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Topic of the Month for January 2019

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Worldwide 60,000,000 people suffer from glaucoma.  It is the 2nd leading cause of blindness in the world.  


1.5 million Americans have been diagnosed with glaucoma, but it is estimated that there are another 1.5 million who have glaucoma, but do not yet know it.  120,000 Americans are blind from glaucoma- 10% of all blindness in the USA.  


The economic impact of glaucoma is huge.  It accounts for 10 million physician visits annually in the USA.  It is estimated to cost the US government $1.5 billion dollars in social security benefits, health care costs, and lost income tax revenues.




Glaucoma is a disease of the optic nerve.  It happens when the fluid pressure inside the eye gets

high enough to damage the optic nerve.  This can happen if either too much fluid is produced

by the eye, or if the fluid does not drain out of the eye properly.  The higher the pressure inside

the eye, the greater the risk of developing glaucoma.  However, how high the pressure has to

be to cause glaucoma varies from person to person.


There are several different types of glaucoma.  The most common type is called Primary Open

Angle Glaucoma (POAG).  This article applies mostly to POAG.




Age: The risk of developing glaucoma rises as you age.  The risk of glaucoma is 7 X greater

after age 60 than it is before age 40.


Family History: It is estimated that 50% of glaucoma is hereditary.  If anyone else in your family

has glaucoma you have a higher risk of developing it yourself.  In fact, your risk is up to

10 X greater if you have a sibling with glaucoma.


Race: African Amercians 6-8 X more likely to develop glaucoma than Caucasians.

African Amercians are 15 X more likely to have vision loss from glaucoma than Caucasians.

Glaucoma is the second leading cause of blindess among African-Americans.  


Medical Conditions: Certain medical conditions may increase your risk of developing glaucoma.  Thses include diabetes, high blood pressure, heart disease, and sleep apnea.


Medications: Long term use of corticosteroids can increase your risk of developing glaucoma.





In most cases, glaucoma has no symptoms in its early stages.  The only way to detect it is through an eye examination.  If your eye doctor suspects glaucoma, there are a series of tests that they may do:


Medical History:  Find out about your medical history, and that of your family members, to see if there are any factors that may increase your risk of developing glaucoma.


Visual Acuity:  Test your vision to see if it has been damaged.


IOP:  Measure the pressure inside your eye.  The higher the pressure, the greater the risk that you may develop glaucoma.  Some people have high pressures, but never develop glaucoma.  Other people develop glaucoma with what is considered a normal pressure.  The IOP is only one factor in determining whether or not you have glaucoma.


Corneal Thickness:  People who are born with thinner corneas are at a greater risk of developing glaucoma.  People who are born with thicker corneas have a lower risk of developing glaucoma.


Visual Fields: Visual field testing checks the function of your optic nerve, searching for signs of damage from glaucoma.


Imaging:  Your doctor may photograph or scan your optic nerve to watch for changes in its appearance over time.  Each person’s optic nerve is unique, and its appearance is generally stable over our lifetime.  When the appearance changes, glaucoma is often the cause.


Your eye doctor will do as many of these tests as is necessary to determine if you have glaucoma.  




Glaucoma cannot be cured.  It can only be treated.  Treatments are designed to slow or prevent

vision loss by lowering the IOP.  


In the United States, the first line of treatment for glaucoma is topical medication:  eye drops.  

There are several different classes of glaucoma drops.  Most are used one or two times daily.  If

one drop does not adequately lower the IOP, a second or even a third can be added.


There are also several surgical treatments for glaucoma.


Lasers can be used to improve the fluid drainage system inside the eye to lower the IOP.


Drainage implants are small shunts placed inside the eye to improve fluid drainage and lower the IOP.


Surgery can be done to create a new drain to lower the IOP.  This surgery is more complex and tends to be used only as a last resort when other treatments have not been successful.


You and your eye doctor can discuss whether medication or surgery is the best treatment

choice for you.


Once treatment begins, you will need to follow up frequently with your eye doctor.  This is

because how low the IOP needs to be to prevent vision loss varies from person to person.   Your

eye doctor will want to be sure that the treatment has lowered the pressure to the level that

they targeted.   They will also want to be sure that when the target pressure is reached, no

further damage is occurring.




The only way to diagnose glaucoma is by have regular eye examinations.  Even if you have

20/20 vision, glaucoma could be slowly damaging your optic nerve.  This is because in most

cases, glaucoma has no symptoms.  It does not usually cause blurred vision or eye pain.  

For this reason, most people do not know that they are developing glaucoma.  This means that

many people are not diagnosed with glaucoma until after they have had it for many years.  By

then it may have caused significant optic nerve damage.  Most people who go blind from

glaucoma are diagnosed late in the course of the disease.


Glaucoma cannot be cured. It can only be managed.  And none of our treatments can restore

vision lost to glaucoma.  We can only try to prevent further vision loss.    For this reason, early

diagnosis is critical to protecting the vision.  If you wait until glaucoma affects your vision, it is

too late!


Have a great 2018, and see your eye doctor this year.  Even if you see well, a check up can

reduce the risk that glaucoma, or some other condition, may damage your vision.