Glaucoma

What is glaucoma?

Glaucoma is a group of diseases that damage the optic nerve at the back of the eye. This nerve is made of many fibres. As fibres are lost, blind spots appear in the field of vision. In many types, the pressure inside the eye rises, because the fluid that should drain from the eye does not drain well.

Two important types:

• Open angle. The most common type. It progresses without pain and at first does not change vision.
• Angle closure. The iris blocks the drainage path. The sudden form is an eye emergency. The chronic form progresses slowly and often has no symptoms.

Glaucoma has been called the “silent thief of sight”, because the sources say about half of the people who have it do not know. Side vision is lost first, and a patient often does not notice for some time.

Who is it for?

This page is for anyone at risk of glaucoma or living with it. Risk factors named in the sources:

• Older age (depending on the group, sources give from forty to sixty years and above)
• A parent, brother or sister with glaucoma
• High eye pressure
• Short-sightedness or long-sightedness
• A past eye injury
• Long-term use of steroid medicines
• Diabetes, high blood pressure or migraine
• In some sources, African, Hispanic or Asian ancestry

Having several risk factors together raises the chance. Having a risk factor means you should be examined, not that you will certainly become ill.

How is it checked and treated?

Diagnosis is through a full eye examination, which usually includes measuring pressure, looking at the optic nerve after dilating the pupil, and a visual field test. The treatment the doctor chooses depends on the type of glaucoma and the amount of damage. The known options are:

• Drops. The most common treatment. They lower the pressure by reducing fluid production or improving drainage. They may cause side effects such as stinging, redness or temporary blurring.
• Laser. Improves the drainage of fluid. The type depends on the type of glaucoma.
• Surgery. Considered when drops and laser are not enough. There are several kinds, and all are for draining fluid.

Treatment usually continues for years or for life. The eye doctor decides which option suits you.

Living with treatment

• Do not stop drops or change the dose without talking to your doctor.
• Go to your follow-up visits. A source says that after treatment starts, many patients are seen every three to six months, but this interval differs from patient to patient.
• At each visit, eye pressure and the visual field may be measured again to see whether treatment is working.
• If you are not putting in the drops correctly or you forget them, tell your doctor so you can find a way. The correct way to put in drops is described in the patient guide.

With treatment and regular follow-up, the risk of serious vision loss is lower for many patients. But every patient is different, and your doctor knows your situation best.

Risks

Glaucoma that is not treated can lead to serious loss of vision and eventually blindness. The treatments themselves have side effects:

• Drops: stinging, redness, blurring, dry mouth, changes in pulse rate
• Laser and surgery: every procedure has its own risks, and the doctor explains them beforehand

If you feel unwell after starting a drop, talk to your doctor and do not put the drop aside yourself.

When to call

These signs can be a sudden attack of angle-closure glaucoma and are an emergency:

• Severe pain in the eye or forehead
• A red eye
• Sudden blurring of vision
• Seeing coloured rings around lights
• Headache, nausea or vomiting

In this case go to the emergency department at once or call 115. Do not drive yourself, and take your medicines with you.

If you have glaucoma and your vision has slowly got worse without these signs, book a visit sooner and do not wait for your next appointment.