What is Glaucoma

Glaucoma is a group of eye diseases that damages the optic nerve within the eye. This usually occurs because of pressure build up in the eye often due to inadequate drainage of fluids.  The optic nerve is responsible for sending signals to the brain which are then interpreted as an image—what we see. Damage to the optic nerve is irreversible. Sadly, this makes glaucoma one of the leading causes of blindness.  Blindness from glaucoma can often be prevented with early detection and treatment.

The eye is constantly making a fluid called aqueous humor. This fluid is made by a structure called the ciliary body, located behind the iris (colored part of the eye). The fluid flows from behind the iris to the front of the iris where it drains at the drainage angle. Fluid production and fluid drainage in the eye is a continuous process. Proper working of the drainage angle and the ciliary body keeps the pressure (intraocular pressure, IOP) in the eye stable. If the drainage angle is not working properly then pressure in the eye will build because aqueous is still being produced and it cannot drain. The nerve fibers that composes the optic nerve are very sensitive to changes in IOP. High IOP or fluctuating IOP will cause damage and death of optic nerve fibers. As these nerve fibers die a small amount of vision is also lost. Vision loss from glaucoma most often is not noticeable to those afflicted until most of the nerve fibers die off.

Open-Angle Glaucoma vs. Angle-Closure Glaucoma

There are many types of glaucoma, but the two main types are: primary open-angle glaucoma and angle-closure glaucoma.

Primary open-angle glaucoma (POAG) is the most common form of glaucoma. With POAG the drainage angle is partially blocked, causing fluid to drain slowly. Because of slow fluid drainage IOP is constantly elevated. The exact cause of POAG is not yet known. POAG usually develops slowly and without symptoms in early stages. As a result, people with POAG will go untreated for years. Those with undiagnosed POAG may be losing peripheral vision without knowing; it is not until severe vision loss as occurred that they will notice something is wrong with their eyes. Regular comprehensive eye exams are the best way to find out if glaucoma is present and to start treating it early before vision loss starts to occur.

Angle -closure glaucoma or “narrow-angle glaucoma” is far less common than POAG. The onset of angle-closure glaucoma is very rapid and constitutes a medical emergency. This usually occurs when the iris protrudes forward causing a narrowing or blocking of the drainage angle formed by the iris and the cornea. When the drainage angle is blocked IOP rises rapidly. This type of glaucoma is an immediate threat to sight, but the good news is that with prompt treatment vision can be persevered with little if any loss in visual acuity. The signs and symptoms of angle-closure glaucoma include:

  • Severe eye pain
  • Nausea and vomiting (along with severe eye pain)
  • Sudden blurred vision
  • Headache
  • Rainbow colored rings or halos around lights
  • Reddening of the eye

Risk Factors

Some types of glaucoma can be a result of eye injury, tumors, advanced cataract, diabetes or even steroid based medication.

According to the American Academy of Ophthalmology there are some people who are at higher than normal risk of acquiring glaucoma. This includes people who:

  • Are over age 40
  • Have family members with glaucoma
  • Are of African, Hispanic, or Asian heritage
  • Have high eye pressure
  • Are farsighted or nearsighted
  • Have had an eye injury
  • Use long-term steroid medications
  • Have corneas that are thin in the center
  • Have thinning of the optic nerve
  • Have diabetes, migraines, high blood pressure, poor circulation or other health problems affecting the whole body.

Glaucoma Treatment Options

There are several treatment options available for glaucoma.

It should be understood that vision loss from glaucoma is permanent; the goal in treating glaucoma is not to restore sight lost, but rather it is to maintain vision and prevent vision loss.

Treatment varies depending on the type and stage of glaucoma. medications in the form of eye drops are usually the first course of action with many forms of glaucoma. These medications are deigned to either reduce the amount of aqueous being produced in the eye or improve the drainage of aqueous trough the natural drainage angle. For more severe glaucoma or for patients who don’t respond to the medications, laser procedures and surgery might be better options. Dr. Emmel will thoroughly discuss his treatment plan and any course of action he deems necessary to lower one’s eye pressure and prevent vision loss.

How Is Glaucoma Detected

Regular comprehensive eye exams with ophthalmologist such as Dr. Emmel is the best way to detect and start treating glaucoma early. If you come to our practice for evaluation of glaucoma or Dr. Emmel suspects you may be at risk for glaucoma he will do one or more of the following tests and procedures:

  • Applanation tonometry to measure intraocular pressure (IOP)
  • Gonioscopy to evaluate drainage angle
  • Ophthalmoscopy to check for damage to the optic nerve
  • Visual field testing to evaluate if there are any abnormal blind spots in your visual field.
  • Corneal thickness measurement


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