiagnosed and untreated, it can cause blindness. However, many people who have glaucoma are unaware that they have it, since most people have no symptoms in the early stages.

“Glaucoma generally affects peripheral vision first, and it’s usually a slow process. Many people don’t realize they are losing their peripheral vision until it’s very advanced,” explains Leila Rafla- Demetrious, MD, an ophthalmologist at Weill Cornell Medicine. “This is why it is so important to have regular eye exams, especially as you get older.”

The American Academy of Ophthalmology recommends that people ages 65 and older have an eye exam every one or two years, even if they have not noticed any changes in their vision.

The Anatomy of Glaucoma

The most common form of glaucoma is open-angle glaucoma. In this condition, the angle in the eye where the iris meets the cornea is normal, but the eye’s trabecular meshwork (its drainage canals) becomes clogged over time, causing an increase in IOP. Symptoms of open-angle glaucoma include patchy blind spots in the side (peripheral) or central vision. In advanced stages, tunnel vision may occur.

The second most common type is angle-closure glaucoma, in which the angle between the iris and cornea is too narrow to permit adequate fluid drainage. Symptoms of angle-closure glaucoma include eye pain, blurred vision, severe headache, seeing “halos” around lights, and nausea and vomiting.

Some people have low-tension or normal-tension glaucoma, in which optic nerve damage occurs even when the IOP is in the normal range (12-21 millimeters of mercury; 22 millimeters or higher indicates an elevated IOP).

Diagnosing Glaucoma

How does an ophthalmologist detect glaucoma if there are no symptoms?

“The visual field tests we perform are very sensitive, and they can detect damage to the optic nerve even if the patient has not noticed a change in their vision. If we can arrest and treat glaucoma in the early stages, patients are more likely to be able to preserve their vision so they can continue to drive, read, and perform other normal activities of daily living,” explains Dr. Rafla-Demetrious.

Glaucoma Medications

Treatment usually begins with medicated eye drops, which, for many patients, can reduce the IOP enough to prevent further damage to the optic nerve.

Glaucoma also may be treated with Durysta, a tiny, biodegradable implant that is placed into the eye.

“This device releases medication into the eye for a period of four to six months,” explains Dr. Rafla- Demetrious. “If a person does well on eye drops, but they don’t use them consistently, Durysta is a good option. The medication is being constantly delivered directly into the eye, so they are getting the maximum benefit.”

Surgical Treatments

If eye drops don’t reduce the IOP, a number of surgical options may be considered.

“There’s a subcategory of surgery called MIGS (minimally invasive glaucoma surgery). MIGS are performed with microscopic-sized equipment. These procedures have a lower risk of side effects than more invasive surgeries,” explains Dr. Rafla-Demetrious. MIGS are most effective for patients with mild to moderate glaucoma.

More invasive surgeries include trabeculoplasty, which opens the drainage canals of the eye, and iridotomy, which makes a hole in the iris through which fluid can drain.

If these procedures aren’t effective, more complicated eye surgery may be needed to save the patient’s vision. “If you have been diagnosed with glaucoma, you need to stay on top of it,” says Dr. Rafla-Demetrious. “Have an ophthalmologist monitor your condition every four to six months, and use medications as directed. Most people do well with medical treatment, but it requires a lifelong commitment to eye care and exams.”

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