Glaucoma being high pressure of the eye, generally greater
than 21 mm/Hg, is the leading cause of blindness throughout
the world, but fortunately is treatable with prevention. Those
that are most at risk are diabetics, senior citizens, Afro-Americans,
and those who are short-sighted with additionally a family history
of glaucoma.
Most people think that glaucoma is a condition that is painful
with red eyes that has something to do with tears. Nothing could
be further from the truth, because typically the most common
form of glaucoma is not painful, and does not cause redness
to the eye. This is why prevention is so important for early
detection and proper treatment.
Recently, Kirby Puckett, a multi-million dollar professional
baseball player for the Minnesota Twins, lost his eyesight in
one eye due, in part, to glaucoma. This Afro-American was only
37 years old when this occurred, therefore having to retire
prematurely from professional sports. This is why the American
Academy of Ophthalmology recommends your first eye examination
to screen for glaucoma to occur in the early thirties, every
couple of years in the forties and fifties, and annually beyond
the age of sixty.
More goes into a glaucoma eye exam than just checking the eye
pressure with a little blue circular light. In other words,
a normal eye pressure doesn't rule out evidence of glaucoma,
because eye pressure can go up and down all the time, mostly
the highest in the morning and the evening.
Also,
another unusual type of glaucoma is where damage to the optic
nerve can occur at even normal pressures of the low teens.
Therefore, visualization of the optic nerve, which is like a
teacup on a saucer, is very important. The greater the cupping,
the more glaucoma that could be present.
With
more severe glaucoma, the lower the pressure must be to prevent
further loss of side vision. Side vision can be regularly
checked by a computerized test called a visual field test
as well. So, vision, eye pressure, optic nerve visualization,
and side vision testing regularly are all important to decide
what is a normal eye pressure for a patient at the Eye Care
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In
the last couple of years, a new photographic modality has
become quite useful and even indispensable in diagnosing early
glaucoma and following it through its early stages. It
is the OCT or optical coherence tomography of the retinal nerve
fiber layer (RNFL). This photographic test is very easy
and only requires a few minutes of fixation when the picture
is taken after dilation of the patient in the Eye Care Center. This
photograph is quite accurate down to even as small as 7 microns
and diagnosing thinning of the nerve layer caused by glaucoma. In
some situations, this photograph can be used in concert or stand
independently from a visual field test to diagnosing early glaucoma
to managing it in its earlier stages. However, the visual
field test becomes more useful later in the disease process
when the nerve fiber layer has already thinned out to some degree.
Starting
treatment of high eye pressure without evidence of loss of
side vision can be a very difficult decision, because eye
drops can be expensive and have side effects. Ongoing studies
will tell the ophthalmologist when to treat what level of
eye pressure in order to prevent even the earliest evidence
of glaucoma. There are
six families of eye drops to help lower the eye pressure,
and beyond this there is laser treatment as well. But once
again, eye drops and laser are only treatment and are not
curable for glaucoma. Recently the genetic cause has been
identified so a cure may be forthcoming in the future.
If the eye
pressure must be lower despite eye drops and laser, then special
surgically created valves called filters with an anti-scarring
medication applied can be performed in a hospital setting.
This cutting form of surgery can achieve eye pressures as
low as single digits without the prolonged use of anti-glaucoma
eye drops. However, it is very involved and when done correctly,
can take several weeks for vision to clear and pressure to
stabilize.
Once again,
glaucoma is treatable and preventable, but not curable or
reversible once damage occurs. Therefore, it is certainly
important to get to the very best eye doctor possible for
even routine checks. Such is offered at the Eye Care Center.
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