Questions Answered

What is glaucoma?

Glaucoma is the term used to describe a number of related conditions that cause damage to the optic nerve, which transmits information from the eye to the brain. It usually (but not always) is associated with high intraocular pressure (IOP). Left untreated, glaucoma can cause blindness.

Is glaucoma curable?

Vision loss from glaucoma cannot be reversed. Routine eye exams are essential to discover glaucoma early and begin glaucoma treatment before significant vision loss has occurred.

What’s the difference between glaucoma and ocular hypertension?

Ocular hypertension is another term for high eye pressure. In ocular hypertension, IOP is higher than normal but does not cause optic nerve damage and vision loss. Ocular hypertension is a risk factor for glaucoma and should be monitored closely.

What are the signs and symptoms of glaucoma?

There are usually no signs that you’re developing glaucoma until vision loss occurs, which is why it’s so important to have regular eye exams. Your optometrist can detect and treat high IOP before it progresses to optic nerve damage and vision loss.

What glaucoma treatments are currently available?

Consultant ophthalmologists usually prescribe special glaucoma eye drops that reduce intraocular pressure. These are used one or several times a day, depending on the medication. If the drops don’t work, surgery may be the next step. In some cases, surgery might be the first option for glaucoma treatment.

If I have glaucoma, will I become blind?

The chances are good that you will not go blind if you take your medication correctly and regularly and follow up with your doctor. Treatment significantly slows the damage that occurs to the optic nerve because of the high pressure in the eye. In fact, if you take your eye drops on schedule each day, you’ll probably keep your eyesight until the day you die of old age!

Is there any way to prevent glaucoma?

Though it’s unclear whether glaucoma can be prevented, you might be able to reduce your risk for the disease by maintaining a healthy lifestyle.

Current research is suggesting that optic nerve nutrition can be enhanced with certain drugs and also with certain nutritional agents, like gingko biloba.

“our suggestion would be to avoid smoking and excessive alcohol, eat a healthy diet, keep your weight down, exercise, take nutritional products and be sure to see your optometrist on a regular basis.”

Factors that may increase your risk are:

  • Being over 50
  • Being over 40 and African-American
  • Having a family history of glaucoma
  • Having a history of serious eye injury
  • Taking steroid medications
  • Having diabetes
  • Being nearsighted
  • Having high blood pressure

People with these risk factors should have their eyes examined on a regular basis to look for the disease.

What can I do to help my parent with glaucoma?

Being diagnosed with glaucoma is scary. Many older people are dealing with several problems that come with age. They often worry that they will become a burden to the family if they lose their vision. So, first, reassure your parent that many people keep their vision with proper medication and care.

Next, help your loved one establish a routine so eye drops are applied correctly on schedule. Some eye drops must be applied several times a day. This can be especially difficult for people with arthritis, and, frankly, not an easy task for anyone to remember! You could offer to help, perhaps by swinging by the house or by calling with a reminder. If that’s not possible, talk with your parent’s doctor to make sure a plan is in place. Compliance with drop regimens is extremely important in glaucoma to prevent permanent vision loss.

If your parent faces surgery, do what you can to help him or her prepare, then arrange transportation to follow-up visits to the doctor.

There are many services and products available to help someone with impaired vision continue to write checks, organize their kitchen, tell time, and even play cards. Contact the Sight Concern to learn about them.

Remember, the best help you can offer is your emotional support.

Can marijuana be used to treat glaucoma?

Not really. While some people tout “natural” benefits of marijuana for treating glaucoma, Mr Tarun Sharma, Glaucoma consultant in Worcestershire says side effects far outweigh any possible benefit that typically is greatly exaggerated. You’re much better off using prescribed medication or treatment that is far more effective than marijuana.

Can I have LASIK surgery if I have glaucoma?

People being treated for glaucoma typically are not good candidates for LASIK. This is because a suction device is used on the eye during the creation of the corneal flap during LASIK surgery, and this briefly causes a significant increase in IOP.

But you might be a candidate for another type of vision correction surgery, such as PRK, which does not require the use of a suction device.

Why do I need Visual Field Tests?

Visual field testing is one of the vital diagnostic tests for glaucoma. During this test, the patient looks straight ahead into a lighted bowl and then responds every time a light is flashed and perceived at different points of your peripheral (or side) vision. This helps draw a map of your field of vision.

When you test vision on an eye chart, only the central vision is tested. But in glaucoma, even in cases when the IOP appears stable, in most cases the field of vision is the first to be affected. By the time central vision is impacted, glaucoma may already be far advanced with almost all peripheral vision lost.

Visual field testing devices all incorporate an internal computer with the ability to store, print, and transmit important patient data. There are many variables involved in obtaining reliable results and it often takes several tests before a reliable initial baseline is established. This is a recognized phenomenon. Further field tests are then performed periodically, their frequency depending on other factors but at least once a year, to detect any new field defects, to visually compare a sequence of reliable field tests, and to look for changes in the field defect pattern that are indications of how the disease is progressing.

Are there other tests for glaucoma I should have?

Corneal thickness measurements are often taken using a pachymeter. Corneal thickness varies among individuals, and thicker corneas may cause a measurement artifact with a higher reading being found. Likewise, thinner corneas are associated with falsely low readings. Also, thin corneas have been found to be an independent risk factor for the development and progression of glaucomatous damage.

Gonioscopy is a test in which a small lens is placed on the eye to allow the sides of the anterior chamber to be visualized. The anterior chamber angle is where fluid exits the eye, and it is important to determine if there are any secondary mechanisms such as trauma, pigment or pseudoexfoliative material obstructing this exit channel causing the eye pressure to be elevated.

Optic nerve photographs are often taken using a retinal camera. By documenting the appearance of the optic nerve and retinal nerve fiber layer at a particular moment, such pictures can establish an initial baseline for future evaluation and can then help recognize progressive damage by allowing a comparison of the current optic nerve appearance to a prior photograph. Special imaging devices such as an Optical Coherence Tomograph (OCT), Heidelberg Retinal Tomograph (HRT), or a scanning laser polarimeter (GDx) may also be used to help assess the health of the optic nerve and retinal nerve fiber layer. These instruments take images of the optic nerve and retina similar to a photographic camera. The images quantify the amount of cupping, size of the optic nerve’s rim and thickness of the fibers that make up the nerve fiber layer. Research has shown that damage to the nerve fiber layer and optic nerve often occurs before visual field changes are recognized. While these devices are not essential for making an initial diagnosis of glaucoma, they can provide important findings for the clinician.

Do nutrition and exercise affect glaucoma?

A healthy diet coupled with a daily routine of exercise is a good prescription for everyone interested in good health. But remember, every patient is different. Before making any drastic change in your diet, it is wise to communicate that intention to your doctor and discuss the pros and cons. The same advice is true for embarking on a new exercise program. While studies show that aerobic exercise can lower intraocular pressure, other forms of exercise can increase pressure. So, if you are a glaucoma patient, it is especially important to check with your doctor before making any lifestyle changes. Such changes could have an impact on the test results your doctor relies on to evaluate the success of your treatment plan.

Can caffeine affect intraocular pressure (IOP)?

For years it was thought that caffeine had no affect on IOP, except in rare instances. Now, with the concept of non-pressure dependent factors such as constriction of the veins or arteries and ocular blood flow, the question is being debated again, since caffeine can affect blood flow. There is no conclusive answer, but too much caffeine is not recommended – especially if you have cardiovascular problems or migraines. As always, only a doctor who examines your eyes can determine the most appropriate treatment for you or answer questions about your specific condition. If you remain unsure or uncomfortable with your options, we recommend seeking a second opinion.

Is there a particular diet that prevents the development of glaucoma?

Glaucoma is an intraocular pressure related optic nerve disease and before answering this question it is worth exploring whether nutritional deficiencies are implicated in optic nerve disease of any kind. Such a question is important because it demonstrates that proper nutrition can be tied to optic nerve health. In point of fact, it is well known that optic nerve atrophy is associated with deficiencies of B12 or folate deficiency. The question is whether associations between nutritional habits and glaucoma exist in developed countries where food is in abundant supply. That is a more difficult question to answer. First, frank nutritional deficiency is very uncommon in the developed world.

No consensus on dietary behavior associated with POAG for a wide range of nutrients including antioxidants and dietary fat currently exists. Dietary habits consistent with overall good health should benefit everyone with or without glaucoma.

Are alternative therapies being studied for their role in glaucoma?

Many available natural compounds used as non-pharmaceutical therapy have been reported to show beneficial effects on circulation, the immune system and neuroprotective activities. The mechanism of action of neuroprotection most common to natural compounds is antioxidant/free radical scavenging activity. However, many other actions are present and some extracts, such as Ginkgo biloba and curcumin, have widespread activity on a number of enzyme systems. There has been a paucity of clinical trials examining neuroprotective effects of these compounds on ocular diseases. More are warranted.

Among natural compounds and extracts of great interest for glaucoma are curcumin, omega-3 fatty acids and Ginkgo biloba. Curcumin, a component of the commonly used spice, turmeric, is a potential neuroprotective candidate for glaucoma.Curcumin studies have increased greatly in recent years, with over 2000 papers published since 2000. Curcumin has shown possible beneficial effects in most of the mechanisms thought to be involved in the development and progression of glaucoma. A pilot study has shown that it slows disease progression. A clinical trial on patients with glaucoma is on the horizon.

Omega-3 fatty acids, found most notably in fish oil, play an important role in reducing oxidative damage in the retina, improving ocular blood flow and protecting against retinal ischemia (decrease in the blood supply) induced by increased IOP. While studies have not specifically addressed glaucoma, it has been suggested that fish oil may reduce IOP and be relevant to glaucoma because of its protective effect on the macula and its benefits for other eye problems.

Ginkgo biloba
extracthas been claimed effective in the treatment of a variety of disorders associated with aging. It appears to have many qualities applicable to the treatment of non-IOP-dependent risk factors for glaucomatous damage. It is believed to improve central and peripheral blood flow, reduce spasm of the blood vessels, and have protective effects against free radicals because of its antioxidant property. It has been shown to be effective in treating Raynaud’s disease, which is strongly associated with normal-tension glaucoma. These and other properties raise the possibility that this herb may be a potential antiglaucoma therapy.

Taking Statins? You May Be Less Likely to Develop Glaucoma

Since so many people take statins to lower their risk for cardiovascular disease, much research has been done recently to determine their effect on the body overall, including the eyes.

Now a study of more than 300,000 people aged 60 and older concludes that those with high blood levels of unhealthy fats who took statins continuously for two years saw their risk for open-angle glaucoma reduced by 8 percent, compared with those who did not take statins.

Statin use may protect the optic nerve and retinal nerve fibers, which are harmed by glaucoma. Since the statins seem to reduce glaucoma risk most before it is diagnosed or in the early stages of the disease, the research may lead to new preventive treatment.

Statins’ apparent ability to reduce glaucoma risk may be due to several factors, including improved blood flow to the optic nerve and retinal nerve cells and enhanced outflow of the aqueous fluid, which may reduce intraocular pressure.

Twice as Many Collisions Possible for Drivers with Advanced Glaucoma

In a recent driving simulation, people with advanced glaucoma had twice as many accidents as those with normal vision.

The study, conducted at Tohoku University Graduate School of Medicine in Sendai, Japan, matched two 36-person groups for age, driving experience and more.

The most common type of accident for both was a collision with a child, car or other object that entered the scene suddenly from the side. But the drivers with glaucoma had more than twice as many collisions as the normal-vision drivers.

The problem is that glaucoma can reduce peripheral vision, whether partially or severely, without harming central vision. People with advanced glaucoma often pass the visual acuity test given in most countries and in most of the United States, because it checks only straight-ahead distance vision.

A visual fields test could prevent those with severe peripheral vision loss from renewing their license. Or it could trigger a requirement for special mirrors to be installed on their vehicles, to help them overcome their side vision loss.

Most Glaucoma Patients Are Not Using Their Eye Drops Correctly

Eye doctors often bemoan the fact that many people with glaucoma don’t use their prescribed medication and lose their vision as a result. But nine out of 10 glaucoma patients who are trying to instill their medicated eye drops don’t do it correctly, suggests a recent study.

This is a serious problem, because it may mean insufficient treatment of the sight-stealing disease. Other issues include the waste of money spent on costly medications and contamination of medication bottles.

During the study, 70 glaucoma patients with a mean age of 54 were watched as they used tear substitute drops with the same method they normally used when instilling glaucoma medication eye drops at home.

The researchers measured the time it took to get the first drop into the eye, the number of drops used, where the drops made contact, any contact with the bottle tip and whether the eyelids and tear ducts closed after each drop. Here are the results:

  • The time it took to instill the first drop ranged from 8.7 to 23.5 seconds (mean was 14.8).
  • The number of drops per instillation ranged from one to eight drops (mean was 1.8).
  • The drops fell onto the eyelids or cheek in 22 patients.
  • Fifty-three patients touched the tip of the bottle to the eye or eye area.
  • Twenty closed their eyes after the drop, and four had their tear ducts close.
  • Six patients (about 9 percent) squeezed one drop into the eyelid sac without bottle tip contact, which is the correct way to use glaucoma drops.

Large Doses of Calcium and Iron Supplements May Increase Glaucoma Risk, Says Study

Iron and calcium supplementation above a certain level may increase your risk of developing glaucoma, says recent research.

In a cross-sectional study of participants in the 2007-2008 National Health and Nutrition Examination Survey, 3,833 people aged 40 or older were interviewed about their use of dietary supplements and antacids (which usually contain calcium) during the previous 30 days.

Those who took at least 800 mg per day of supplementary calcium or at least 18 mg per day of supplementary iron (both are oxidants) had a greater chance of glaucomatous disease than those not taking these supplements. In fact, taking both iron and calcium above these levels increased the odds of developing glaucoma even more.

For perspective, here are the amounts of iron and calcium found in some popular supplements:

  • A two-tablet dose of Tums Ultra Strength 1000 contains 800 mg of calcium, while two tablets of Tums Extra Strength 750 contain 600 mg.
  • A one-tablet daily dose of Centrum Silver Women 50+ contains 500 mg of calcium and 8 mg of iron, while the same dose of Centrum Women Under 50 contains the same amount of calcium but 18 mg of iron· A two-tablet daily dose of Nature Made Calcium 500 mg with Vitamin D contains 1,000 mg of calcium. Incidentally, this is the recommended daily amount of calcium, according to the label.
  • A one-tablet daily dose of Nature Made Iron contains 65 mg of iron.

The researchers noted that further study is needed to decide whether oxidant intake is a definite risk factor for the eye disease.

Advice for Clinic appointments

At this consultation your past medical history will be recorded and a thorough eye examination will be performed. The examination is painless, so there is nothing to worry about, but it may be lengthy, as it may be necessary to dilate your pupils. You should expect to spend up to an hour at the clinic. Every effort is made to see you as close to your scheduled appointment, however, emergencies do occur and consultations sometimes take longer than expected.

Following your consultation, your ocular condition will be discussed with you, as well as the approach to treatment and the results you could expect to achieve.