Glaucoma is a group of complex diseases, most of which are caused by an increase in liquid production. If the eye’s trabecular meshwork becomes blocked or constricted, fluid backup occurs in the eye that, over time, injures the optic nerve. The liquid buildup creates too much pressure within the eye.
Glaucoma is classified into three primary types: primary open-angle glaucoma, angle-closure glaucoma, and normal-tension glaucoma. This post focuses on the two most common forms—primary open-angle and angle-closure glaucoma—as part of our discussion on Glaucoma Causes, Types, and Treatments.
The third, normal-tension glaucoma, is a condition in which the optic nerve is damaged without any extra pressure. Those at highest risk of this much rarer condition are those with a family history of irregular heart rhythm and those of Japanese ancestry. Migraines, Raynaud’s disease, and sleep apnea are some of the other risk factors to look out for.
Primary Open-Angle Glaucoma
This is the most common form of glaucoma, which occurs when the eye’s drainage canals develop clogs over time. It is the most difficult to diagnose because it develops slowly, and there are rarely any early warning signs.
According to the Glaucoma Research Foundation, open-angle glaucoma can be distinguished by the following symptoms:
- Slow clogging of the drainage canals, resulting in increased eye pressure
- Loss of peripheral vision
- In advanced stages, tunnel vision
Regular visits to your eye doctor can prevent long-term damage, and if detected early enough, the disease typically responds well to treatment.
Angle-Closure Glaucoma
A less common form, but still the second most common, is angle-closure glaucoma – sometimes called narrow-angle or acute glaucoma. With this type of glaucoma, eye pressure typically rises very quickly, and the iris is not as wide and open as it should be.
Narrow angles can go undetected just like open angles, except when there is an acute attack). If the pupil increases in size too much or too quickly, it can cause the rim of the iris to gather over the drainage canals, resulting in a radical increase in eye pressure.
Acute angle-closure glaucoma develops very quickly, with very noticeable symptoms and damage. This type demands immediate attention to prevent irreversible damage to vision.
Symptoms of Acute Angle-Closure Glaucoma can include:
- Nausea and vomiting
- Eye pain
- Abrupt onset of visual disturbance
- Distorted or hazy vision
- Halos or rainbows around light
- Reddening of the eye
Who is At-Risk for Glaucoma?
Glaucoma can affect everyone—although hereditary glaucoma is the most common form, certain groups are at higher risk. Studies reveal that African Americans over 40 and individuals over 60, especially Hispanics, are more vulnerable. Understanding Glaucoma Causes, Types, and Treatments is essential, and high-risk individuals should schedule regular eye exams at least every two years to catch early signs and protect their vision.
Glaucoma Treatment
Unfortunately, there is no cure for glaucoma, and any damage caused is permanent, but the disease is manageable, and most people retain their eyesight. Depending on the type of glaucoma, there are several treatment options, which include everything from eye drops to surgical procedures.
Open-Angle Glaucoma
For those with primary open-angle glaucoma, the following treatment options are available:
- Eye drops—Depending on the severity of the glaucoma, eye drops are typically the first step in treatment.
- Medication—These are given to patients in an effort to reduce overall pressure on the eye. According to the American Academy of Ophthalmology, possible side effects of the medication include stinging or itching, dry mouth, red eyes, and altered energy level. It is imperative that medicine is taken as prescribed to avoid any vision-threatening damage.
- Surgical Procedures—When medications are unsuccessful or have intolerably adverse side effects, surgery is often the best option. Two common surgical options for primary open-angle glaucoma are argon laser trabeculoplasty and selective laser trabeculoplasty. Incisional surgery is also a secondary option if the laser surgery doesn’t quite complete the job.
Argon Laser Trabeculoplasty (ALT) is only used with open-angle glaucoma patients. It creates small and evenly spaced burns in the trabecular meshwork, giving the extra fluid access to new drainage. If this procedure is successful, most patients continue taking glaucoma medications to maximize surgery results, though not at the same dosage as before.
Selective Laser Trabeculoplasty (SLT)—This procedure uses a newer, low-energy laser to treat targeted cells in the drainage angle. Standard postoperative treatment includes close observation, eye drops, or an oral non-steroidal anti-inflammatory drug. Combining SLT with regular glaucoma medications usually produces better results, though again, at different dosage levels than before.
Angle-Closure Glaucoma
People suffering from angle-closure glaucoma typically have laser or conventional surgery. It’s not uncommon for doctors to perform surgery on both eyes as a safety measure. These surgeries are successful and typically long-lasting afterward. The main surgical option for angle-closure glaucoma is laser iridotomy.
This surgery is usually a preventative measure and is always recommended for narrow angles, many times before the patient is started on glaucoma medications. However, glaucoma medications are usually effective, as well.
Laser iridotomy makes a tiny hole approximately the size of a pinhead through the iris to improve fluid flow to the drainage angle. This option is the surgery most people will have. However, if the glaucoma is complicated or especially severe, incisional surgery may be needed at the doctor’s discretion.
Incisional surgery comes in two forms, spelled almost the same. A trabeculotomy is surgery where incisions are made, but no eye tissue is removed to clear the eye for drainage. A trabeculectomy requires partial removal of the eye drainage system. As glaucoma is usually more severe with incisional surgery, the doctor might also implant a valve in the eye to allow proper drainage.
Incisional surgery requires a longer visit. Surgery plus recovery time can take 4 to 8 hours, compared to about one hour for laser surgery.
Regular checkups remain crucial, especially as many common forms of glaucoma—with various glaucoma causes, types and treatments—can develop after surgery. Staying on top of your eye health helps prevent serious damage and vision loss. Routine visits to Barnet Dulaney Perkins Eye Center allow you to catch early signs of glaucoma and receive expert care to maintain your overall vision health for years to come.
