Glaucoma

Causes Of Glaucoma

The clear fluid inside the eye is called the aqueous humor. This fluid nourishes the eye and gives it its shape. The eye constantly makes aqueous humour. As the new aqueous enters the eye the same amount should drain out of the eye through an area called the drainage angle. This procedure maintains a constant intraocular pressure (IOP) in the eye. Any blockade or problem in drainage results in fluid build up in the eye. As the IOP increases, the optic nerve may get damaged.

More than a million microscopic nerve fibres make up the optic nerve. It's similar to an electric cable, which is made up of numerous little wires. When these nerve fibres begin to perish, one may start getting blind spots in the vision. These blind spots are mostly noticed when the  majority of the optic nerve fibres have been destroyed. In case all the fibres are lost, it leads to blindness.

Types Of Glaucoma

1. Open angle glaucoma or wide angle glaucoma

Open-angle glaucoma is the most prevalent type of glaucoma. It occurs when the drainage canals get partially occluded. As a result, the pressure in the eye begins to rise, thereby harming the optic nerve. This process happens gradually and may go unnoticed for years as most people don’t show any symptoms initially. Open-angle glaucoma usually tends to run in families. The risk of acquiring the disease is higher if your parent or grandparent suffered from it.

2. Angle-closure glaucoma or narrow angle glaucoma or closed-angle glaucoma

Angle-closure glaucoma is a relatively less common condition in which the iris (the colored part of the eye that controls light exposure) bulges forward, narrowing or blocking the drainage angle created by the cornea (clear outer part of the eye) and iris. As a result, the drainage of aqueous humor is affected, thereby causing an acute rise in eye pressure. People with small drainage angles are more likely to develop angle-closure glaucoma. 

Angle-closure glaucoma can develop quickly (acute angle-closure glaucoma) or gradually (progressive angle-closure glaucoma or chronic angle-closure glaucoma). Glaucoma with acute angle closure is a medical emergency. 

3. Normal tension glaucoma

Even though your eye pressure is within the usual range, your optic nerve is injured with normal-tension glaucoma. No one knows why this is the case. It's possible that you have a sensitive optic nerve or that your optic nerve isn't getting enough blood. Atherosclerosis, or the accumulation of fatty deposits (plaque) in the arteries, or other disorders that affect circulation could be blamed for the reduced blood flow. 

4. Congenital glaucoma or childhood, infantile or pediatric glaucoma

Congenital Glaucoma is a condition that can affect newborns and children who have a defect in the angle of their eye. It might be present from birth or evolve over time. Drainage blockages or an underlying medical issue could cause optic nerve injury. It is thought to be genetic in origin which usually runs in families or due to any abnormal development during pregnancy.

5. Pigmentary glaucoma 

Pigmentary Glaucoma is also a form of secondary open-angle glaucoma. In pigmentary glaucoma, pigment granules that give colour to the iris disperse and build up in the drainage ducts of the eye, delaying or stopping the fluid to exit the eye. This leads to an increase in IOP and eventual damage to the optic nerve.

6. Secondary glaucoma

Secondary glaucoma is a condition in which other diseases cause increase in eye pressure, resulting in optic nerve damage and eventually loss of vision. Eye trauma, eye diseases like uveitis which cause inflammation in the eye, eye tumors, advanced cases of cataract or diabetes or use of drugs like corticosteroids etc. can give rise to this condition.

7. Pseudoexfoliative glaucoma

In this form of secondary open-angle glaucoma, a flaky material exfoliates from the outer layer of the eye lens. This material accumulates in the angle between the cornea and iris and occludes the drainage system of the eye, increasing the eye pressure and damaging the optic nerve. It is usually seen in people of Scandinavian descent.

8. Iridocorneal endothelial syndrome 

In this rare form of glaucoma, cells on the back of the cornea spread over the eye's drainage tissue and across the surface of the iris. These cells also form adhesions that stick the iris to the cornea, further congesting the drainage channels.

Risk Factors For Galucoma

Because chronic types of glaucoma can cause vision loss before any symptoms or signs appear, be aware of the following risk factors: 

• Very high internal eye pressure (intraocular pressure) 

• Being over 60 years of age 

• Having a family history of glaucoma 

• People of African American, Russian, Irish, Japanese, Hispanic, Inuit, or Scandinavian origin

• Decrease in corneal thickness and rigidity

• Having high degree of nearsightedness (myopia) or farsightedness (hypermetropia) or conditions that affect vision

• Eye injury or in certain types of eye surgery

• Medical conditions like diabetes, heart disease, high blood pressure, and sickle cell anemia 

• Long-term use of corticosteroid medicines, particularly eye drops.  

Symptoms Of Glaucoma

Glaucoma usually has no early warning signs or symptoms. It progresses slowly and can go years without causing apparent vision loss.  

Because the early loss of vision is of side or peripheral vision, and the visual acuity or sharpness of vision is preserved until late in the disease, most persons with open-angle glaucoma feel fine and do not notice a change in their vision at first. The condition is usually fairly advanced by the time a patient notices vision loss. Glaucoma causes vision loss that is irreversible, even with surgery. 

However, there are certain signs and symptoms of glaucoma that should not be ignored. These include:

Halos around light: When the pressure rises quickly due to closed angle glaucoma, the cornea becomes waterlogged which can affect the vision leading to halos around lights.

Pain in the eyes: It is mostly seen when there is a sudden buildup of pressure. It does not act as one of the characteristic features/symptoms of glaucoma when the rise in pressure is gradual and not sudden. In some cases, vomiting or nausea accompanying severe eye pain is also seen.

Tunnel vision: It is one of the common symptoms of glaucoma. In this, the pressure on the nerves can damage the retinal nerve fibres which can lead to a characteristic pattern of vision loss. This leads to tunnel vision in which the peripheral vision is blocked. For example, when seeing a photo, you may not be able to see the peripheral picture but can see the centre portion of the picture with clarity. This can be seen when undergoing testing of the eyes.

Changes in the optic disc: The rise in intraocular pressure can lead to cupped, pale optic disc which acts as the key symptoms of glaucoma.

Enlargement of the eye: In kids below three years of age, enlargement of the eye due to raised intraocular pressure can occur. It is one of the characteristic symptoms of glaucoma. In adults, the eye cannot enlarge greatly because growth has ceased.

Diagnosis Of Glaucoma

A comprehensive eye exam is the only approach to diagnose glaucoma with certainty. Only checking ocular pressure during a glaucoma screening is insufficient to detect glaucoma. 

Your ophthalmologist will do the following during a glaucoma exam: 

• Measure the pressure in your eyes 

• Examine the drainage angle of your eye 

• Check for damage to your optic nerve. 

• Check your peripheral vision (side vision). 

• Take a picture of your optic nerve or use a computer to calculate its size. 

• Take a measurement of your cornea's thickness 

• Slit lamp is used by an ophthalmologist to check a woman's eyes. 

Before making a glaucoma diagnosis, five variables should be checked to ensure safety and accuracy. These include:

• The inner eye pressure

• The shape and color of the optic nerve

• The complete field of vision

• The angle in the eye where the iris meets the cornea

• Thickness of the cornea

Tests for glaucoma

Two common eye tests for glaucoma patients are tonometry and ophthalmoscopy, however other tests such as perimetry, gonioscopy and pachymetry also help with the diagnosis.

1. Tonometry 

Tonometry is a test that measures the pressure inside your eye. Eye drops are used to numb the eye during tonometry. A small device or a warm puff of air is used to apply a small amount of pressure to the eye to measure the intraocular pressure.

Pressure is measured in millimetres of mercury (mm Hg). When the pressure in the eye exceeds 20 mm Hg, glaucoma is diagnosed. Some people, however, might develop glaucoma at pressures ranging from 12 to 20 mm Hg as each person's eye pressure is different. 

2. Ophthalmoscopy 

This diagnostic procedure allows your doctor to check the damage in the optic nerve. After dilatation of the pupil with eye drops, the doctor will use a magnifying tool called an ophthalmoscope and a light source to see inside the eye.This allows the doctor to check the structure and colour of the optic nerve through your eye. 

If your intraocular pressure (IOP) is abnormally high or the optic nerve appears abnormal, your doctor may order one or both of the following glaucoma exams: perimetry and gonioscopy. 

3. Perimetry 

Perimetry is a test that measures the visual field function ie. the total area where objects can be seen in the peripheral vision while the eye is focused on a central point.

You will be asked to look straight ahead while a light spot is repeatedly presented in different areas of your peripheral vision during this test. This aids in the creation of a "map" of your vision. 

3. Gonioscopy 

Gonioscopy is a painless examination to determine whether the drainage angle, which is the area where fluid drains out of the eye, is open or closed. 

4. Pachymetry 

Pachymetry is a painless test that determines the thickness of the eye’s cornea using a probe called a pachymeter.

Prevention Of Glaucoma

These self-care tips can help you diagnose glaucoma in its early stages, which is critical for preventing or reducing vision loss. 

• Get dilated eye exams on a regular basis. Glaucoma can be detected early on in the course of a full eye checkup, before it causes major damage. 

• If you're under 40 years old, the American Academy of Ophthalmology recommends a comprehensive eye exam every five to ten years; every two to four years if you're 40 to 54 years old; every one to three years if you're 55 to 64 years old; and every one to two years if you're over 65 years old. If you're at risk for glaucoma, you'll need to get your eyes checked more frequently. Inquire with your doctor about the best screening schedule for you. 

• You should be aware of your family's eye health history. Glaucoma is a disease that runs in families. If you're at a higher risk, you may need to be screened more frequently. 

• Exercise in a safe manner. Regular, moderate exercise can lower ocular pressure and may help to prevent glaucoma. Consult your doctor about an exercise regimen that is right for you. 

• Use the eyedrops as directed on a regular basis. Glaucoma eye drops can dramatically lower the risk of glaucoma developing from excessive eye pressure. Even if you don't have any symptoms, eye drops prescribed by your doctor must be used on a regular basis to be effective. 

• Protect your eyes by wearing sunglasses. Glaucoma can develop as a result of serious eye damage. When utilising power tools or playing high-speed racquet sports in enclosed courts, wear eye protection.

The key to protecting your eyesight against glaucoma damage is early detection, which can be achieved through regular and comprehensive eye exams. Five typical glaucoma tests are included in a comprehensive eye exam. 

It is critical to have your eyes tested on a regular basis. At the age of 40, you should get a baseline eye examination. At this age, you may notice the first indicators of eye disease and vision problems. Based on the results of this screening, your eye doctor will advise you on how often you should have follow-up checks. 

If you have high risk factors for glaucoma, such as diabetes, high blood pressure, or a family history of glaucoma, you should get an eye check right once. 

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Specialist To Visit

Glaucoma can be diagnosed by an ophthalmologist, who can be referred by your family doctor or general practitioner. Regular eye exams can aid your ophthalmologist in detecting this condition before it causes vision loss. Your ophthalmologist can advise you on how frequently you should have your eyes examined.

Glaucoma can be detected by an optometrist, but the illness must be diagnosed and treated by an ophthalmologist. Glaucoma cannot be diagnosed or treated by an optician.

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Treatment Of Glaucoma 

Glaucoma can't be reversed once it's started. Treatment and regular examinations, on the other hand, can help decrease or prevent vision loss, especially if the disease is caught early. 

Reduced eye pressure is used to treat glaucoma (intraocular pressure). Prescription eye drops, oral drugs, laser treatment, surgery, or a combination of these may be available depending on your situation. 

1. Eyedrops 

Prescription eye drops are frequently used to treat glaucoma. These can help lower eye pressure by changing the way fluid drains from your eye or reducing the amount of fluid produced by your eye. Depending on how low your eye pressure needs to be, you may require more than one of the eyedrops listed below. Prescription eye drops include the following: 

Prostaglandins: These reduce your eye pressure by increasing the outflow of the fluid in your eye (aqueous humour). Mild reddening and stinging of the eyes, darkening of the iris, darkening of the pigment of the eyelashes or eyelid skin, and blurred vision are all possible adverse effects. This medication is only to be taken once a day. Some of the medications in this category are:

• Latanoprost 

• Travoprost 

• Tafluprost

• Bimatoprost

Beta-blockers: Beta-blockers are a type of medication that prevents the body from lowering the pressure in your eye by reducing the production of fluid in your eye (intraocular pressure). Breathing difficulties, a decreased heart rate, lower blood pressure, impotence, and weariness are all possible adverse effects. Depending on your condition, this class of medicine may be given for once- or twice-daily use. Examples include:

• Timolol 

• Betaxolol

Alpha adrenergic agonists: These decrease aqueous humour production and promote fluid outflow in your eye. An erratic heart rate, elevated blood pressure, weariness, red, itchy, or swollen eyes, and a dry mouth are all possible adverse effects. This class of medication is normally administered twice daily, although it can also be prescribed three times a day. Common examples are:

• Apraclonidine 

• Brimonidine

Carbonic anhydrase inhibitors: These medications lessen the amount of fluid produced in your eyes. A metallic taste, frequent urination, and tingling in the fingers and toes are all possible adverse effects. This class of medication is normally administered twice daily, although it can also be prescribed three times a day. Examples are:

• Dorzolamide

• Brinzolamide

• Acetazolamide

Inhibitor of the Rho kinase: This medication decreases ocular pressure by inhibiting the rho kinase enzymes that cause fluid accumulation. Eye redness, irritation, and deposits accumulating on the cornea are all possible side effects. Netarsudil is an example of this class of medicine which is taken once a day. 

Miotic/cholinergic agents: These medicines enhance the amount of fluid that leaves your eye. Headache, eye discomfort, smaller pupils, hazy or poor vision, and nearsightedness are all possible side effects. This type of medication is typically administered up to four times per day. These drugs are no longer commonly recommended due to the risk of side effects and the requirement for daily administration. Pilocarpine is an example of this medicine. 

Note!

You may notice certain adverse effects unrelated to your eyes since some of the eye drop medicine is absorbed into your circulation. 

• Close your eyes for one to two minutes after placing the drops in to reduce absorption. 

• You can also squeeze lightly at the corner of your eyes near your nose for one or two minutes to shut the tear duct. 

• Remove any unused drops from your eyelid using a cotton swab. 

• If you need to use artificial tears or have been prescribed many eye drops, space them out so that you wait at least five minutes between drops. 

2. Oral medications

If eye drops alone aren't enough to lower your eye pressure, your doctor may prescribe an oral drug such as carbonic anhydrase inhibitors. Frequent urination, tingling in the fingers and toes, sadness, stomach distress, and kidney stones are all possible adverse effects.

3. Surgery

To treat glaucoma, laser surgery is mostly done to aid in the drainage of aqueous humor from the eye. These treatments are frequently performed in an outpatient surgical centre or at an ophthalmologist's office. Some of the procedures are:

Trabeculoplasty: This operation can be used instead of or in addition to drugs for persons who have open-angle glaucoma.  The eye surgeon uses a laser to improve the drainage angle. As a result, fluid drains effectively and ocular pressure is reduced. 

Iridotomy: It  is advised for people with angle-closure glaucoma. In this, a laser is used by the ophthalmologist to make a tiny hole in the iris which aids in the passage of fluid to the drainage angle. 

Trabeculectomy: Trabeculectomy is a type of glaucoma surgery that creates a new pathway for drainage of fluid inside the eye. It is used to prevent vision loss due to glaucoma by lowering the eye pressure.

Drainage devices for glaucoma: A small drainage tube may be implanted in your eye by an ophthalmologist. The fluid is sent to a collection region by the glaucoma drainage implant (called a reservoir). Following that, the fluid is absorbed into neighbouring blood arteries. 

Cataract surgery: Cataract surgery is a procedure that is used to remove a cataract. The removal of the normal lens of the eye can reduce ocular pressure in some patients with narrow angles. The iris and cornea are too close together when the angles are narrow. This can obstruct the drainage duct in the eye. When the lens of the eye is removed during cataract surgery, more space is created for fluid to exit the eye. 

Home-care For Glaucoma

1. Eat a nutritious diet

• Nutritional factors have been demonstrated to influence eye health and may even prevent the progression of diseases like glaucoma. 

• Some vitamins and nutrients may influence IOP, as well as the occurrence and progression of glaucoma. Fruits and vegetables strong in vitamins A and C, as well as carotenoids, tend to be particularly beneficial. 

• As a result, leafy greens like spinach, collard greens, kale, and brussels sprouts are among the most vital vegetables to eat in your diet. 

• Antioxidants may also aid in the prevention of additional optic nerve injury. Antioxidants can be found in cranberries, black and green teas, flax seeds, pomegranates, and acai berries, among other foods. 

• Other fruits and vegetables to include in your fruit and vegetable intake include peaches, carrots, beets, green beans, and radishes. Caffeine may increase ocular pressure, so experts advise avoiding consuming too much coffee and caffeinated beverages. 

2. Exercise every day

Exercise on a regular basis to maintain a healthy IOP. Moderate exercise can aid in the maintenance of a healthy IOP. This is due to the fact that exercise boosts blood flow to your eyes and throughout your body. Exercising vigorously, on the other hand, might raise IOP, so don't overdo it. Exercising can help you to maintain a healthy body mass index (BMI) as high or low BMI is known to increase the risk of glaucoma.

Remember that certain yoga poses might cause an increase in IOP, which is bad for glaucoma patients. Avoid headstands and extended downward-facing dog, legs on the wall, plough, and standing forward bends if you have glaucoma and practise yoga. Instead, practise meditation. Stress appears to raise a person's chances of having a high IOP. Daily meditation can help reduce ocular pressure. 

3. Try supplements

Glaucoma supplements made from natural ingredients: If you have a vitamin or mineral shortage, you can restore it with natural and over-the-counter supplements such as: 

• Zinc 

• Calcium 

• Magnesium 

• Vitamin A

• Vitamin B-complex

• Vitamin C

• Vitamin E 

All of these things are especially crucial for people who have glaucoma. Taking a daily multivitamin can assist if you feel like your nutrition is lacking. Vitamin supplements, on the other hand, have not been clinically shown to prevent or cure glaucoma. 

4. Go for regular checkups

Get your eyes checked for glaucoma. If you have a family history of the condition, this is extremely crucial. Also, maintain proper dental hygiene and schedule frequent dental visits. Periodontal (gum) disease has been linked to an increased incidence of primary open-angle glaucoma in some studies (POAG). 

Even if you are considering natural alternatives to cure your glaucoma, always ask your doctor before using any medicine or supplements. Certain herbs are thought to benefit in the treatment of glaucoma are ginkgo, bilberry, and forskolin.

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Home-care tips for caregivers 

If you have a friend or family member who suffers from glaucoma, you'll want to learn everything you can about the disease. You will be able to provide supportive, caring, and practical assistance in this manner. Although asking for help may be difficult for your loved one, it is critical to communicate freely and precisely. Encourage him/her to be as specific as possible about how you can assist. 

Here are some suggestions for assisting a loved one with glaucoma: 

Aids for people with low vision 

1. Low-vision aids 

These are specialized optical equipment that can help people make better use of their remaining vision and continue to perform the things they enjoy. Health insurance covers a lot of low-vision aids. Here are a few examples: 

• Magnifiers made to order for reading, crocheting, and other close work 

• Text-to-speech machines that are computerised 

• Telescopes that may be carried in one's hand or worn on one's spectacles for seeing distant objects 

• You can assist your loved one by accompanying him or her to the eye doctor on their next visit. Take a notepad and a pen or pencil with you to jot down the doctor's advice.

• Create customized resources that lists organisations, products, and services that can assist people with low vision. 
  
  

You or the patient might inquire with the doctor about which optical aids will be most beneficial for his or her specific needs. 

2. Non-optical aids

These may also be recommended by the doctor to assist a person with impaired vision enjoy life more fully. Here are several examples: 

• Large-print books, Audio books 

• Playing cards, clocks, phones, and pillboxes are examples of large-print goods. 

3. Household security 

You can assist your loved one in making home improvements to improve visibility and lessen the chance of falling. Here are some ideas: 

• Lighting: Use high-wattage light bulbs and additional lamps or task lighting to ensure that your home is well illuminated. The kitchen, bathroom, and work rooms are all important areas to concentrate on. 

• Remove any unwanted clutter from your home. Offer to assist in the organisation and labelling of critical materials. 

• Information about how to contact us: Make a large-print list of vital phone numbers on bold-lined paper. Include doctors, transportation, and emergency contacts on the list, and keep it in a handy location. 

• Mark stairwells or slopes with brightly coloured tape to aid mobility. The ideal colours to use are those that contrast with the flooring.

Complications Of Glaucoma

Because you can't feel the pressure in your eye, the major concern with glaucoma is the lack of symptoms. Only a small percentage of people experience headaches, red eyes or blurred vision. If you don't get your eyes examined on a regular basis, you may discover permanent "holes" in your vision or, in advanced stages, "tunnel vision." Glaucoma treatment failure frequently results in blindness. 

It could be a sign of an angle-closure attack if you have acute eye discomfort, redness, nausea and vomiting, and blurred vision. The iris expands or slides forward to completely block the trabecular meshwork in this acute condition.

If you have angle-closure glaucoma, you're more likely to have an acute episode in the dark because the pupil opens up and the angle narrows in low light. There may be halos surrounding objects and slight blurring in a moderate assault, but there is no pain.

Extreme discomfort and a red, swollen eye indicate a medical emergency; if not treated, people can go blind quickly.

Living With Glaucoma

To effectively control your glaucoma, you will usually just need to make a few lifestyle changes. You can continue to live a full life as long as you are diagnosed early, see your doctor on a regular basis, and follow your doctor's treatment recommendations. 

• Schedule medication intake around daily routines like waking, mealtimes, and bedtime. Your drugs will become a natural part of your day in this manner. 

• It's just as vital to pay attention to your emotional and psychological health just like your physical health.

• Make sure to express your emotions. It can be beneficial to talk about your anxieties, especially in the beginning. Confide in your spouse, a family member, a close friend, or a clergy member. 

• Speak with other glaucoma sufferers. It can be beneficial and soothing to share thoughts and feelings regarding living with a chronic illness. 

Points to remember when outdoors 

Some everyday tasks such as driving or participating in sports, may become more difficult. Some of the possible impacts of glaucoma that may interfere with your activities are loss of contrast sensitivity, glare issues, and light sensitivity. 

For example, if you have difficulty seeing at night, you might want to avoid driving at night. Stay safe by changing your schedule so that you accomplish most of your trips during the day. 

Sunglasses or tinted lenses can aid with glare and contrast. Yellow, amber, and brown are the finest tints to filter away glare from fluorescent lights. On a bright day, try utilising brown lenses for your glasses. Use lighter shades of yellow and amber on overcast days or at night. 

Other tips and tricks that can help!

• Even though some glaucoma treatments make your eyes feel irritated or blurry, do not rub them. 

• It's a good idea to use goggles when swimming and protective glasses when doing yard work or playing contact sports if you've undergone eye surgery. 

• Pay attention to the rest of your body. It's just as vital to look after your whole health as it is to look after your eyes. 

• It's critical to eat healthy meals, exercise regularly, avoid smoking, limit caffeine use, and maintain a healthy weight. 

• Before beginning any intense exercise regimen, see your physician. 

• Drink alcohol in moderation. 

• Make time for relaxation and reduce stress in your life.