Glaucoma is a class of disorders that develop similarly. The amount of aqueous (pronounced a-kwee-us) humor, a watery fluid that fills the inside of the eyeball, begins to build up. As more of this fluid collects, it places greater pressure on all parts of the eye, including the optic nerve. Eventually the excess pressure destroys the nerve. It is the leading cause of irreversible blindness in the US.
More than two million people in this country have glaucoma and about 80,000 are legally blind because of it. The condition is about three times as common among African Americans as among Caucasians or Hispanics. The risk for glaucoma increases rapidly with age, but the condition can affect any age group, including newborn infants and fetuses.
There are four major types of glaucoma: open angle (chronic), angle closure (acute), congenital, and secondary. All four types are characterized by increased pressure within the eyeball causing progressive damage to the optic nerve.
Often, there are no symptoms. Vision stays normal, and there is no pain. However, as the disease progresses, a person with glaucoma may notice his or her side vision gradually failing. Objects in the front may still be seen clearly, but objects to the side may be missed. As glaucoma worsens, the field of vision narrows and blindness results. Optic nerve damage reduces side vision first, and then central vision is affected. The result without proper treatment could be blindness.
Risk factors for glaucoma include ethnicity, increasing age, diabetes, and the presence of glaucoma in another family member.
Your eye doctor will take a detailed medical history and a comprehensive eye examination. The pressure inside the eye is called intraocular pressure (IOP), and if it is high, that is often a sign of glaucoma. To measure IOP, the doctor uses a tonometer, which may blow a puff of air onto your eye or it may be illuminated blue and gently placed directly on the surface of your eye after you eye has been numbed with topical anesthetic drops.
Glaucoma may be treated with either medication, laser treatment, or surgery. Medication is usually tried first. The drugs used are substances that reduce intraocular pressure. In general, they either decrease the rate at which aqueous humor is produced in the eye, or they increase the rate at which it is drained off. Various individual drugs and combinations of drugs may have to be tried to see which works best for any one patient.
Some patients do not respond well to medication. In such cases, laser treatments to increase the flow of aqueous fluid may be performed. For more severe cases or eyes that are not responding well to medications and laser treaments, special shunts may be inserted to open up the canals through which aqueous humor drains out of the eye. This surgical procedure provides a filtering channel, relieving the pressure within the eye.
The last decade has brought wonderful advances in the glaucoma surgical arena, with far smaller incisions, less tissue manipulation, and faster recovery. These surgeries are referred to as MIGS – Minimally Invasive Glaucoma Surgery.
These surgeries are often combined with cataract surgery, as they are often done through the same incision, thereby greatly decreasing surgical manipulation of the eye, decreasing the time necessary for surgery, and promoting faster recovery and visual rehabilitation.
Dr. Panzo was the first physician in Lake County to use the leading-edge SLT Laser technology, which sends out tiny bursts of low-energy laser light to treat patients with open-angle glaucoma. The SLT reduces intraocular pressure, creates no scarring of the inner eye meshwork, and may reduce the need for lifelong use of eye drops or medications and the resulting side effects those medications may cause.