As we age, taking care of our eyes becomes more important than ever. One condition that often goes unnoticed but can significantly affect our vision is glaucoma. Often called ‘the silent thief of sight’, glaucoma can stealthily damage the optic nerve over time, causing gradual vision loss and potentially leading to blindness. The good news is that with early detection and treatment, the impacts of glaucoma can be managed.
What is glaucoma?
Glaucoma is an eye condition that impacts the optic nerve. According to the Canadian Association of Optometrists, it is one of the leading causes of blindness, affecting more than 450,000 Canadians.
Dr. Steven Schendel, a glaucoma specialist who works and teaches in BC, explains, “the optic nerve is the cable that connects the eye, which sees, with the brain, which processes information. In glaucoma, that nerve becomes damaged over time.”
There are several types of glaucoma. The most common and well-known type of glaucoma is primary open-angle glaucoma, which causes damage to the optic nerve through increased pressure in the eye.
Less common types of glaucoma include:
Angle-closure glaucoma. Symptoms can include eye redness, pain, blurred vision, nausea, vomiting and headaches, and seeing halos around lights. If these symptoms come on suddenly, it is important to seek urgent care to rule out angle-closure glaucoma, which can cause blindness in a short period of time.
Secondary glaucoma is the result of eye pressure caused by an underlying condition such as an injury, infection, or tumour.
Normal-tension glaucoma occurs when the optic nerve is damaged even though eye pressure stays within an average range.
“One of the major challenges with glaucoma is that patients don’t notice loss of vision until the disease is typically very advanced. It’s what we call an asymptomatic disease,” explains Dr. Schendel. As glaucoma progresses, it can lead to a loss of peripheral vision and eventually cause tunnel vision, which can interfere with daily activities such as driving. If left untreated, permanent vision loss may occur.
How is glaucoma diagnosed?
Pressure increases in your eyes are often detectable by your eye doctor before you might notice symptoms. Once your doctor suspects glaucoma, they would trigger more testing and follow up over time before making a definitive diagnosis.
Included among risk factors are a family history of glaucoma, certain cardiovascular conditions, eye-related conditions, and age. When it comes to aging as a risk factor, some researchers say that one way to understand glaucoma is as an acceleration of the aging process which naturally leads to vision loss over time.
“We really encourage screening whenever individuals get their eyes checked or get glasses, or every one to two years from age 40 years on. If we can catch people early and put them on appropriate treatments, we can preserve a lot of vision, and patients can do very well for a very long time,” reassures Dr. Schendel.
If your eye specialist suspects glaucoma, they may conduct a number of different vision tests in their office. These tests allow your ophthalmologist to determine the extent of damage to the optic nerve, as well as which treatment might be best suited for your situation.
Dr. Schendel explains, “Putting those many pieces together allows a clear picture to form.” Still, he says, sometimes a diagnosis isn’t definite. “If findings are suspicious, we will follow that person over a number of months or years to determine if we should be doing more.”
Treating glaucoma
When it comes to managing glaucoma, Dr. Schendel says pressure in the eye can be controlled, “by using different therapies that can involve using eye drops, lasers or surgeries. Most ophthalmologists, depending on the patient, would probably consider starting with drops or laser first. There’s lots of good evidence to suggest those are very good places to start with treatment.”
Medication
A number of medications are available to treat glaucoma. Generally, prescription eye drops are used to help lower eye pressure.
Laser therapy
Some types of glaucoma can be treated by laser, a treatment easily done in your eye specialist’s office. This procedure uses laser to open up the eye’s drainage system, lowering eye pressure.
Surgery
Surgery is considered when medications and laser treatments have not been successful in lowering eye pressure sufficiently to prevent damage. In this case, your ophthalmologist may recommend you be evaluated by a glaucoma specialist for trabeculectomy or a tube shunt, which take place in an operating room.
Individuals considering cataract surgery with mild to moderate glaucoma are also sometimes candidates for a newer set of treatments called minimally invasive glaucoma surgeries (MIGS). During this procedure a microstent – smaller than an eyelash – is implanted to reduce pressure in the eye, says Dr. Schendel. “These are a class of surgeries that we add to cataract surgery that don’t increase risk of infection and have rapid recovery.”
Many factors are taken into consideration by eye specialists in consultation with their patients, when considering the best treatment approach for glaucoma. Dr. Schendel emphasizes the importance of an open discussion between patients and doctors.
“When patients come to my office and they’re not sure about surgery, I give them some information to take home, give them an opportunity to ask some questions. Usually, we have time to figure it out and typically, using drops or laser while they consider surgery.”
He ends with reassurance, “the important thing to understand about glaucoma is that it’s a treatable condition.”
That is, treatable once detected, especially when diagnosed early. With care and careful management, it’s possible to delay — or even prevent — permanent vision loss. Have you seen your eye doctor recently? Make an appointment today and keep your vision — and quality of life — in check as you age.
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