January 3, 2011

Glaucoma Awareness Month

By Nikhil Wagle
Eye Surgeons Associates

The second leading cause of blindness in the United States is glaucoma. A chronic disease that affects about four million Americans over the age of 40, half of whom remain unaware they have the disease. Unlike most other diseases, the most common form of glaucoma has no obvious symptoms and can permanently damage vision without warning. Once vision is lost to glaucoma, it can never be restored.

Glaucoma is a disease in which the optic nerve degenerates over time. The optic nerve is responsible for transporting the visual stimuli from the eye to the brain where they can be further processed into a visual image. When the nerve deteriorates, the connection between the eye and brain is lost and vision is irreversibly impaired. First the peripheral vision is lost, and if the condition is not detected in a timely manner, the central or reading vision is also permanently affected.

Glaucoma is typically characterized by a buildup of fluid within the eye, causing intraocular pressure to increase (although, there are cases where a person with high pressure shows no signs of optic nerve damage while another can have normal pressure with significant nerve loss). In a healthy eye, fluid containing nutrients to bathe the eye and help the eyeball maintain its shape is continuously drained and replenished, however, in a person with glaucoma, this fluid either does not drain properly or is created in excess, resulting in pressure that, if left untreated, eventually damages the optic nerve. When this occurs, partial or total vision loss may result. Because vision loss is irreversible and painless, early detection and treatment is critical. The only acceptable treatment for glaucoma is to lower intraocular pressure.

Certain groups of people have been shown to be at increased risk for developing glaucoma. These groups include: people over the age of 40, people who have a family history of glaucoma, African and Hispanic Americans, people who have diabetes, hypertension, myopia (nearsightedness), poor ocular circulation, a previous eye injury, people who have used steroid/cortisone medications on a long-term basis and especially people with elevated intraocular pressure. It is especially important for individuals who are at high risk to visit an eye doctor regularly for dilated eye exams.

Treatment options have come a long way not only to improve the lives of people suffering from glaucoma, but help arrest the disease before vision loss occurs for people who are diagnosed early. Treatment modalities for glaucoma include eye drops, laser, or incisional surgery. One of the latest alternatives in glaucoma management is Selective Laser Trabeculoplasty. It has been clinically proven to reduce intraocular pressure (IOP). SLT is the ideal treatment modality. It has virtually no side effects thereby eliminating or reducing the quantity of prescription medications, eye drops, surgery and other invasive treatments required to control the disease. This therapy can be administered in the ophthalmologist’s office. Relatively painless, the SLT does not cause scarring or damage to the eye like other laser treatments and has been shown to effectively keep pressure lower for several years. SLT may also be an alternative for patients who have been treated unsuccessfully with laser surgery in the past or with pressure lowering eye drops.

New once-daily prescription eye drops, new combination medications and refinements to conventional surgical procedures have also been added to the arsenal of treatment options for the disease. Current research topics in the field of glaucoma include looking at the genetics of glaucoma as well as examining certain neurotransmitters as playing a role in the cause of glaucoma. Hopefully, these research areas may help to identify the cause of glaucoma and improve methods of detection and treatment of this insidious and devastating disease.

Nikhil Wagle, M.D. with Eye Surgeons Associates, is board certified and a diplomat of the American Board of Ophthalmology. He completed a fellowship in glaucoma. Dr. Wagle practices at our Bettendorf, Iowa, and Rock Island and Silvis, Illinois offices. For more information visit us online at www.esaeyecare.com.