What is glaucoma? Glaucoma is an eye disease that may cause loss of vision. It occurs as a result of a buildup of fluid in the eyeball. Imagine that the inside of your eye is like a sink, with the faucet always running and the drain always open. Like water in the sink, the fluid in your eye moves in and out. The fluid nourishes your eye and keeps it healthy. After the fluid circulates, it empties through a drain in the front of your eye.

In people with glaucoma, the drain in the eye is blocked and the fluid can't run out of the eyeball. Instead, the fluid builds up and causes increased pressure in the eye.

How does increased pressure damage your eye?
The increased pressure in the eye destroys the nerve cells in your eye, causing you to lose your vision. At first, you may have blind spots only in your peripheral, or side, vision. If your glaucoma isn't treated, your central vision will also be affected. When glaucoma causes vision loss, the loss is permanent. Nothing can restore dead nerve cells.


What causes glaucoma?
The eye constantly produces aqueous, the clear fluid that fills the anterior chamber (the space between the cornea and iris). The aqueous filters out of the anterior chamber through a complex drainage system. The delicate balance between the production and drainage of aqueous determines the eye’s intraocular pressure (IOP). Most people’s IOPs fall between 8 and 21. However, some eyes can tolerate higher pressures than others. That’s why it may be normal for one person to have a higher pressure than another.

Detection and Diagnosis
Because glaucoma does not cause symptoms in most cases; those who are 40 or older should have an annual examination including a measurement of the intraocular pressure. Those who are glaucoma suspects may need additional testing. The glaucoma evaluation has several components. In addition to measuring the intraocular pressure, the doctor will also evaluate the health of the optic nerve (ophthalmoscopy), test the peripheral vision (visual field test), and examine the structures in the front of the eye with a special lens (gonioscopy) before making a diagnosis.

The doctor evaluates the optic nerve and grades its health by noting the cup to disc ratio. This is simply a comparison of the cup (the depressed area in the center of the nerve) to the entire diameter of the optic nerve. As glaucoma progresses, the area of cupping, or depression, increases. Therefore, a patient with a higher ratio has more damage.

The progression of glaucoma is monitored with a visual field test. This test maps the peripheral vision, allowing the doctor to determine the extent of vision loss from glaucoma and a measure of the effectiveness of the treatment. The visual field test is periodically repeated to verify that the intraocular pressure is being adequately controlled.

The structures in the front of the eye are normally difficult to see without the help of a special gonioscopy lens. This special mirrored contact lens allows the doctor to examine the anterior chamber and the eye’s drainage system.

Treatment
Most patients with glaucoma require only medication to control the eye pressure. Sometimes, several medications that complement each other are necessary to reduce the pressure adequately.

Surgery is indicated when medical treatment fails to lower the pressure satisfactorily. There are several types of procedures, some involve laser and can be done in the office, and others must be performed in the operating room. The objective of any glaucoma operation is to allow fluid to drain from the eye more efficiently.

Please call us at 770-448-5587 if you have any questions or concern.