Glaucoma treatment

Can glaucoma be stopped?

What is Glaucoma?

Glaucoma is a general term used to describe a group of eye disorders that damage the optic nerve. It’s the most common form of optic nerve damage leading to vision loss. In most cases, fluid builds up in the front part of the eye. This extra fluid puts pressure on the eye, gradually damaging the optic nerve. This pressure is known as intraocular pressure (IOP), or eye pressure.

Glaucoma is one of the leading causes of blindness for people over the age of 60. It can occur at any age but is more common in older adults.

Many forms of glaucoma have no warning signs. The effect is so gradual that you may not notice a change in vision until the condition is at an advanced stage.

Because vision loss due to glaucoma can’t be recovered, it’s important to have regular eye exams that include measurements of your eye pressure so a diagnosis can be made in its early stages and treated appropriately. If glaucoma is recognized early, vision loss can be slowed or prevented. If you have the condition, you’ll generally need treatment for the rest of your life.

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Before Glaucoma Treatment

What is the optic nerve?

Your optic nerve plays a crucial role in vision. It sends signals from the retina (neural tissue in the back of your eye, like the film of an old-fashioned camera) to the brain. Your brain relies on these signals to create images.

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Symptoms of Glaucoma

The signs and symptoms of glaucoma vary depending on the type and stage of your condition. For example:

. Open-angle glaucoma

. Patchy blind spots in your side (peripheral) or central vision, frequently in both eyes.

. Tunnel vision in the advanced stages

. Acute angle-closure glaucoma

. Severe headache

. Eye pain

. Nausea and vomiting

. Blurred vision

. Halos around lights

. Eye redness

If left untreated, glaucoma will eventually cause blindness. Even with treatment, about 15 percent of people with glaucoma become blind in at least one eye within 20 years.

When to see a doctor

Promptly go to an emergency room or an eye doctor’s (ophthalmologist’s) office if you experience some of the symptoms of acute angle-closure glaucoma, such as severe headache, eye pain and blurred vision.

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Causes

Glaucoma is the result of damage to the optic nerve. As this nerve gradually deteriorates, blind spots develop in your visual field. For reasons that doctors don’t fully understand, this nerve damage is usually related to increased pressure in the eye.

Elevated eye pressure is due to a buildup of a fluid (aqueous humor) that flows throughout the inside of your eye. This internal fluid normally drains out through a tissue called the trabecular meshwork at the angle where the iris and cornea meet. When fluid is overproduced or the drainage system doesn’t work properly, the fluid can’t flow out at its normal rate and eye pressure increases.

Glaucoma tends to run in families. In some people, scientists have identified genes related to high eye pressure and optic nerve damage.

Risk factors

Because chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, be aware of these risk factors:

. Having high internal eye pressure (intraocular pressure)

. Being over age 60

. Being black, Asian or Hispanic

. Having a family history of glaucoma

. Having certain medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anemia.

. Having corneas that are thin in the center

. Being extremely nearsighted or farsighted

. Having had an eye injury or certain types of eye surgery

. Taking corticosteroid medications, especially eyedrops, for a long time

Does glaucoma affect both eyes?

Most people develop glaucoma in both eyes, although the disease initially may be worse in one eye. With open-angle glaucoma, one eye may have moderate or severe damage, while the other eye may be mildly affected. Over time, the disease damages both eyes.

People with closed-angle glaucoma in one eye have a 40% to 80% chance of developing the same type of glaucoma in the other eye within five to 10 years.

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Diagnosis

How is glaucoma diagnosed?

It’s possible to have glaucoma and not know it. Regular eye exams are important to catch glaucoma or other eye problems. Eye exams can assess optic health and vision loss.

To check for glaucoma, your eye doctor may do one or more of these painless tests:

. Dilated eye exam to widen pupils and view the optic nerve at the back of the eyes.

. Gonioscopy to examine the angle where the iris and cornea meet.

. Optical coherence tomography (OCT) to look for changes in the optic nerve that may indicate glaucoma.

. Ocular pressure test (tonometry) to measure eye pressure.

. Pachymetry to measure corneal thickness.

. Slit-lamp exam to examine the inside of the eye with a special microscope called a slit lamp.

. Visual acuity test (eye charts) to check for vision loss.

. Visual field test (perimetry) to check for changes in peripheral vision (your ability to see things off to the side).

Prevention

These self-care steps can help you detect glaucoma in its early stages, which is important in preventing vision loss or slowing its progress.

. Get regular dilated eye examinations. Regular comprehensive eye exams can help detect glaucoma in its early stages, before significant damage occurs. As a general rule, the American Academy of Ophthalmology recommends having a comprehensive eye exam every five to 10 years if you’re under 40 years old; every two to four years if you’re 40 to 54 years old; every one to three years if you’re 55 to 64 years old; and every one to two years if you’re older than 65. If you’re at risk of glaucoma, you’ll need more frequent screening. Ask your doctor to recommend the right screening schedule for you.

. Know your family’s eye health history. Glaucoma tends to run in families. If you’re at increased risk, you may need more frequent screening.

. Exercise safely. Regular, moderate exercise may help prevent glaucoma by reducing eye pressure. Talk with your doctor about an appropriate exercise program.

. Take prescribed eyedrops regularly. Glaucoma eyedrops can significantly reduce the risk that high eye pressure will progress to glaucoma. To be effective, eyedrops prescribed by your doctor need to be used regularly even if you have no symptoms.

. Wear eye protection. Serious eye injuries can lead to glaucoma. Wear eye protection when using power tools or playing high-speed racket sports in enclosed courts.

During Glaucoma Treatment

What are the types of glaucoma?

There are several types of glaucoma, including:

. Open-angle glaucoma

Open-angle glaucoma is the most common form of the disease. The drainage angle formed by the cornea and iris remains open, but the trabecular meshwork is partially blocked. This causes pressure in the eye to gradually increase. This pressure damages the optic nerve. It happens so slowly that you may lose vision before you’re even aware of a problem.

. Angle-closure glaucoma

Angle-closure glaucoma, also called closed-angle glaucoma, occurs when the iris bulges forward to narrow or block the drainage angle formed by the cornea and iris. As a result, fluid can’t circulate through the eye and pressure increases. Some people have narrow drainage angles, putting them at increased risk of angle-closure glaucoma.

Angle-closure glaucoma may occur suddenly (acute angle-closure glaucoma) or gradually (chronic angle-closure glaucoma). Acute angle-closure glaucoma is a medical emergency.

. Normal-tension glaucoma

In normal-tension glaucoma, your optic nerve becomes damaged even though your eye pressure is within the normal range. No one knows the exact reason for this. You may have a sensitive optic nerve, or you may have less blood being supplied to your optic nerve. This limited blood flow could be caused by atherosclerosis — the buildup of fatty deposits (plaque) in the arteries — or other conditions that impair circulation.

. Glaucoma in children

It’s possible for infants and children to have glaucoma. It may be present from birth or develop in the first few years of life. The optic nerve damage may be caused by drainage blockages or an underlying medical condition.

. Pigmentary glaucoma

In pigmentary glaucoma, pigment granules from your iris build up in the drainage channels, slowing or blocking fluid exiting your eye. Activities such as jogging sometimes stir up the pigment granules, depositing them on the trabecular meshwork and causing intermittent pressure elevations.

Treatment

The damage caused by glaucoma can’t be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially if you catch the disease in its early stages.

Glaucoma is treated by lowering your eye pressure (intraocular pressure). Depending on your situation, your options may include prescription eyedrops, oral medications, laser treatment, surgery or a combination of any of these.

Eyedrops

Glaucoma treatment often starts with prescription eyedrops. These can help decrease eye pressure by improving how fluid drains from your eye or by decreasing the amount of fluid your eye makes. Depending on how low your eye pressure needs to be, more than one of the eyedrops below may need to be prescribed.

Prescription eyedrop medications include:

. Prostaglandins. These increase the outflow of the fluid in your eye (aqueous humor), thereby reducing your eye pressure. Medicines in this category include latanoprost (Xalatan), travoprost (Travatan Z), tafluprost (Zioptan), bimatoprost (Lumigan) and latanoprostene bunod (Vyzulta).

Possible side effects include mild reddening and stinging of the eyes, darkening of the iris, darkening of the pigment of the eyelashes or eyelid skin, and blurred vision. This class of drug is prescribed for once-a-day use.

. Beta blockers. These reduce the production of fluid in your eye, thereby lowering the pressure in your eye (intraocular pressure). Examples include timolol (Betimol, Istalol, and Timoptic) and betaxolol (Betoptic).

Possible side effects include difficulty breathing, slowed heart rate, lower blood pressure, impotence and fatigue. This class of drug can be prescribed for once- or twice-daily use depending on your condition.

. Alpha-adrenergic agonists. These reduce the production of aqueous humor and increase outflow of the fluid in your eye. Examples include apraclonidine (Iopidine) and brimonidine (Alphagan P, Qoliana).

Possible side effects include an irregular heart rate, high blood pressure, fatigue, red, itchy or swollen eyes, and dry mouth. This class of drug is usually prescribed for twice-daily use but sometimes can be prescribed for use three times a day.

. Carbonic anhydrase inhibitors. These medicines reduce the production of fluid in your eye. Examples include dorzolamide (Trusopt) and brinzolamide (Azopt). Possible side effects include a metallic taste, frequent urination, and tingling in the fingers and toes. This class of drug is usually prescribed for twice-daily use but sometimes can be prescribed for use three times a day.

. Rho kinase inhibitor. This medicine lowers eye pressure by suppressing the rho kinase enzymes responsible for fluid increase. It is available as netarsudil (Rhopressa) and is prescribed for once-a-day use. Possible side effects include eye redness, eye discomfort and deposits forming on the cornea.

. Miotic or cholinergic agents. These increase the outflow of fluid from your eye. An example is pilocarpine (Isopto Carpine). Side effects include headache, eye ache, smaller pupils, possible blurred or dim vision, and nearsightedness. This class of medicine is usually prescribed to be used up to four times a day. Because of potential side effects and the need for frequent daily use, these medications are not prescribed very often anymore.

Because some of the eyedrop medicine is absorbed into your bloodstream, you may experience some side effects unrelated to your eyes. To minimize this absorption, close your eyes for one to two minutes after putting the drops in. You may also press lightly at the corner of your eyes near your nose to close the tear duct for one or two minutes. Wipe off any unused drops from your eyelid.

If you have been prescribed multiple eyedrops or you need to use artificial tears, space them out so that you are waiting at least five minutes in between types of drops.

Oral medications

If eyedrops alone don’t bring your eye pressure down to the desired level, your doctor may also prescribe an oral medication, usually a carbonic anhydrase inhibitor. Possible side effects include frequent urination, tingling in the fingers and toes, depression, stomach upset, and kidney stones.

Surgery and other therapies

Other treatment options include laser therapy and various surgical procedures. The following techniques are intended to improve the drainage of fluid within the eye, thereby lowering pressure:

. Laser therapy. Laser trabeculoplasty is an option if you have open-angle glaucoma. It’s done in your doctor’s office. Your doctor uses a small laser beam to open clogged channels in the trabecular meshwork. It may take a few weeks before the full effect of this procedure becomes apparent.

. Filtering surgery. With a surgical procedure called a trabeculectomy, your surgeon creates an opening in the white of the eye (sclera) and removes part of the trabecular meshwork.

Drainage tubes. In this procedure, your eye surgeon inserts a small tube shunt in your eye to drain away excess fluid to lower your eye pressure.

. Minimally invasive glaucoma surgery (MIGS). Your doctor may suggest a MIGS procedure to lower your eye pressure. These procedures generally require less immediate postoperative care and have less risk than trabeculectomy or installing a drainage device. They are often combined with cataract surgery. There are a number of MIGS techniques available, and your doctor will discuss which procedure may be right for you.

After your procedure, you’ll need to see your doctor for follow-up exams. And you may eventually need to undergo additional procedures if your eye pressure begins to rise or other changes occur in your eye.

Treating acute angle-closure glaucoma

Acute angle-closure glaucoma is a medical emergency. If you’re diagnosed with this condition, you’ll need urgent treatment to reduce the pressure in your eye. This generally will require both medication and laser or other surgical procedures.

You may have a procedure called a laser peripheral iridotomy in which the doctor creates a small opening in your iris using a laser. This allows fluid (aqueous humor) to flow through it, relieving eye pressure.

Lifestyle and home remedies

These tips may help you control high eye pressure or promote eye health.

. Eat a healthy diet. Eating a healthy diet can help you maintain your health, but it won’t prevent glaucoma from worsening. Several vitamins and nutrients are important to eye health, including zinc, copper, selenium, and antioxidant vitamins C, E, and A.

. Exercise safely. Regular exercise may reduce eye pressure in open-angle glaucoma. Talk to your doctor about an appropriate exercise program.

. Limit your caffeine. Drinking beverages with large amounts of caffeine may increase your eye pressure.

. Sip fluids frequently. Drink only moderate amounts of fluids at any given time during the course of a day. Drinking a quart or more of any liquid within a short time may temporarily increase eye pressure.

. Sleep with your head elevated. Using a wedge pillow that keeps your head slightly raised, about 20 degrees, has been shown to reduce intraocular pressure while you sleep.

. Take prescribed medicine. Using your eyedrops or other medications as prescribed can help you get the best possible result from your treatment. Be sure to use the drops exactly as prescribed. Otherwise, your optic nerve damage could worsen.

Alternative medicine

Some alternative medicine approaches may help your overall health, but none is an effective glaucoma remedy. Talk with your doctor about their possible benefits and risks.

. Herbal remedies. Some herbal supplements, such as bilberry extract, have been advertised as glaucoma remedies. But further study is needed to prove their effectiveness. Don’t use herbal supplements in place of proven therapies.

. Relaxation techniques. Stress may trigger an attack of acute angle-closure glaucoma. If you’re at risk of this condition, find healthy ways to cope with stress. Meditation and other techniques may help.

. Marijuana. Research shows that marijuana lowers eye pressure in people with glaucoma, but only for three to four hours. Other, standard treatments are more effective. We don’t recommend marijuana for treating glaucoma.

After Glaucoma Treatment

Surgery Follow-Up

For the first few weeks after surgery, vision in the eye where you had glaucoma surgery will probably remain blurry. This will get better over a few weeks. You will rely more on your other eye to see, assuming that you have good vision in that eye.

Your eye may look red, irritated, or swollen after surgery—this is completely normal.

You also may feel as if you have something in your eye. Take care to not rub your eye as this could cause further damage.

If you have had a type of glaucoma surgery called a trabeculectomy, your eye also may form a bleb, which you can think of as a drainage pipe to help fluid reach the outside of the eye. This aids in relieving eye pressure. Blebs typically form where other people can’t see them, such as under the eyelid.

Your doctor will want to see you several times within the six-week period after surgery to make sure your eye is healing properly and to evaluate how fluid drains out of your eye. This usually includes an appointment a day and then a week after surgery and then two to four other appointments through those six weeks.

Your eye doctor may schedule fewer appointments depending on how your healing progresses. During a follow-up appointment, your eye doctor may remove any stitches that are in the eye.

You may eventually need to change your glasses or contact lens prescription after glaucoma surgery. Your doctor will let you know when or if you should start using your glaucoma medicines again. Sometimes, glaucoma surgery can reduce or change the number of glaucoma drops that you use.

Recovery Timeline

Recovery from glaucoma surgery typically takes a few days to a few weeks, depending on the type of job you have and the vision in your non-surgical eye. Vision in that eye is important because you’ll rely on that eye a lot more to see until the blurriness in your surgical eye reduces.

You should be able to return to your job in about a week or two. You shouldn’t have any restrictions on watching TV, using your phone or other electronic devices, or using your computer after glaucoma surgery. However, your eyes may tire quickly after using them in the initial days or weeks after surgery.

In the first couple of weeks after surgery, avoid intense exercise such as running or lifting more than 10 pounds. Your doctor can give you more guidance on the timeline to return to more strenuous exercise. You’ll also want to avoid activities that involve bending, lifting, or straining, as those could put unneeded pressure on the eye.

In the first few weeks, you’ll also want to avoid:

. Getting your hair colored or permed

. Having water near the eye

. Rubbing the eye

. Swimming

. Wearing contact lenses

. Wearing eye makeup

All of those could put your surgical eye at risk for damage or infection if water or bacteria get inside the eye. Make sure to wear sunglasses outside if your eyes feel more sensitive to the sun.

Most people who have glaucoma surgery don’t have significant pain. However, if pain is a problem, find out from your doctor if it’s OK to use Tylenol (acetaminophen) or another other-the-counter pain reliever.

Although a bleb normally forms after a trabeculectomy to help drain fluid outside of the eye, there still is a chance you’ll need a procedure called a needling to remove scar tissue around the bleb.

Any type of surgery may cause you to experience changes in your mental health, including glaucoma surgery. Having glaucoma is associated with a greater risk for depression. This is because you may have to face a growing reliance on others and less dependence associated with vision loss.

If you find yourself feeling sad or anxious after glaucoma surgery, talk to a trusted friend or family member. You also could ask your eye doctor or primary care doctor about a referral to a mental health professional, such as a therapist.

Wound Care

Immediately after glaucoma surgery, you will most likely wear a shield over the eye, but your doctor will eventually switch you to use the shield only at night for about two weeks. The shield helps to protect the eye against damage and infections.

You also may have to insert eye drops such as antibiotics, anti-scarring medications, or steroids. When you insert drops, your eyes may burn or water up more than usual. This should stop after a day or two post-surgery.

Pay close attention to the instructions on how to insert eye drops. Always wash your hands before using eye drops. If you have any trouble inserting eye drops on your own, ask a family member or caregiver for help.

Let your eye doctor know if you have any of the following symptoms:

. Pus or discharge that comes out of the eye

. Redness or swelling in the eye area

. A fever

. New pain in the eye

. Symptoms of a blood clot in your leg, such as pain in your leg or groin or leg redness or swelling.

These symptoms could indicate an infection that needs to get treated promptly.

What can I expect if I have glaucoma?

Blindness is a rare complication for people with glaucoma if detected early. However, glaucoma is a chronic and progressive condition that often causes some degree of vision loss over time. The earlier you catch glaucoma and start treatments, the better the odds of saving your vision. Treatments can slow down disease progression and vision loss. If you’re at high risk for glaucoma, regular eye exams are a must.