Glaucoma of the Eye

Is Glaucoma Hereditary?

Dr. Fava notes some glaucomas run in families. If one parent has open-angle glaucoma, the chances that an offspring will have a similar condition are about 10 times greater than in the non-glaucoma population.

How Is Glaucoma Detected?

Dr. Maria advocates for regular eye examinations and glaucoma tests from an ophthalmologist as the best way to detect glaucoma of the eye, including angle closure glaucoma. During a complete and painless examination, your eye doctor will measure the intraocular pressure (tonometry); inspect the drainage angle (gonioscopy); evaluate the optic nerve (ophthalmoscopy); and test the visual field of each eye (perimetry).

Photography of the optic nerve or other computerized imaging may be recommended. Some of these tests may not be necessary for everyone. These tests may need to be repeated on a regular basis to monitor any changes in your condition.

What Are the Different Types of Glaucoma?

Glaucoma actually describes a group of diseases affecting the eye, and many different types of glaucoma exist. There are two basic types of glaucoma, both involve the drainage system of the eye.

Open angle glaucoma is the most common type of glaucoma and occurs with aging. Although the drainage angle is open, the drain becomes defective, causing a gradual increase of pressure within the eye. If the increased pressure results in optic nerve damage, it is known as primary open angle glaucoma. Over 90% of adult glaucoma patients have this type of glaucoma. Frequently there are no symptoms and most patients are unaware of any trouble until the optic nerve is severely damaged. Low tension glaucoma is a variant in which vision loss occurs at normal pressures.

Narrow angle glaucoma is a condition where the drainage angle becomes blocked in people who have eyes that have narrow angles. In these types of eyes, the iris can act like a drain plug and either completely or partially block off the drainage angle resulting in a rapid and dangerous rise in the eye pressure. This is called acute angle closure glaucoma. Symptoms of angle closure glaucoma can include blurred vision, severe eye pain, headache, rainbow halos around lights, and nausea and vomiting. A more gradual and painless closing of the angle is called chronic angle closure glaucoma.

Other Glaucomas

Secondary glaucoma occurs when there is an identifiable cause for the glaucoma, such as prior trauma, inflammation or surgery. Congenital glaucoma is a rare condition affecting infants where the drainage angle is abnormal from birth.

Your ophthalmologist will weigh these factors and any symptoms of optic nerve damage and glaucoma symptoms before deciding whether you should be monitored closely for glaucoma of the eye. Regular monitoring means your risk of developing glaucoma of the eye is higher than normal and you need to have regular glaucoma tests to detect the early signs of symptoms of optic nerve damage.

Can Glaucoma of the Eye Be Treated?

Yes, glaucoma of the eye can be treated to prevent or slow damage to your eye. Even for those with considerable vision loss, treatment of advanced stages of the disease often can be effective in preventing further deterioration. Moreover, when the glaucoma of the eye has only damaged the optic nerve rather than deadened it, some return of function is possible.

The higher the intraocular pressure, the more likely the possibility of glaucoma symptoms and vision loss. Your ophthalmologist will work to determine the best intraocular pressure for you. This typically takes multiple visits and repeated glaucoma tests, often over a period of months or years.

Treatment options for glaucoma of the eye include operative eye surgery, eye drops and laser surgery for glaucoma.

Treatments for Glaucoma of the Eye

Eye drops: Drops instilled in the eyes one to four times a day serve to lower the intraocular pressure and treat glaucoma of the eye by a variety of mechanisms. Some lower the pressure by decreasing the production of fluid, some by increasing the outflow and some by a combination of both. Sometimes more than one kind of drop is used at a time. These drops are powerful medications and can have systemic side effects. Dr. Fava and Dr. Maria will discuss these with you and take into account your other medical conditions before deciding which medicines are best for your glaucoma of the eye.

Medications for glaucoma of the eye can preserve your vision, but they may also produce side effects. You should notify your ophthalmologist if you think you may be experiencing any of these:

• A stinging or itching sensation
• Red eyes or redness of the skin surrounding the eyes
• Changes in pulse and heartbeat
• Changes in energy level
• Changes in breathing (especially with asthma or emphysema)
• Dry mouth
• Changes in sense of taste
• Headaches
• Blurred vision
• Change in eye color

All medications can have side effects or can interact with other medications. Therefore, it is important that you make a list of the medications you take regularly and share this list with each doctor you see.

Laser Surgery for Glaucoma: Different types of laser surgery for glaucoma may be effective for different types of glaucoma. In primary open-angle glaucoma, the drainage angle is treated with a laser (called a trabeculoplasty). This laser surgery for glaucoma has proven to be very effective in lowering the eye pressure and may be the first line of treatment in certain patients. Dr. Maria and Dr. Fava have been using the advanced SLT laser in their office since 2003. In angle-closure glaucoma, a hole is made in the iris (iridotomy) to restore the flow of fluid to the drainage angle.

Operative Eye Surgery: When the glaucoma of the eye has progressed to the point where operative eye surgery is needed, the ophthalmologist uses micro-surgery to create a new drainage channel for the aqueous fluid to leave the eye, which lowers the intraocular pressure. Eye surgery is recommended if your ophthalmologist feels it is necessary to prevent further damage to the optic nerve. As with laser surgery for glaucoma, eye surgery is typically an outpatient procedure.

Who Performs Laser Surgery for Glaucoma and Operative Eye Surgery?

Dr. Maria and Dr. Fava are ophthalmologists who perform laser surgery for glaucoma and operative eye surgery. They are fully trained in the most modern laser and microsurgical techniques for glaucoma of the eye procedures, including small-incision and no-stitch cataract surgery and releasable-suture glaucoma filtration surgery.

An ophthalmologist is a medical doctor with specialized training in diagnosing and treating all eye diseases and disorders, including glaucoma of the eye, and is the only eye care provider professionally qualified to perform laser surgery for glaucoma and operative eye surgery.

Where Is Laser Surgery for Glaucoma and Operative Eye Surgery Performed?

Both Dr. Fava & Dr. Maria perform most laser surgery for glaucoma and operative eye surgery at Valley View Surgical Center, a state-of-the-art accredited facility in Lebanon, PA, that is adjacent to the office of Fava & Maria Eye Associates.

What Is My Part in Glaucoma of the Eye Treatment?

Treatment for glaucoma of the eye requires teamwork between you and your doctor. Your ophthalmologist can prescribe treatment for glaucoma, but only you can make sure you follow his instructions.

Once you begin treatment for glaucoma of the eye, your ophthalmologist will want to see you more frequently. Typically, you can expect to visit your ophthalmologist every three to six months, but this will vary depending on your treatment needs.

Helpful Hints

• Know what type of glaucoma of the eye you have.
  Some medicines may make glaucoma worse. This depends on the type of glaucoma of the eye you have, as well as the glaucoma symptoms experienced and the symptoms of optic nerve damage. Most patients with open angle glaucoma can take any type of medicine without affecting their intraocular pressure.
• Take your drops as they have been prescribed for you.
  Keep your eyes closed for about 5 minutes after putting your drops in. If you are on more than one drop, wait 15-20 minutes between drops so the first one is not washed away.
• Carry the names of your medicines and a list of your medical diagnoses with you.
  This will help should you ever have a medical emergency which might interrupt your medication or lead the examining physician to misinterpret the size of your pupils.