A reliable sense of sight is a gift which many tend to take for granted until it is too late. It can be easily taken away from anyone, and sometimes even without one knowing. Such is the case involving glaucoma, an eye impairment for which an individual’s vision deteriorates without any noticeable symptoms, and only an eye exam to help identify it.
This then stresses the need for adequate education on proper eye care, to diagnose the likes of glaucoma early on, and possibly reduce its impact on people’s lives.
What is Glaucoma?
Glaucoma is a group of diseases that damages the optic nerve. Imagine your eyes as a round tank filled with water, at which the fluid constantly flows in and out at a balanced rate. In most cases of glaucoma, there is a disruption of this balance due to blockage in the drain or impairment in the outflow pipes of the tank. Buildup of fluid or aqueous inside the eye leads to abnormal elevation of pressure, which in turns exerts overwhelming force on to the optic nerve. Persistent and progressive compression on the nerve will then lead to irreversible damage, manifested as gradual blurring of vision, dark spots, and if left untreated, blindness.
Often regarded as a silent thief of sight, glaucoma often does not present with obvious features until it is too late. Non-specific signs and symptoms of glaucoma may include blurring of vision, headache, eye pain, eye redness, glare or photophobia, which is also seen in other eye conditions. Caution and proper attention is important when experiencing such conditions.
Those that are most at risk of contracting glaucoma include people:
Over the age of 60
With African or Asian descent
With a family history of glaucoma
With a medical history that can cause glaucoma (diabetes, high blood pressure, nearsightedness, eye injury/surgery)
Using corticosteroids for prolonged periods
The World Health Organization (WHO), states that glaucoma is the fourth (4th) leading cause of moderate to severe vision impairments. It is highly important and beneficial to have your regular eye checkup to screen for glaucoma, and manage the diseases if present. Your eye doctor may check for signs of eye deterioration and nerve damage, among other tests.
Depending on the stage of your disease, your ophthalmologist may offer a wide range of options which may include medications, laser procedure or surgery to control the glaucoma, and prevent further vision loss and total blindness.
An umbrella term, glaucoma refers to a group of disorders that damages the optic nerve. In most cases, the prolonged increase in intraocular pressure (IOP) due to a fluid buildup in the eye is the primary cause of this eye impairment, which causes damage to the optic nerve.
Glaucoma results in visual impairments; and, in the worst case scenario, leads to irreversible blindness. The World Health Organization (WHO), in fact, states that glaucoma is the fourth (4th) leading cause of moderate to severe vision impairments.
Those that are most at risk of contracting glaucoma include people:
Over the age of 60
With African or Asian descent
With a family history of glaucoma
With a medical history that can cause glaucoma (diabetes, high blood pressure, nearsightedness, eye injury/surgery)
Using corticosteroids for prolonged periods
As mentioned, getting regular eye checkup is essential in detecting and managing glaucoma. The ophthalmologist may check for signs of eye deterioration and nerve damage or loss, among other tests.
Unfortunately, there is no answer to how to prevent it. However, proper medication and surgery can reduce the IOP to prevent further vision loss and total blindness.
Glaucoma: Causes and Prevention
Glaucoma Risk Factors
Elevated intraocular pressure
High eye pressure can increase the risk for glaucoma, wherein the pressure inside the eye gets too high that it may damage the optic nerve and lead to vision loss. Eye pressure gets higher when fluid cannot normally drain out of the front of the eye.
This fluid normally flows through the anterior chamber, the space between the cornea and the iris, and out of an opening where the iris and cornea meet. In this opening is the trabecular meshwork. The fluid passes through this spongy tissue to drain out of the eye. Pressure in the eye increases when the trabecular meshwork blocks fluid from draining back into the bloodstream.
Not everyone with high eye pressure will develop glaucoma, as people with normal eye pressure can also develop it. The development of glaucoma depends on the amount of pressure the optic nerve can handle and this differs for each individual. For most, an eye pressure above 21 is higher than normal.
It is recommended to have regular dilated eye exams so an eye doctor can determine the level of eye pressure is normal for you.
Damaged optic nerve
An increase in a patient’s IOP can damage the optic nerve, the organ responsible for transmitting visual information to the brain. As a result, the nerve gradually dies out, causing blind spots in the patient’s vision, eventually resulting in blindness.
Eye injury
Any injury to a person’s eye can cause traumatic glaucoma.
Blunt trauma, such as sports-related injuries, can cause tearing and bleeding inside the eye. The accumulation of blood due to the damaged drains increases the IOP, injuring the optic nerve.
Penetrating eye injuries resulting from sharp instruments or debris can leave irritating wounds and induce swelling and bleeding, prompting the IOP to rise.
Genetics
Patients with a history of glaucoma in their families are at high risk of inheriting the condition. Genetic studies show that inheritance is a common risk factor for the rare early-onset and common adult-onset forms of the disease.
Surgery
An elevated IOP is sometimes observed among patients who have undergone intraocular surgeries. Most patients’ eye pressures revert to normal even without treatment, while some experience nerve damage that eventually progresses into glaucoma.
Corticosteroid medication
Many people use corticosteroid medication to treat inflammations, allergies, and immune diseases. However, it can cause increased outflow resistance of aqueous humor, raising the IOP over a few days or weeks. If left untreated, the buildup can develop into steroid-induced glaucoma.
Farsightedness
Farsightedness or high hyperopia can increase the risk for glaucoma, particularly narrow angle glaucoma or angle closure glaucoma, due to a shorter axial length of the eye. Narrow angle glaucoma occurs when there is a relative crowding in the eye due to the restriction in the flow of intraocular fluid between parts of the eye.
Nearsightedness
Nearsighted or myopic people, especially those with worsening visions, are twice as likely to be diagnosed with glaucoma. Unfortunately, myopia also lowers the accuracy of imaging systems, making glaucoma diagnosis more difficult for nearsighted patients.
How to Prevent Glaucoma
Get regular eye checkups
Regular eye examinations by your ophthalmologist can help catch the presence of glaucoma even before any symptoms surface. Primary open-angle glaucoma, which is the most common type of glaucoma, is hereditary. If an immediate family member has glaucoma, you may be at a higher risk for the condition–making regular eye exams necessary for early detection.
Protect eyes from possible trauma
Eye protection goes beyond the wearing of contact lenses or glasses for vision correction. Wear protective eyewear during sports or while working on your home. Protective eyewear such as safety glasses, goggles, face shields, or welding glasses can shield the eyes from hazardous chemicals or other substances, flying debris or other small particles, and projectiles or objects that could fly into the eyes unexpectedly.
Avoid inadvertent use of steroids
Steroids may cause changes in the aqueous fluid outflow system that can increase eye pressure. Due to the increased resistance at the trabecular meshwork, the outflow of fluid in the eye is reduced. If unrecognized, this steroid response can lead to steroid-induced glaucoma and permanent optic nerve damage.
Make sure to monitor intraocular pressure while on steroids. People in high-risk groups, such as those with a family history of glaucoma, should limit exposure to steroids unless absolutely necessary. Patients considering steroid use are advised to consult with a physician and ophthalmologist.
Avoid smoking
Smoking can significantly affect the retinal nerve fiber layer (RNFL). The RNFL collects visual data from the retinal nerves, which direct the data to the optic nerve, which then takes these visual signals to the brain. Studies show that smokers can have a significantly thinner RNFL compared to non-smokers, and a thinning RNFL is a symptom associated with glaucoma and other eye conditions.
Keeping Glaucoma at Bay
While glaucoma has no cure, patients can take preventative measures to reduce the chances of glaucoma progression. Getting proper education about the causes of glaucoma is an excellent start. Moreover, identifying it early to begin treatment is critical to minimize its impact on the patient’s life.
Proper eye care is usually not at the top of one’s priorities, but it is about time it is given enough attention, before things become irreversible.
To receive a professional diagnosis and treatment plan, secure an appointment with Makati Medical Center’s eye care services. The hospital is equipped with world-class facilities and delivers exceptional healthcare services to guarantee that no glaucoma goes unnoticed and untreated.
VICTOR EPHRAIME VENERACION PAULINO, M.D.
Dr. Paulino is a comprehensive ophthalmologist and glaucoma specialist diplomate of the Philippine Board of Ophthalmology. He is the vice-chair for the training and residency training officer at the Department of Ophthalmology, Makati Medical Center. He earned his fellowship in glaucoma at the Eye Institute of St. Luke’s Medical Center and had his residency in ophthalmology at Makati Medical Center.
He has won various awards, placing first for the Fellow’s Research Paper Contest at the Philippine Academy of Ophthalmology, St. Luke’s Eye Institute Research Forum, and for the Fellows’ Surgical Video Contest at the Virtual Annual Congress in the Philippine Academy of Ophthalmology.
Dr. Paulino is also a medical reviewer for Hello Doctor PH, an online platform for patient education and awareness. You may also find him on Facebook.
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