What is glaucoma?

The term glaucoma describes a family of diseases that causes damage to the optic nerve and the optic disc.  When the nerve fibers that make up the optic nerve are damaged, they are unable to transmit data to our brain. Dr. Suzanna Billinghurst uses state of the art technology to diagnose and treat glaucoma at Orion Eye Center.

What is the optic nerve?

The optic nerve is located in the back of the eye and consists of over one million nerve fibers. When light enters our eye, it is focused on the retina and the electric impulses from the optic nerve transfer that data to our brain so that we can turn it into the images we see. The effects of glaucoma can damage the optic nerve and in turn prevent or alter the transmission of those electric impulses to our brain.

What is the optic disc?

The optic disc is the area at the back of the eye, on the retina, where the fibers that form the
optic nerve leave the eye and head toward the brain. Consider the optic disc to be the
“plug” for a cord of fiber that transmits data from our eyes, to our brain.

What's going on in the eye

This video describes how fluid in the eye regulates eye pressure.

What you see

This video will show you how Glaucoma can affect your vision.

Closed Angle Glaucoma

This video describes how Closed Angle Glaucoma will affect the flow of fluid and pressure in your eye.

Diagnosis

Glaucoma is best detected by a dilated eye exam and detailed analysis of the optic nerve. Routine eye pressure checks without dilation will fail to diagnose many cases because the pressure of the eye is not the best indicator of glaucoma presence or risk.

Usually, glaucoma is first treated with prescription eye drops that work to lower the eye pressure. In patients with “Low-Pressure” Glaucoma, it is important to still lower the pressure to treat the disease. Sometimes a laser treatment called Argon Laser Trabeculoplasty (ALT) or Selective Laser Trabeculoplasty (SLT) is used to additionally lower the pressure inside the eye. These procedures usually help for a few years and Dr. Billinghurst will want to closely monitor the progression of the disease in your eyes to best determine what course of treatment is best for you.

When the eye pressure cannot be controlled or when vision loss occurs despite treatment, a major surgery called trabeculectomy or tube shunt may be done. These surgeries are effective but carry significant risks and are only used when other methods fail.

Characateristics

Glaucoma is a progressive disease without a cure. Our goal is to slow it down so much that you are never bothered by the vision loss. However, sometimes the disease progresses despite all efforts to slow it down and despite having low eye pressures. It is for this reason that frequent testing is required.

The disease usually progresses slowly over years. However, about 15% of patients are “fast  progressors.” Consequently, we tend to do more frequent checks at the time of diagnosis and in advanced disease.

It has NO SYMPTOMS until the disease is advanced; no blurred vision and no pain. In the early stages of the disease, patients have no way of knowing they have it, other than an eye doctor telling them so. For this reason, glaucoma is known as the “thief of sight.”

The genes that cause glaucoma are hereditary, so it is common for an affected patient to have close relatives that also have the disease. We recommend anyone with a family history of glaucoma to be aware of their increases risk of developing the condition and to see an ophthalmologist for testing.

Glaucoma usually occurs in patients over 50 years of age, though we occasionally diagnose children and young adults with it.

The vision loss caused by progressed glaucoma usually starts in the periphery or side vision, and slowly works its way into the center.

Types of glaucoma

Primary Open Angle (POAG)

  • This is the most common type of glaucoma.
  • Patients have high intraocular (eye) pressure.
  • Treated with pressure-lowering eye drops, a special type of laser surgery or major surgery to form a new drainage channel in the eye.

Normal Tension (NTG)

  • Patients have normal eye pressures.
  • Often patients with this type of glaucoma also report having sleep apnea, a sleep disorder in which patients cease breathing while asleep.
  • Treated with pressure lowering eye drops, a special type of laser surgery or major surgery in advanced cases.

Narrow Angle (NAG)

  • Most common in patients of Asian descent.
  • More common in farsighted patients (patients who see clearly in the distance, but objects up close are blurry).
  • Symptoms may include headaches when in the dark.
  • Our eyes have fluid that flows in and out to naturally regulate our eye pressure. If your eye is affected by this type of glaucoma the path for fluid outflow is restricted, causing pressure to build (narrow anterior chamber angle)
  • Treated with a special type of laser surgery.

Pigmentary (PG)

  • The iris is the colored portion of your eye. With this type of glaucoma, pigment from the iris sheds off and clogs up the “drain” (trabeculum) of the eye fluid (aqueous).
  • Symptoms involve temporary blurred vision or headache.
  • Treatment includes a variety of laser procedures (laser trabeculoplasty) and sometimes pressure-lowering prescription eye drops. 

Exfoliative (EXG)

  • This is caused by a systemic condition that creates build-up of an abnormal material within the body. When this material forms in the eye it is call exfoliative material and builds up on the lens of the eye. When this material sheds, it clogs the “drain” of the eye (trabeculum).
  • Exfoliative glaucoma is more difficult to control than some of the other types.
  • This type of glaucoma makes cataract surgery more difficult. 

Neovascular

  • This type of glaucoma affects patients who suffer from another condition such as diabetes, or retinal vascular occlusion, that reduces the normal flow of blood to the tissues in the eye.
  • Lack of oxygen (hypoxia) causes the tissues of the body to release chemicals (vascular endothelial growth factor – VEGF) that promote the growth of new but abnormal blood vessels.
  • These new defective blood vessels leak blood into the eye tissues and form a fibrous scar tissue. The scar tissue tightens and can cause other problems like a retinal detachment or further bleeding.
  • Treatment often includes laser treatment of the retina (pan-retinal photocoagulation) and injections of anti-VEGF drugs like Avastin or Lucentis.

Laser Iridotomy

This video describes one type of Glaucoma treatment.

Trabeculoplasty

This video describes one type of Glaucoma Surgery.

Mini-Filtration
Surgery

This video describes another type of surgery that can help with some types of Glaucoma.

Treatment

The most common method of treating glaucoma is with prescription eye drops that are put in the eye. There are also a few studies that have indicated some natural remedies that may help with the treatment of glaucoma.

Nutrition

It is believed that patients with diets high in fruits and vegetables were about 70% less likely to develop glaucoma.

  • Small studies show that omega-3 fatty acids somewhat lower eye pressure.
  • Ginkgo biloba, commonly used to increase blood flow to tissue and improve memory, has shown interesting abilities to protect the nerves in some studies.
  • Curcumin (Curry) has been shown in small studies to be helpful.

There are a few things that may increase your eye pressure, that you will want to avoid;

  • Coffee has been shown to increase eye pressure a small amount.
  • Wearing a necktie and having the top button of your shirt buttoned will raise your eye pressure a couple of points.
  • Some activities should be avoided by people suffering from glaucoma. These include activities that would keep your head in a downward position such as prolonged yoga poses, or headstands.
Tips for using prescription eye drops
  • Remember to put your drops in every day. This is the single most important thing you can do to preserve your vision.
  • We recommend you use artificial tears three or four times per day when taking glaucoma eye drops. This will reduce or eliminate the dry eye symptoms many patients get from the prescription medications and will help your eyes feel more comfortable.
  • Do not use any other eye drops, such as artificial tears, within 10 minutes of the glaucoma eye drops. This will prevent you from flushing the medicated eye drop out with the artificial tear.
  • Use the Punctal Occlusion Technique when you put in any prescription eye drops. To do this, put gentle pressure with your finger in the corner of your eye next to your nose and hold it there for at least 30 seconds. Do this as soon as the drop goes into your eye and it will minimize the drops leaving your eye through your tear drains and into your throat.
  • It is very important to keep your appointments to monitor your eye pressure.  Sometimes the glaucoma medication loses effectiveness if it does you will not know unless you keep your appointment.

Our Glaucoma Specialist

glaucoma doc, Dr. Suzanna Billinghurst headshot

General Eye information

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Eye Safety
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How to Insert Eye Drops

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How Often to Have Eye Exams

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