Glaucoma Need Not Steal Sight, Experts Say

FRIDAY, April 20 (HealthDay News) — Though glaucoma has been
nicknamed the silent thief of sight, eye experts now say it generally
doesn’t have to be that way.

“For most people, if you treat early, you should have vision for a
lifetime,” said Dr. Mark Fromer, an ophthalmologist at Lenox Hill Hospital
and medical director of the Fromer Eye Centers, both in New York City, and
the eye surgeon director for the New York Rangers hockey team.

Glaucoma isn’t just one disease but a group of conditions that cause
damage to the optic nerve, which connects the eye to the brain. Left
untreated, glaucoma can in fact cause blindness. And because the disease
can progress for long periods undetected, experts stress that checkups and
early detection are key to maintaining vision.

Most forms of glaucoma develop because of increased pressure in the
eye, according to the Glaucoma Foundation. High eye pressure, also known
as intraocular pressure, is the biggest risk factor for developing
glaucoma. However, some people have what’s called normal tension glaucoma,
and they can have optic nerve damage even when eye pressure is normal.

“Some people are just more susceptible to optic nerve damage,” Fromer
noted.

The most common form of glaucoma is called primary open-angle glaucoma,
he said. The angle referred to is where the cornea and the iris meet.
Fluid normally drains through the angle. Sometimes, however, the fluid
drains too slowly, which allows it to build up and increase the pressure
in the eye. The increased pressure causes optic nerve damage, and, as the
damage increases, so does peripheral vision loss.

If the angle narrows or closes completely, an acute form of glaucoma
can develop. The pressure rises quickly and causes pain, blurred vision
and halos around lights. This is a medical emergency that requires
immediate treatment to save vision.

“If you develop severe pain in your eye, get seen right away at the
ER,” said Dr. Gregory Harmon, a New York City ophthalmologist who’s
chairman of the Glaucoma Foundation. “Without treatment, you can have a
permanent loss of vision.”

People who have a family history of glaucoma are more likely to develop
glaucoma themselves. Harmon said that blacks and Hispanics have a four to
five times higher risk for glaucoma than whites. Older people, especially
those who are also developing cataracts, have an increased risk of
glaucoma as well, according to Fromer. And those who take any type of
steroid medication — whether it’s oral, inhaled or even a topical
cream — also face a higher risk for glaucoma, he noted.

The American Academy of Ophthalmology recommends that people older than
40 have a baseline eye exam and then discuss how often follow-up visits
are necessary based on their particular glaucoma risk factors. After 65,
testing is recommended every year or two.

The most commonly used test for glaucoma is called tonometry, which
involves looking into a device that blows a small puff of air into your
eye. Though it can be slightly startling, the test is painless. Another
important tool for detecting glaucoma is the dilated eye exam, which
Harmon said “allows us to look at the optic nerve and evaluate the optic
nerve health.”

If there’s evidence of optic nerve damage, your eye doctor will
probably conduct a visual field test as well. You’ll be asked to click a
button whenever you see flashes of light, which lets the doctor determine
whether you’ve lost any peripheral vision.

If the doctor diagnoses glaucoma, treatment usually begins with eye
drops that help lower pressure in the eyes. Eye drops can decrease fluid
production, or they can help open the drainage ducts. There are also oral
medications that can be used, according to Harmon. Eye drops may need to
be used as many as four times a day, but Fromer said that most eye
doctors start with once-daily drops given at night.

“We try to keep it simple,” he said, “but if one eye drop doesn’t work,
we’ll add another for a synergistic effect.”

If eye drops aren’t effective, the next step is usually laser
treatment. If those treatments don’t work, then surgery to implant more
effective drainage tubes can be done.

What’s important to know is that these treatments can be effective at
preventing vision loss — but if you’ve already lost vision, they can’t
get it back.

“We can prevent but not reverse vision loss,” Harmon said.

He also said that regular exercise — 20 minutes of aerobic exercise
most days of the week — can help lower eye pressure. “The healthier your
body is, the healthier your eyes are,” he noted. Just be sure to clear any
exercise program with your doctor first because some types of exercise can
raise eye pressure.

The bottom line, to Fromer, is that you can’t prevent the development
of glaucoma but you can protect your sight.

“If you’re gonna get glaucoma, you’re gonna get glaucoma,” he said.
“But you don’t have to lose your vision. It can be protected with
appropriate medications.”

More information

The Glaucoma Foundation has more on glaucoma.

A companion article looks at one man’s story of living with glaucoma after being
diagnosed as a teenager.

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