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Glaucoma

Glaucoma refers to a collection of eye disorders that damage the nerve fiber layer of the retina that exit the eye bundled into the optic nerve. The optic nerve transmits visual images to the brain. This nerve fiber layer loss from Glaucoma comes from eye pressures that are too high for an individual. All of our patients are checked for Glaucoma. After age 60, a person should be checked annually for glaucoma. The risk of glaucoma progressively increases after the age of forty. Elderly, African Americans, those individuals on frequent steroids, diabetics, and high myopes are all at a higher risk of developing glaucoma. High risk patients should be checked regularly at a younger age. Each year, approximately 2.2 million people in the United States are diagnosed with glaucoma and the disorder is the second leading cause of blindness in the United States. Glaucoma generally is not cured, but with early detection and treatment it can be controlled.

What are the different types of glaucoma?

Primary open-angle glaucoma is the most common type of glaucoma. It develops gradually due to poor drainage of the aqueous fluid produced in the eye and the building up of eye pressure. It is usually asymptomatic until its’ late stages. Therefore, you depend on qualified eye exams to detect the condition early. Over time, inadequately treated glaucoma can lead to loss of the nerve fiber layer, damage to the optic nerve, visual field loss and eventually vision loss.

Angle-closure glaucoma (also known as narrow-angle glaucoma) is a less common form of the condition that can cause vision loss if severe. This form of glaucoma occurs when the drainage angle of the eye, formed by the cornea and iris, closes or becomes blocked. As a result, fluid is prevented from draining properly and pressure on the optic nerve is increased. Angle-closure glaucoma can be chronic and develop gradually or acute and appear suddenly. For prevention we use a simple, painless iris laser treatment for an eye at risk of angle closure. Since this condition can be both painful and blinding.

Normal-tension glaucoma occurs when the optic nerve is damaged despite the fact that pressure in the eye is not high. This form of glaucoma is also known as low-tension or normal-pressure glaucoma. It is treated in a similar fashion as open angle glaucoma with the goal of lowering the eye pressure.

What are the symptoms of glaucoma?

Most glaucoma is open angle or normal tension type and is asymptomatic until later stages when the loss of peripheral vision loss is more obvious and usually unrecoverable. In the case of angle closure glaucoma, pressures can get high enough to cause nausea, vomiting, severe headache as well as eye pain and redness.

How is glaucoma diagnosed?

During a comprehensive eye exam the eye pressure is checked by tonometry (painless) and the optic nerve is examined for tell tale signs of glaucoma. Dr. Gilbert likes to describe the optic nerve appearing on his exam as looking like a donut. The larger the donut hole in the optic nerve, the more likely glaucoma is present. If glaucoma is suspected then we use in-house nerve fiber layer photos (OCT) and measurement of the peripheral vision (Visual Field test), as well as a measurement of corneal thickness to determine whether or not glaucoma is present.

Optic Nerve | Visual Field Loss

How is Glaucoma treated?

There are several methods used to treat glaucoma:

  1. The most common eye drop type is used once daily. There are about six types of glaucoma drops.
  2. Laser Surgery often done in our office is quick and comfortable and helps achieve controlled eye pressures.
  3. ECP- Endolaser Cyclo Photcoagulation – commonly used at the time of Cataract Surgery to reduce aqeous fluid production and hence better control glaucoma.
  4. Microsurgery.
  5. Trabeculectomy – surgical filter, less common and used when other treatments have been inadequate. Surgical filters work by creating a new controlled channel in the eye to increase outflow of fluid, hence reducing the eye pressure.
  6. Surgical Shunt implant – for more complicated cases.
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