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GLAUCOMA 
Glaucoma is a group of eye diseases that lead to damage of the optic nerve (the bundle of nerve fibers that carries information from the eye to the brain), which can lead to vision loss and ultimately blindness. Optic nerve damage usually occurs in the presence of high eye (intraocular) pressure; however, it can occur with normal or even less than normal eye pressure.

 

Vision experts believe that half of those affected by glaucoma may not know it, since there are usually no symptoms in its early stages. By the time an individual notice something is wrong, the disease has already caused considerable damage. Vision lost due to glaucoma cannot be regained. Although there is no cure, medications, laser and surgery can help slow and oftentimes eliminate the disease’s progression

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Glaucoma is a leading cause of blindness among African Americans and Hispanics in the U.S. Three times as many African Americans have glaucoma than Caucasians, and four times as many are blind. Between the ages of 45 and 64, glaucoma is fifteen times more likely to cause blindness in African Americans than in Caucasians.

 

There are two main forms of Glaucoma: Open-Angle (the most common form affecting approximately 95% of individuals) and Narrow/Closed-angle.

 

Open angle glaucoma is progressive. Initially, there are usually no symptoms, but as eye pressure gradually builds, at some point the optic nerve is impaired, and peripheral vision is lost. Without treatment, an individual can become totally blind.

 

glaucoma contracted VF

 

Narrow/Closed-angle glaucoma may be acute or chronic. In acute closed-angle glaucoma the normal flow of eye fluid (aqueous humor), out of the eye, is suddenly blocked. Symptoms may include sudden severe pain, nausea, vomiting, blurred vision and seeing a rainbow halo around lights. Acute closed-angle glaucoma is a medical emergency and must be treated immediately or blindness could occur in one or two days. Chronic closed-angle glaucoma progresses more slowly and can damage the eye without symptoms, similar to open-angle glaucoma.

 

Regular eye exams are critical in the detection and treatment of the disease.  The more common tests to help detect and monitor the progression of glaucoma are:

 

1. Tonometry is an internal eye pressure measuring device.   

2. Ophthalmoscopy is used to examine the inside of the eye.  Special magnifying lenses with this instrument is used to view the optic nerve and retina. The color, shape and

overall health of the optic nerve is important in glaucoma assessment. A digital camera may be used to photograph and compare the detailed appearance of the optic nerve over time.

3. Gonioscopy is a test that uses a special mirrored device to determine if the eye outflow angle structure is open, closed or damaged.

4. Visual field testing measures the fullness of a person's side or peripheral vision.

5. Optic Nerve Fiber Analysis using the Optical Coherence Tomography (OCT)  is a method of glaucoma testing in which the thickness of the Optic nerve fibers is measured. Thinning areas may indicate damage caused by glaucoma. This test is especially good for patients who may be considered a glaucoma suspect, as well as for persons with glaucoma, to monitor the absence or the progression of the disease.

6. Pachymetry is the method of measuring the thickness of the cornea. The thickness of the cornea influences the eye pressure level reading when tonometry is performed.

 

The most common treatment for glaucoma is eye drops. There are many different categories of eye drops, but all are used to either decrease the amount of fluid (aqueous humor) in the eye or improve its outward flow. Sometimes a combination of different category eye drops is used for pressure control. The doctor will decide which medications are best suited for each patient based on test results and previously discussed analysis and rate of progression.

 

Currently, laser procedures are most frequently used when eyedrops alone are not able to maintain internal eye pressure at a safe level. Laser procedures normally lower eye pressure, but the length of time of duration depends on many factors, including age of the patient, the type of glaucoma and other medical conditions that may be present. In many cases, continued medication at reduced frequency is necessary for ideal control.

 

Normally, conventional filtration pressure reducing surgery is used as a therapy for glaucoma after other treatment strategies, such as medications and laser surgery, have failed. When deciding on a treatment option, the ophthalmologist will consider the unique aspects of each person’s case, including severity of the disease, response to medication and other health issues.

 

It is very important to have regularly scheduled eye examinations, particularly as you age, or if you have any of the risk factors associated with glaucoma, such as family members with the disease. Uncontrolled glaucoma normally has no symptoms until vision is lost and never regained. However, if diagnosed early, glaucoma is treatable.  Eye pressure can be monitored and controlled, and disease progression can be delayed or stabilized.