By: Meg Irish
Published on January 17, 2019
Many of us don’t always consider the importance of eye health until it is too late, and a condition has progressed. This is very true in the case of glaucoma patients. The American Academy of Ophthalmology estimates that nearly half of Americans with glaucoma are unaware they have the condition because they lack the symptoms. Because it often goes undetected in its earliest stages, glaucoma is referred to as “the sneak thief of sight.” This is why doctors stress the importance of annual comprehensive eye exams.
In a third of patients, they may have up to 50% optic nerve damage but show no signs of high eye pressure or peripheral vision impairment. The only way to find out if you have the condition is through an eye exam. There’s no cure for glaucoma; however, preventing vision loss and blindness can be achieved through early treatment.
Glaucoma is an eye disease that can cause vision loss by damaging the optic nerve, which sends information from your eye to your brain. For most patients, the condition is diagnosed by optic nerve changes, increased intraocular pressure, or abnormalities on other diagnostic exams. Scientists are not sure what causes glaucoma, but we do know treatments to lower high eye pressure can slow the progression of the disease.
“Doctors say the eyes are the windows into the cardiovascular system. It tells us so much about your health. The best advice I can give my patients is to have your eyes examined regularly and always, always wear eye protection,” said board certified ophthalmologist, Dawnielle J. Kerner, MD of the TPMG Ophthalmology Center in Norfolk.
During a glaucoma eye exam, an ophthalmologist will measure eye pressure, inspect the eye’s draining angle to determine open or closed glaucoma, examine the optic nerve for damage, test peripheral vision, and measure the thickness of your cornea. Any irregularities in these measures would signal to the doctor the patient may have glaucoma and needs further treatment. This exam also helps to determine whether the glaucoma is early, moderate, advanced, or absolute. Absolute means the patient has lost all vision and is blind.
Some people are classified as glaucoma suspects because they have slightly abnormal optic nerves, but other tests for glaucoma, such as visual fields, optical coherence tomography, and the intraocular pressure are normal. Tests are then repeated during follow-up exams to see if the glaucoma is being controlled or is getting worse. If the glaucoma is getting worse then additional treatments will be started to prevent loss of vision. This is why regular check-ups are so important, the earlier glaucoma is diagnosed the more aggressively doctors can treat it and avoid further irreversible damage.
According to the American Academy of Ophthalmology, high risk and low risk depends upon a number of risk factors, if patients have 3 risk factors they are considered high risk.
- Age – the older you are, the greater the risk (especially those over the age of 60)
- Family history – if you have a parent or sibling with glaucoma, you are more likely to develop the condition.
- Race – African Americans who are 40-years-old and over are 4-5 times more likely to have glaucoma than others.
- Diabetes – too much glucose in the blood can result in eye problems.
- High Blood Pressure – can affect vision, leading to blocked veins and arteries in the retina.
- Long-term use of steroids – elevates eye pressure in one third of people.
- Near Sightedness – depends on the anatomical composition of your eye
- High myopic patients are those very nearsighted with over -8 diopters and are at risk for angle-closure glaucoma. It is felt that the sclera is less rigid and contribute to the high myopia and the glaucoma.
Types of Glaucoma
The two major types of glaucoma include open-angle and closed-angle glaucoma as well as many types of secondary glaucoma.
Affecting three million Americans, open-angle glaucoma is the most prevalent type of glaucoma and develops with age. It occurs with a slow collapse of the drainage pathways of the eye and increases the intraocular pressure (IOP). This disease gradually steals vision with little notice of change. The initial loss is of side or peripheral vision and does not occur until advanced stages of the disease. Because symptoms are late to develop, this is another reason doctors stress the importance of regular eye exams in order to prescribe a preventable treatment to protect vision. Dr. Kerner treats open-angle glaucoma with drops, laser surgery, and then surgery. Ocular hypertension is a type of open-angle glaucoma.
Much less common, closed-angle glaucoma develops as the lens in the eye grows thicker with age and pushes the iris, closing the drainage pathway. As a result, trabecular meshwork inside the eye is obstructed or damaged, making it difficult for fluid to properly drain increasing eye pressure. Initial symptoms of closed-angle glaucoma include sudden severe eye pain, blurred vision, bright halos appearing around objects, eye redness, or tenderness. To diagnose this type of glaucoma, an ophthalmologist will examine your eyes, ask questions about your condition, and measure your eye pressure. Closed-angle glaucoma is treated with laser surgery and then cataract surgery. Risk factors for closed-angle glaucoma include age, being far-sighted, and having Asian ancestry. Dr Kerner treats closed-angle glaucoma with laser and cataract surgery.
Secondary glaucoma is glaucoma secondary to other diseases such as diabetes, sarcoidosis, or from trauma or from other types of eye surgery. Or glaucoma from medications such as steroid induced glaucoma.
Prevention and Treatment
Glaucoma is a slow, progressive, and irreversible disease that can lead to blindness. For this reason, it is important to take all the necessary measures to prevent the progression of the disease. The American Academy of Ophthalmology recommends that African Americans and people with a family history of glaucoma have an annual eye exam starting at 55-years-old. For patients with high blood pressure and diabetes, maintaining a healthy and balanced diet can also help promote eye health and fight glaucoma.
Patients first diagnosed with glaucoma are often afraid they will go blind. To put them at ease, Dr. Kerner spends time counseling her patients on various methods to slow down the progression and maintain good eye health. This includes routine eye-exams, using drops as directed, keeping blood pressure and blood sugar at bay, and proper diet and exercise. Most importantly, it means establishing a strong patient-provider relationship and working together as a team to do everything possible to maintain eye health and keep eye pressure under control.
It’s up to you to help save your sight. Find support and encouragement from your family, doctor, and friends if you are living with glaucoma.
About Dr. Dawnielle Kerner
Dawnielle J. Kerner, MD, is a highly-skilled, board certified ophthalmologist with over 20 years of clinical experience. Dr. Kerner has a special interest in treating patients with glaucoma; this includes patients 12 years of age and older with congenital glaucoma. As an active member of several organizations, including the American Academy of Ophthalmology and The American Society of Cataract and Refractive Surgeons, she is passionate about educating others on all types of vision and eye conditions. She is currently accepting new patients at her office, The Ophthalmology Center in Norfolk.