The Symptoms: Diagnosing and Treating Glaucoma

Glaucoma is one of the leading causes of vision loss among senior citizens. What makes glaucoma particularly dangerous is that it’s asymptomatic in the early stages, so many patients don’t realize they have the condition until it’s advanced to a late stage.

In fact, only 50% of people with glaucoma are aware they have it. The progression of glaucoma is very gradual, and most people don’t notice any vision changes until the condition is already at an advanced stage. That’s why it’s important to know the warning signs and risk factors. Remember, while treatment can slow the progression of glaucoma, it can’t repair damage that already occurred.

What Are the Symptoms?

There are several types of glaucoma, each with a different set of symptoms. These are the most common types:

1. Open-angle glaucoma – This is the most common form of glaucoma. The condition is caused by clogged drainage canals, which can increase the eye pressure and damage the optic nerve. Symptoms include blind spots in the peripheral (side) and central vision and, eventually, tunnel vision.
2. Angle-closure glaucoma – This is a less common form of glaucoma, but it’s particularly dangerous because it tends to advance quickly. The condition develops when the iris bulges and narrows or blocks the drainage angle, cutting off circulation and increasing eye pressure. Symptoms include blurry vision, severe headache, eye pain, nausea and vomiting, seeing halos around lights, and red eyes. If you experience any of these symptoms, see an eye specialist right away.
3. Normal-tension glaucoma – Damage to the optic nerve is usually caused by increased eye pressure. However, people with normal-tension glaucoma experience optic nerve damage even though their eye pressure is well within the normal pressure range of 12-22 mm Hg. The causes of this condition are still unknown.

What Are the Risk Factors?

While anyone can develop glaucoma, certain factors can increase your risk of contracting the condition:

1. Age – Glaucoma can affect anyone, regardless of age, although it’s more common among people over 60.
2. Family history – Having a family history of open-angle glaucoma, which is hereditary, increases your risk of glaucoma by about four to nine times
3. Conditions related to your blood flow – These conditions include migraines, diabetes, low blood pressure and hypertension.
4. Steroid use – Some studies have observed a link between the use of steroids and glaucoma. A study conducted in 1997 included in the Journal of American Medical Association found that there was a 40% increased incidence of ocular hypertension and open-angle glaucoma in asthmatic adults that needed 14 to 35 puffs of steroid inhaler. Keep in mind that this is a high dose, one that’s only administered in severe cases.
5. Previous eye injuries – Eye trauma can damage the drainage systems, potentially causing secondary open-angle or traumatic glaucoma.
6. Nearsightedness or farsightedness – These refractive errors can increase your risk of developing glaucoma.

The Importance of Eye Exams

The best way to prevent complications arising from glaucoma is to see an eye specialist, whether it’s for a routine contact eye exam or a comprehensive eye examination. Early detection and treatment can help minimize damage to your eyesight. As a general rule of thumb, the American Academy of Ophthalmology recommends undergoing an eye exam with varying frequency depending on your age:

1. Every five to 10 years under the age of 40
2. Every one to three years before from age 40 to 54
3. Every one to two years from age 55 to 64
4. Every six to 12 months after age 65

How Glaucoma Is Treated

Should your eye doctor notice any signs of glaucoma, they may recommend any of the following treatment options:

Prescription eye drops – Doctors may prescribe one or more types of eye drops to those with mild or moderate glaucoma, depending on their IOP. There might be side effects, like eye redness or irritation, after using the drops, but these should only be temporary.

Quick Tip: You might experience other side effects, not related to your eyes, if the eyedrop medicine is absorbed into your bloodstream. To prevent the drops from being absorbed too quickly, close your eyes for a minute or two after administering the eye drops. If your doctor prescribed more than one type of eye drops, make sure to wait at least five minutes between administering the second type.

Laser treatment – If you find it difficult to administer eye drops, your doctor might recommend laser treatment, namely selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT). These low-risk treatment options can help open up the eyes’ natural drainage system, reducing IOP. The treatment can be done in the doctors’ office within a few minutes and requires no cutting or stitches. Normally, patients can go back to their daily routine quickly after undergoing laser treatment.

Micro-invasive glaucoma (MIGS) surgeries -MIGS surgery involves implanting a tiny device in your eye to help improve drainage and lower IOP. Like laser treatment, MIGS surgeries are relatively low-risk and can be done quickly.

Trabeculectomy and tube shunt – Older patients with advanced glaucoma might need to undergo traditional glaucoma surgeries. In a trabeculectomy, a surgeon will make a small incision in the eye to allow fluid to drain and lower the IOP. In a tube shunt surgery, the surgeon will implant a small tube through which fluid can drain out of the eye. Traditional glaucoma surgery is more invasive and involves more complications than any of the aforementioned options, but is still safe and effective. You shouldn’t be too worried about undergoing this treatment, however. Your optometrist will carefully weigh the pros and cons of the traditional glaucoma surgery, compared with the less invasive options, before making a recommendation.

Other Ways of Reducing the Risk of Glaucoma

Aside from routine eye exams, you can reduce your risk of developing glaucoma by:

1. Exercising regularly – Moderate exercise, such as brisk walking or jogging, can lower intraocular pressure (IOP). Yoga is also beneficial, but doctors recommend avoiding inverted positions such as headstands or shoulder stands, as these can raise your IOP. Ask an eye specialist about an exercise routine they would recommend for you.
2. Know your family history – You’ll need more frequent screenings if there’s a history of glaucoma within your family.
3. Wearing protective eyewear – Wearing protective eyewear while playing baseball or high-speed racket sports, or doing home improvement projects, can protect your eyes from trauma and injury.
4. Eat a healthy diet – Eating a diet rich in nutrients essential to eye health, such as zinc, copper, selenium and vitamins C, E and A, can help prevent glaucoma from worsening. Try to avoid drinking too much tea and coffee as well—large doses of caffeine can raise your IOP.
5. Sip fluids throughout the day – Avoid drinking more than a quart of water within a short amount of time, as it can increase IOP. Instead, take small but frequent sips.
6. Sleep with your head slightly raised – Sleeping with a wedge pillow that’s raised about 20 degrees can help lower IOP.

Don’t Forget to Follow Up With Your Eye Doctor

Keep in mind that glaucoma doesn’t disappear even after treatment. Remember, the symptoms of the condition don’t manifest until it has progressed to an advanced stage. By working with your optometrist and health professionals at your local eye clinic, you can maintain your target IOP and prevent damage to your vision.