Glaucoma

Eye Doctors of Washington provides advanced treatment options to effectively manage glaucoma and prevent severe damage to the optic nerve. Since the condition often progresses without any symptoms, people may not realize they have it until they begin to experience vision loss. Left untreated, glaucoma can lead to blindness. This makes it extremely important to have regular eye examinations to check for signs of glaucoma and other conditions.

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To learn more about this common eye condition, you can schedule an appointment with one of our glaucoma specialists, as well as visit the pages below, where we have provided more in-depth descriptions about diagnosis and treatment.

Glaucoma Fundamentals

Glaucoma is a condition related to high pressure inside your eye(s). If the pressure is too high for an extended period of time, there can be damage to the optic nerve – the nerve that connects the eye to the brain. When the optic nerve is damaged, the nerve takes on the characteristic appearance of glaucoma, and a person can start to lose vision, typically side (or peripheral) vision first. If glaucoma is not well-controlled, a person could ultimately lose all vision in the affected eye(s).

glaucoma

There are two main challenges in diagnosing glaucoma:

    1. Pressure – Eye pressure, like the pressure inside a basketball or soccer ball, is necessary for the eye to have an appropriate shape and function. Normal, “safe” eye pressures for most people run between 10 and 22 mmHg. A person can have higher than average eye pressures and not have glaucoma, or a person could have average eye pressures and have glaucoma. Eye pressure is an important risk factor, but it is not the only consideration in diagnosing glaucoma.

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  1. Optic nerve appearance – When the optic nerve is damaged in glaucoma, it takes on a characteristic appearance, where the optic nerve “cup,” the central bowl-shaped depression of the optic nerve, gets larger over time. Some people, however, are born with non-glaucomatous, large optic nerve cups appearing similar to optic nerves that are damaged by glaucoma.

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Glaucoma Diagnosis

To make the diagnosis of glaucoma, we take into consideration a number of factors, such as: the appearance of your optic nerves and your eye pressures; the results of a number of diagnostic tests such as corneal thickness, nerve fiber thickness, and visual field testing; and risk factors for glaucoma such as your age, family history of glaucoma, race, and your general health. In some patients, the diagnosis of glaucoma is very straightforward – the eye and optic nerve appear either very healthy or very much like glaucoma. Many patients may have a number of concerning risk factors, eye findings, or test results that may or may not be related to glaucoma damage. It may take many months or years to diagnose the presence or absence of glaucoma with certainty, by determining if the optic nerve, visual field testing, or other diagnostic tests are changing (getting worse) over time.

Risk Factors for Glaucoma:

  • Age
  • Family history of glaucoma
  • Family history of blindness
  • African/Asian/Asian-Indian/Hispanic heritage
  • Nearsightedness (myopia)
  • Diabetes
  • High blood pressure
  • Heart disease
  • Lung disease
  • History of eye trauma
  • History of corticosteroid use
  • Sleep apnea
  • Very low blood pressure
  • Inflammation in the body
  • Hypothyroidism
  • Migraine headaches
Ocular Findings:

  • Optic nerve appearance
  • Asymmetry between optic nerves
  • Parapapillary atrophy
  • High eye pressure
  • History of high eye pressure
  • Fluctuant eye pressure
  • Thin corneas
  • Visual field loss
  • Nerve fiber layer loss (OCT/HRT scan)
  • Pseudoexfoliation syndrome
  • Pigment dispersion syndrome
  • Autonomic dysfunction

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Open Angle vs. Narrow Angle Glaucoma

There are two main categories of glaucoma – open angle and narrow angle. Open angle glaucoma, the more common type, occurs when the aqueous fluid within the eye can access the drainage system, but the drainage system itself does not function well.

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Narrow angle glaucoma occurs when the drainage system is blocked or obstructed by the iris (or the colored part of your eye). When the aqueous fluid cannot drain out of the eye, the eye pressure will rise. If the eye pressure is too high for too long, optic nerve damage can occur, resulting in a loss of peripheral vision or ultimately total blindness.

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People who are farsighted (farsighted eyes are smaller than typical eyes) or people with a family member with narrow angles are at greatest risk for developing narrow angle glaucoma. A person with narrow angles may be at risk for an acute, painful attack of glaucoma because of a sudden buildup of pressure in the eye which can lead to severe damage to your optic nerve. Narrow angle glaucoma may also cause intermittent angle closure, with patients experiencing episodes of headaches or eye pain with blurry vision.

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Your doctor will evaluate your risk factors and your eyes to determine if you are at risk for developing angle closure glaucoma, or if your elevated eye pressure or glaucoma damage are related to narrow angles in the eyes

Glaucoma Treatment

Once the diagnosis of glaucoma is established, efforts can be made to treat a person so glaucoma damage, and visual field loss, are slowed or stopped. Currently, eye pressure is the main factor that eye doctors can modify to treat glaucoma. There is no one “safe” pressure for an individual’s eye, but based on a number of research studies and our clinical experience, “safe” target pressures can be set. If it appears your glaucoma is getting worse, then medical, laser, or surgical therapy may be advanced to achieve lower eye pressures. In most cases, a “safe” eye pressure can be obtained through one or more interventions. The most common treatments for glaucoma are eye drops, designed to lower eye pressure. Some interventions, such as medicine, laser, or surgery may work for many years, but can become less effective over time. In general, glaucoma cannot be cured, but it can be controlled.

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To learn more about the glaucoma, as well as available treatments to help manage the condition, contact us to schedule your appointment with one of our experienced glaucoma specialists.

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