National Glaucoma Month
Bitterroot Valley Eye Associates
A Service of Marcus Daly Memorial Hospital
Mark Calderwood, MD
300 North 10th Street
Hamilton, MT 59840
In observance of national glaucoma month, this article will discuss one
of the more obscure but relevant eye diseases that cause a significant
number of people to lose vision permanently. There are about 2.5 million
Americans affected by glaucoma and 200,000 new cases per year. That number
is increasing. Yet for most, glaucoma is very treatable if caught early
through screening. So what is glaucoma?
Glaucoma is a group of disorders that cause damage to the optic nerve
in the eye from abnormal pressure. The optic nerve, found in the back
of the globe, is the structure which transmits images from the retina
(like the film in a camera) to the brain. Once the damage is done it's
gone forever. There is no way to reverse it. That's why it's imperative
to catch it early. And the only way to catch it early is to be checked
regularly by your eye doctor because most people are unaware they have
it until the damage is very advanced. Most forms are totally asymptomatic.
Though many people think of glaucoma as a disease that affects peripheral
or side vision, it can affect any area of vision and in fact can affect
the central vision early on.
There are a number of different forms of glaucoma. The most common is
called chronic open angle glaucoma or COAG. The damage to the nerve comes
from long term high pressures in the eye for certain patients. We used
to believe there was a range of normal pressures (10-21 mmHg). However,
as time has gone by we realize some people can withstand high pressures,
while others are very sensitive to lower pressures. It is very individualistic.
And often it can take years to determine if the patient actually has glaucoma,
because early on the changes can be very subtle. There is currently no
single test to make a diagnosis. There is no blood test.
Usually serial eye pressures, pictures, viewings, and visual fields (an
office test checking for the whole vision of each eye peripherally and
centrally) are taken. Family history can also play an important role.
Therefore, if it runs in your family you should be checked regularly.
If you have COAG, there are a number of treatment options. The most common
treatment is with a variety of eye drops. These medications have become
very effective and for most people can control the disorder very well
with minimum to no side effects, but it does require trial and error to
determine which works best for each patient. Alternative treatment includes
laser treatments called ALT or SLT. These can be used as first line therapy,
adjuncts to therapy, or alternates if meds fail. In progressive disease
with use of the aforementioned treatments, more invasive and risky surgical
options (trabeculectomy or stents) may be required. These are typically
performed by a glaucoma specialist.
Other forms of glaucoma include angle closure, pigmentary, pseudoexfoliation,
neovascular (diabetes the most common cause), congenital, traumatic, and
low pressure or normal tension glaucoma. These are much less common and
have different treatment modalities. Feel free to discuss these with your
So what do we recommend? If you have a family history of COAG you should
start getting screened every two years at the age of 40. With no history
we recommend testing annually after 60. Demand that you get tested with
non-airpuff techniques which are far more accurate and reproducible. The
most common reason for progression of disease is noncompliance with medications.
The most important thing however is to become educated, informed, and
screen regularly. With proper treatment and follow up glaucoma can be
controlled instead of controlling.
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Questions and or comments regarding this week's health column please
contact, Mark Calderwood, MD at Bitterroot Valley Eye Associates, a service
of Marcus Daly Memorial Hospital, 300 North 10th Street, Hamilton, MT
59840. Working together to build a healthier community!