Glaucoma

Glaucoma usually has no early warning signs or symptoms. It progresses slowly and can go years without causing apparent vision loss. Because the early loss of vision is in the side or peripheral vision, and the visual acuity or sharpness of vision is preserved until late in the disease, most persons with open-angle glaucoma feel fine and do not notice a change in their vision at first. The condition is usually fairly advanced by the time a patient notices vision loss. Glaucoma causes vision loss that is irreversible, even with surgery.

However, there are certain signs and symptoms of glaucoma that should not be ignored. These include:

• Halos around light: When the pressure rises quickly due to closed-angle glaucoma, the cornea becomes waterlogged, which can affect vision, leading to halos around lights.
• Pain in the eyes: This is mostly seen when there is a sudden buildup of pressure. It does not act as one of the characteristic features or symptoms of glaucoma when the rise in pressure is gradual. In some cases, vomiting or nausea accompanying severe eye pain is also observed.
• Tunnel vision: This is a common symptom of glaucoma. The pressure on the nerves can damage the retinal nerve fibers, leading to a characteristic pattern of vision loss. This results in tunnel vision, where peripheral vision is blocked. For example, when viewing a photo, one may only see the center portion clearly while the peripheral picture is obscured. This can be detected during eye testing.
• Changes in the optic disc: The rise in intraocular pressure can lead to a cupped, pale optic disc, which is a key symptom of glaucoma.
• Enlargement of the eye: In children under three years of age, enlargement of the eye due to raised intraocular pressure can occur, which is a characteristic symptom of glaucoma. In adults, the eye cannot enlarge significantly because growth has ceased.

The clear fluid inside the eye is called the aqueous humor. This fluid nourishes the eye and gives it its shape. The eye constantly produces aqueous humor. As new aqueous enters the eye, the same amount should drain out through an area called the drainage angle. This process maintains a constant intraocular pressure (IOP) in the eye. Any blockage or problem in drainage results in fluid buildup in the eye. As the IOP increases, the optic nerve may become damaged.

More than a million microscopic nerve fibers make up the optic nerve. It is similar to an electric cable, which consists of numerous small wires. When these nerve fibers begin to perish, one may start to experience blind spots in their vision. These blind spots are primarily noticed when the majority of the optic nerve fibers have been destroyed. If all the fibers are lost, it can lead to blindness.

Because chronic types of glaucoma can cause vision loss before any symptoms or signs appear, be aware of the following risk factors:

• Very high internal eye pressure (intraocular pressure)
• Being over 60 years of age
• Having a family history of glaucoma
• People of African American, Russian, Irish, Japanese, Hispanic, Inuit, or Scandinavian origin
• Decrease in corneal thickness and rigidity
• Having a high degree of nearsightedness (myopia) or farsightedness (hypermetropia) or conditions that affect vision
• Eye injury or certain types of eye surgery
• Medical conditions like diabetes, heart disease, high blood pressure, and sickle cell anemia
• Long-term use of corticosteroid medicines, particularly eye drops

A comprehensive eye exam is the only approach to diagnose glaucoma with certainty. Only checking ocular pressure during a glaucoma screening is insufficient to detect glaucoma.

Your ophthalmologist will do the following during a glaucoma exam:

• Measure the pressure in your eyes
• Examine the drainage angle of your eye
• Check for damage to your optic nerve
• Check your peripheral vision (side vision)
• Take a picture of your optic nerve or use a computer to calculate its size
• Take a measurement of your cornea's thickness
• Use a slit lamp to examine your eyes

Before making a glaucoma diagnosis, five variables should be checked to ensure safety and accuracy. These include:

• The inner eye pressure
• The shape and color of the optic nerve
• The complete field of vision
• The angle in the eye where the iris meets the cornea
• The thickness of the cornea

Tests for glaucoma

Two common eye tests for glaucoma patients are tonometry and ophthalmoscopy; however, other tests such as perimetry, gonioscopy, and pachymetry also aid in the diagnosis.

1. Tonometry
   Tonometry measures the pressure inside your eye. Eye drops are used to numb the eye during the procedure. A small device or a warm puff of air applies a small amount of pressure to measure the intraocular pressure. Pressure is measured in millimeters of mercury (mm Hg). When the pressure in the eye exceeds 20 mm Hg, glaucoma is diagnosed. Some individuals may develop glaucoma at pressures ranging from 12 to 20 mm Hg, as eye pressure varies among individuals.
2. Ophthalmoscopy
   This diagnostic procedure allows your doctor to check for damage to the optic nerve. After dilating the pupil with eye drops, the doctor will use a magnifying tool called an ophthalmoscope and a light source to examine the inside of the eye. This helps the doctor assess the structure and color of the optic nerve.
3. Perimetry
   Perimetry measures the visual field function, i.e., the total area where objects can be seen in peripheral vision while focusing on a central point. You will be asked to look straight ahead while a light spot is presented in different areas of your peripheral vision. This aids in creating a "map" of your vision.
4. Gonioscopy
   Gonioscopy is a painless examination to determine whether the drainage angle, the area where fluid drains out of the eye, is open or closed.
5. Pachymetry
   Pachymetry is a painless test that determines the thickness of the eye’s cornea using a probe called a pachymeter.

These self-care tips can help you diagnose glaucoma in its early stages, which is critical for preventing or reducing vision loss.

• Get dilated eye exams on a regular basis. Glaucoma can be detected early in the course of a full eye checkup, before it causes major damage.
• If you're under 40 years old, the American Academy of Ophthalmology recommends a comprehensive eye exam every five to ten years; every two to four years if you're 40 to 54 years old; every one to three years if you're 55 to 64 years old; and every one to two years if you're over 65 years old. If you're at risk for glaucoma, you'll need to get your eyes checked more frequently. Inquire with your doctor about the best screening schedule for you.
• You should be aware of your family's eye health history. Glaucoma is a disease that runs in families. If you're at a higher risk, you may need to be screened more frequently.
• Exercise in a safe manner. Regular, moderate exercise can lower ocular pressure and may help to prevent glaucoma. Consult your doctor about an exercise regimen that is right for you.
• Use the eye drops as directed on a regular basis. Glaucoma eye drops can dramatically lower the risk of glaucoma developing from excessive eye pressure. Even if you don't have any symptoms, eye drops prescribed by your doctor must be used on a regular basis to be effective.
• Protect your eyes by wearing sunglasses. Glaucoma can develop as a result of serious eye damage. When utilizing power tools or playing high-speed racquet sports in enclosed courts, wear eye protection.

The key to protecting your eyesight against glaucoma damage is early detection, which can be achieved through regular and comprehensive eye exams. Five typical glaucoma tests are included in a comprehensive eye exam.

It is critical to have your eyes tested on a regular basis. At the age of 40, you should get a baseline eye examination. At this age, you may notice the first indicators of eye disease and vision problems. Based on the results of this screening, your eye doctor will advise you on how often you should have follow-up checks.

If you have high risk factors for glaucoma, such as diabetes, high blood pressure, or a family history of glaucoma, you should get an eye check right away.

5 simple tips to prevent vision problems. Click to read!

Glaucoma cannot be reversed once it has started. However, treatment and regular examinations can help decrease or prevent vision loss, especially if the disease is caught early.

Reduced eye pressure (intraocular pressure) is used to treat glaucoma. Depending on your situation, prescription eye drops, oral medications, laser treatment, surgery, or a combination of these may be available.

1. Eyedrops

Prescription eye drops are frequently used to treat glaucoma. They can help lower eye pressure by changing the way fluid drains from your eye or by reducing the amount of fluid produced by your eye. Depending on how low your eye pressure needs to be, you may require more than one type of eyedrop. Prescription eye drops include:

• Prostaglandins: These reduce eye pressure by increasing the outflow of fluid in your eye (aqueous humor). Possible side effects include mild redness and stinging of the eyes, darkening of the iris, darkening of the pigment of the eyelashes or eyelid skin, and blurred vision. This medication is typically taken once a day. Examples include:
  • Latanoprost
  • Travoprost
  • Tafluprost
  • Bimatoprost
• Beta-blockers: These medications reduce the production of fluid in your eye, thereby preventing the body from lowering eye pressure. Possible side effects include breathing difficulties, decreased heart rate, lower blood pressure, impotence, and fatigue. Depending on your condition, this class of medicine may be prescribed for once or twice-daily use. Examples include:
  • Timolol
  • Betaxolol
• Alpha adrenergic agonists: These decrease aqueous humor production and promote fluid outflow from your eye. Possible side effects include erratic heart rate, elevated blood pressure, fatigue, red, itchy, or swollen eyes, and dry mouth. This class of medication is normally administered twice daily, although it can also be prescribed three times a day. Common examples are:
  • Apraclonidine
  • Brimonidine
• Carbonic anhydrase inhibitors: These medications reduce the amount of fluid produced in your eyes. Possible side effects include metallic taste, frequent urination, and tingling in the fingers and toes. This class of medication is normally administered twice daily, although it can also be prescribed three times a day. Examples are:
  • Dorzolamide
  • Brinzolamide
  • Acetazolamide
• Inhibitor of the Rho kinase: This medication decreases ocular pressure by inhibiting the rho kinase enzymes that cause fluid accumulation. Possible side effects include eye redness, irritation, and deposits accumulating on the cornea. Netarsudil is an example of this class of medicine, which is taken once a day.
• Miotic/cholinergic agents: These medicines enhance the amount of fluid that leaves your eye. Possible side effects include headache, eye discomfort, smaller pupils, hazy or poor vision, and nearsightedness. This type of medication is typically administered up to four times per day. These drugs are no longer commonly recommended due to the risk of side effects and the requirement for daily administration. Pilocarpine is an example of this medicine.

Note: You may notice certain adverse effects unrelated to your eyes since some of the eye drop medication is absorbed into your circulation.

• Close your eyes for one to two minutes after placing the drops in to reduce absorption.
• You can also squeeze lightly at the corner of your eyes near your nose for one or two minutes to close the tear duct.
• Remove any unused drops from your eyelid using a cotton swab.
• If you need to use artificial tears or have been prescribed multiple eye drops, space them out by waiting at least five minutes between drops.

2. Oral medications

If eye drops alone are insufficient to lower your eye pressure, your doctor may prescribe an oral medication such as carbonic anhydrase inhibitors. Possible side effects include frequent urination, tingling in the fingers and toes, depression, stomach distress, and kidney stones.

3. Surgery

Laser surgery is primarily performed to aid in the drainage of aqueous humor from the eye. These treatments are frequently conducted in an outpatient surgical center or at an ophthalmologist's office. Some of the procedures include:

• Trabeculoplasty: This operation can be used instead of or in addition to medications for individuals with open-angle glaucoma. The eye surgeon uses a laser to improve the drainage angle, allowing fluid to drain effectively and reducing ocular pressure.
• Iridotomy: This procedure is recommended for individuals with angle-closure glaucoma. A laser is used by the ophthalmologist to create a small hole in the iris, facilitating fluid passage to the drainage angle.
• Trabeculectomy: This type of glaucoma surgery creates a new pathway for fluid drainage inside the eye. It is used to prevent vision loss due to glaucoma by lowering eye pressure.
• Drainage devices for glaucoma: An ophthalmologist may implant a small drainage tube in your eye. The glaucoma drainage implant directs fluid to a collection area, which is then absorbed into nearby blood vessels.
• Cataract surgery: This procedure removes a cataract. In some patients with narrow angles, the removal of the normal lens of the eye can reduce ocular pressure. Narrow angles can obstruct the drainage duct in the eye, and cataract surgery creates more space for fluid to exit the eye.

1. Eat a nutritious diet

Nutritional factors have been demonstrated to influence eye health and may even prevent the progression of diseases like glaucoma.

Some vitamins and nutrients may influence IOP, as well as the occurrence and progression of glaucoma. Fruits and vegetables rich in vitamins A and C, as well as carotenoids, tend to be particularly beneficial.

Leafy greens like spinach, collard greens, kale, and brussels sprouts are among the most vital vegetables to include in your diet.

Antioxidants may also aid in the prevention of additional optic nerve injury. Antioxidants can be found in cranberries, black and green teas, flax seeds, pomegranates, and acai berries, among other foods.

Other fruits and vegetables to include in your intake are peaches, carrots, beets, green beans, and radishes. Caffeine may increase ocular pressure, so experts advise limiting consumption of coffee and caffeinated beverages.

2. Exercise every day

Exercise regularly to maintain a healthy IOP. Moderate exercise can help maintain a healthy IOP by boosting blood flow to your eyes and throughout your body. However, vigorous exercise might raise IOP, so avoid overexertion. Regular exercise can also help maintain a healthy body mass index (BMI), as both high and low BMI are known to increase the risk of glaucoma.

Be mindful that certain yoga poses may increase IOP, which is detrimental for glaucoma patients. Avoid headstands, extended downward-facing dog, legs on the wall, plough, and standing forward bends if you have glaucoma. Instead, practice meditation, as stress appears to raise the risk of high IOP. Daily meditation can help reduce ocular pressure.

3. Try supplements

If you have a vitamin or mineral deficiency, consider natural and over-the-counter supplements such as:

• Zinc
• Calcium
• Magnesium
• Vitamin A
• Vitamin B-complex
• Vitamin C
• Vitamin E

These nutrients are especially crucial for individuals with glaucoma. Taking a daily multivitamin can assist if your nutrition is lacking, but vitamin supplements have not been clinically proven to prevent or cure glaucoma.

4. Go for regular checkups

Get your eyes checked for glaucoma, especially if you have a family history of the condition. Additionally, maintain proper dental hygiene and schedule frequent dental visits, as periodontal (gum) disease has been linked to an increased incidence of primary open-angle glaucoma (POAG) in some studies.

Even if you are considering natural alternatives to treat your glaucoma, always consult your doctor before using any medications or supplements. Certain herbs thought to benefit glaucoma treatment include ginkgo, bilberry, and forskolin.

Home-care tips for caregivers

If you have a friend or family member who suffers from glaucoma, learning about the disease will enable you to provide supportive, caring, and practical assistance. While it may be difficult for your loved one to ask for help, open and clear communication is essential. Encourage them to be specific about how you can assist.

Here are some suggestions for assisting a loved one with glaucoma:

Aids for people with low vision

1. Low-vision aids

These specialized optical devices can help individuals make better use of their remaining vision and continue to engage in activities they enjoy. Many low-vision aids are covered by health insurance. Examples include:

• Custom magnifiers for reading, crocheting, and other close work
• Text-to-speech machines
• Telescopes that can be handheld or worn on spectacles for distant viewing

You can assist your loved one by accompanying them to their next eye doctor visit. Bring a notepad and pen to jot down the doctor's advice.

Create customized resources that list organizations, products, and services that can assist people with low vision. You or the patient can inquire with the doctor about which optical aids may be most beneficial for specific needs.

2. Non-optical aids

These may also be recommended by the doctor to help individuals with impaired vision enjoy life more fully. Examples include:

• Large-print books
• Audio books
• Large-print playing cards, clocks, phones, and pillboxes

3. Household security

You can help your loved one make home improvements to enhance visibility and reduce the risk of falling. Suggestions include:

• Lighting: Use high-wattage light bulbs and additional lamps or task lighting to ensure that your home is well illuminated, focusing on the kitchen, bathroom, and work areas.
• Remove unwanted clutter from your home and offer to assist in organizing and labeling critical materials.
• Make a large-print list of vital phone numbers on bold-lined paper, including doctors, transportation, and emergency contacts, and keep it in an easily accessible location.
• Mark stairwells or slopes with brightly colored tape to aid mobility, using colors that contrast with the flooring.

Because you can't feel the pressure in your eye, the major concern with glaucoma is the lack of symptoms. Only a small percentage of people experience:

• Headaches
• Red eyes
• Blurred vision

If you don't get your eyes examined regularly, you may discover permanent "holes" in your vision or, in advanced stages, "tunnel vision." Glaucoma treatment failure frequently results in blindness.

Acute eye discomfort, redness, nausea and vomiting, and blurred vision may indicate an angle-closure attack. In this acute condition, the iris expands or slides forward to completely block the trabecular meshwork.

If you have angle-closure glaucoma, you are more likely to experience an acute episode in the dark because the pupil opens up and the angle narrows in low light. You may notice:

• Halos surrounding objects
• Slight blurring in a moderate assault
• No pain

Extreme discomfort and a red, swollen eye indicate a medical emergency; if not treated, individuals can go blind quickly.

To effectively control your glaucoma, you will usually just need to make a few lifestyle changes. You can continue to live a full life as long as you are diagnosed early, see your doctor on a regular basis, and follow your doctor's treatment recommendations.

Schedule medication intake around daily routines like waking, mealtimes, and bedtime. Your drugs will become a natural part of your day in this manner.

It is just as vital to pay attention to your emotional and psychological health as it is to your physical health.

Make sure to express your emotions. It can be beneficial to talk about your anxieties, especially in the beginning. Confide in your spouse, a family member, a close friend, or a clergy member.

Speak with other glaucoma sufferers. It can be beneficial and soothing to share thoughts and feelings regarding living with a chronic illness.

Points to remember when outdoors

• Some everyday tasks such as driving or participating in sports may become more difficult. Possible impacts of glaucoma that may interfere with your activities include loss of contrast sensitivity, glare issues, and light sensitivity.
• If you have difficulty seeing at night, you might want to avoid driving at night. Stay safe by changing your schedule so that you accomplish most of your trips during the day.
• Sunglasses or tinted lenses can aid with glare and contrast. Yellow, amber, and brown are the best tints to filter away glare from fluorescent lights. On a bright day, try using brown lenses for your glasses. Use lighter shades of yellow and amber on overcast days or at night.

Other tips and tricks that can help!

• Even though some glaucoma treatments make your eyes feel irritated or blurry, do not rub them.
• It is a good idea to use goggles when swimming and protective glasses when doing yard work or playing contact sports if you have undergone eye surgery.
• Pay attention to the rest of your body. It is just as vital to look after your overall health as it is to look after your eyes.
• It is critical to eat healthy meals, exercise regularly, avoid smoking, limit caffeine use, and maintain a healthy weight.
• Before beginning any intense exercise regimen, consult your physician.
• Drink alcohol in moderation.
• Make time for relaxation and reduce stress in your life.