What is glaucoma?

Glaucoma is a disease of the optic nerve, which is the part of the eye that carries the images we see from the eye to the brain. The optic nerve is made up of many nerve fibers (like an electric cable containing numerous wires). Glaucoma damages nerve fibers, which can cause blind spots in our vision and vision loss to develop.

Glaucoma has to do with the pressure inside the eye, or intraocular pressure (IOP). When the clear liquid called the aqueous humor–which normally flows in and out of the eye–cannot drain properly, pressure builds up in the eye. The resulting increase in IOP can damage the optic nerve.

The most common form of glaucoma is primary open-angle glaucoma, where the aqueous fluid that normally circulates in the front portion of the eye is blocked from flowing back out of the eye through a tiny drainage system. This causes the pressure inside your eye to increase, which can damage the optic nerve and lead to vision loss. Most people who develop primary open-angle glaucoma notice no symptoms until their vision is impaired.

How does it occur?

A clear, watery fluid called the aqueous humor normally circulates in your eye. When the flow of this fluid out of the eye becomes blocked, the pressure increases inside the eye. The increased pressure can damage the optic nerve.

There are two main types of glaucoma, depending on how the flow of fluid is blocked:

• Open-angle glaucoma is caused by a gradual blockage in the area that drains fluid from the eyes into the drainage channels. It is the more common type of glaucoma in the US and Europe. It usually affects both eyes.
• Closed-angle glaucoma is a blockage caused by a change in the position of the iris (the colored part of the eye). The change in position causes the iris to block the drainage channels. This type of glaucoma usually happens in one eye at a time. If you get glaucoma in one eye, you are at risk for having the same problem in the other eye. When this type of glaucoma happens suddenly, it is called acute closed-angle glaucoma and is a serious medical emergency.

Glaucoma tends to run in families. It occurs most often after age 35, but sometimes even children have it. Glaucoma is a common eye problem in people over age 60. It is more common among people of African American decent.

What are the symptoms?

Open-angle and other chronic forms of glaucoma often have no symptoms in the early stages. In later stages, patients begin to notice a loss of vision, and the side vision is affected first.

Symptoms of acute closed-angle glaucoma include:

• severe eye pain
• seeing halos around lights
• ausea and vomiting
• headache
• loss of vision

How is it diagnosed?

Here at West Boca Eye Center, we always screen our patients for vision problems during routine checkups, and checking the eye pressure is one of those screening tests.

Dr. Bellotte may use the following tests to diagnose glaucoma:

• Tonometry, a painless procedure used to measure the pressure in your eyes; this newer modality has taken the place of the puff-of-air-test many patients recall.
• Ophthalmoscopy, in which Dr. Bellotte use an instrument to look at the optic nerve inside your eye.
• Visual field testing, which can show early changes in your side vision caused by damage to the optic nerve; Dr. Bellotte have the newest visual field machines available, which can detect glaucomatous defects up to five years earlier than previous visual field technology.
• Gonioscopy, which is a method of examining the drainage channels of your eye
• Pachymetry, which is a new technology that predicts how the thickness of your cornea may leave you more or less susceptible to high eye pressures.
• Optical Coherence Tomography (OCT), another important new technology to measure the retinal nerve fiber layer thickness of your optic nerve. This will quantify precisely if and how much glaucoma damage your optic nerve may have. It can be used as a comparison over time to see if the glaucoma is causing damage by thinning out your optic nerve tissue. Here at West Boca Eye Center, we are fortunate to have the latest in OCT technology, even though it has not reached many other offices yet.

How is it treated?

The goal in the treatment of glaucoma is to reduce the pressure in your eyes. This may be done with eyedrops, oral medication, laser surgery, or filtering surgery. Some eyedrops reduce the amount of fluid made by your eye. Others increase the amount of fluid that flows out. Surgery relieves pressure inside the eye by opening up the drainage channel or by making another opening through which the fluid can drain.

Dr. Bellotte will be able to tell you which treatment is right for you.

How long will the effects last?

Loss of vision caused by glaucoma is permanent. This is why glaucoma needs to be diagnosed and treated as early as possible, to stop further damage to the optic nerve.

If Dr. Bellotte give you medication to control the pressure in your eye, you may need to take it for the rest of your life.

How can I take care of myself?

• Take your medication as prescribed.
• Carefully follow Dr. Bellotte’s recommendations for follow-up visits and pressure measurements.
• Call us here at West Boca Eye Center if you have any side effects from your medication, or any pain or change in vision of your eyes.

How can I help prevent glaucoma?

Unfortunately, glaucoma cannot be prevented. However, blindness can be prevented if glaucoma is treated before pressure in the eye has damaged the optic nerve too much.

You may be able to help prevent glaucoma from becoming severe if you:

• Have a regular eye exam. How often you need to see Dr. Bellotte will then depend on how severely your optic nerve has been damaged.
• Learn about your family history. Many types of glaucoma tend to run in families.

Visit Dr. Bellotte at West Boca Eye Center at once if you see halos around lights or notice any changes in your vision.