Glaucoma: The Silent Stealer of Sight Susan Chorkoff, MD
Updated: Nov 14, 2019
Every day I see patients with a disease that can silently steal away vision. That disease is glaucoma. There are different types and subtypes of glaucoma; however, the most common type of glaucoma in the US, open-angle glaucoma, often develops and slowly progresses without symptoms. Early detection of glaucoma can mitigate potential damage to the visual system. Comprehensive eye exams by an experienced eye care provider can tell you if you have glaucoma or if you should be followed for the development of this disease. January is glaucoma awareness month, so we thought it would be valuable to learn more about this sight-stealing disease. At its most basic, glaucoma is a disease of the optic nerve, the structure responsible for carrying all the visual information the eye receives to the visual centers of the brain. Symptoms often become noticeable only after significant, permanent and irreversible damage has been done to the optic nerve. Unfortunately, once this amount of damage occurs, it is often difficult to gain control of the disease. If left untreated, glaucoma may result in total blindness. And while glaucoma is not curable, it is treatable and, if detected early, chances are good that one may retain good visual function.
Are there risk factors for glaucoma? Besides elevated intraocular pressure, advanced age is a major risk factor for the development and progression of glaucoma. However, glaucoma may develop at any age. Much more rarely, babies are born with glaucoma or develop it soon after. Children and young adults may also develop the disease. Race is another important factor in the development of glaucoma. While glaucoma occurs in every racial group, the prevalence of open-angle glaucoma is three to four times greater in African Americans and Hispanics than in Caucasians. It appears to be a more aggressive disease in blacks and results in blindness at least four times more commonly than in whites. Hispanics tend to develop glaucoma at older ages than Caucasians. Inuits and Asians have a higher incidence of a more acute and often symptomatic form of glaucoma called angle-closure glaucoma. A family history of glaucoma is another notable risk factor. Associated diseases include diabetes mellitus and hypertension. A history of chronic steroid use (topical ophthalmic eye drops, nasal, inhaled or oral), ocular injury and chronic inflammatory diseases of the eye place one at higher risk for glaucoma and should prompt a complete eye evaluation by an ophthalmologist. Myopia, or near-sightedness, places one at a higher risk for open-angle glaucoma, while far-sightedness is associated with narrow-angle glaucoma. If glaucoma (most commonly) has no symptoms, how do I know if I have glaucoma? Glaucoma can be detected with a thorough eye examination by an ophthalmologist. Careful evaluation of the optic nerves is essential. And while elevated intraocular pressure is an important risk factor for glaucoma, it is important to note that not all patients will have high intraocular pressure at the time of the examination. In fact, glaucoma may develop with normal intraocular pressures.
How is glaucoma treated? Treatment might consist of eye drops, lasers or surgeries. All current therapies are designed to lower the fluid buildup, or pressure, within the eye. At present, this is the only proven way to control glaucoma progression.
What are the symptoms of glaucoma? As mentioned earlier, the most common type of glaucoma in this country, open-angle glaucoma, has no symptoms in early- to even late-stage disease. Advanced glaucoma may result in visual symptoms that are often difficult for patients to describe: areas of blur, haziness or fogginess in the peripheral or central vision, increasing dimness of vision, or the awareness that objects disappear and reappear in the field of vision. Angle-closure glaucoma occurs less frequently in the United States; however, it is a leading cause of bilateral vision loss in Asian countries and, in fact, the world. Symptoms of this type of glaucoma, in contrast to open-angle glaucoma, are not subtle and may cause significant eye pain, headache, nausea, vomiting, blurred vision and colored haloes around lights. Congenital glaucoma may be present at birth and may manifest with excess tearing, irritability and sensitivity to light. Babies born with glaucoma may have larger than normal globes, and the cornea (the central, outer covering of the eye) may become cloudy.What can I do to prevent the development of glaucoma? Currently, we cannot prevent most types of glaucoma. The best chance to ensure that you do not develop significant visual dysfunction from glaucoma is through early detection: a thorough screening eye exam by age 40, earlier if you have any of the above-mentioned risk factors. Then, make sure to follow your doctor's recommendations for follow-up. Ask your family members whether they have glaucoma and inform your children and other relatives if there is a history of the disease.
What can I do if I have glaucoma to prevent it from getting worse? Following your eye doctor’s recommendations as to the frequency of follow-up and adherence to treatment is your best chance for preventing the progression of glaucoma. Several lifestyle alterations have been found to result in the elevation or lowering of the intraocular pressure but have not been shown to slow or advance the development or progression of the disease. Broad recommendations regarding these changes cannot be made, and you should check with your doctor as to what may be best for you. Regular aerobic exercise has been shown to lower intraocular pressure, while rapid ingestion of large amounts of fluid, head-down yoga positions or use of inversion tables, playing wind instruments and weight lifting with breath holding can increase intraocular pressure. Use of alcohol, tobacco and caffeine may have varying effects on intraocular pressure, depending on the frequency of use. High caffeine intake and cigarette use have been associated with an increased risk of developing glaucoma in some studies. Recent data suggest that a diet high in nitrates and dark green, leafy vegetables may lower the risk of developing glaucoma. Lifestyle approaches should be considered complementary to, and not in lieu of, conventional treatment for glaucoma.
Is marijuana helpful in controlling glaucoma? Marijuana does have a short-term intraocular pressure-lowering effect lasting three to four hours; however, there is a lack of evidence that it alters the course of glaucoma. As 24-hour control of the eye pressure is essential in glaucoma treatment, concern exists about the practicality and safety of continuous marijuana use. Currently, the American Academy of Ophthalmology does not recommend marijuana for the treatment of glaucoma.
Susan Chortkoff, MD
Susan C. Chortkoff received her undergraduate and medical degree from Emory University in Atlanta in 1985 and 1989 respectively. She completed a residency in Ophthalmology in 1994 at the California Pacific Medical Center in San Francisco and practiced general ophthalmology in Burlingame and San Mateo before taking a break from medical practice to attend to her young family. Following a move to Salt Lake City in 2007, she completed a fellowship in glaucoma at the John A. Moran Eye Center at the University of Utah. She currently practices with the Glaucoma Division at the Moran Eye Center. In her free time, Susan enjoys exploring Utah’s many opportunities for outdoor adventure, including mountain biking, hiking, skiing and fly fishing with her husband, Ben.
Susan C. Chortkoff, MD Adjunct Assistant Professor of Ophthalmology John A. Moran Eye Center University of Utah in Salt Lake City, Utah
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