Glaucoma

Diagnosis

Regular eye examinations are crucial for detecting conditions like glaucoma, which may develop without noticeable symptoms. These exams enable the assessment of optic health and the identification of potential vision loss. To screen for glaucoma, an eye doctor may conduct various painless tests, including:

• Dilated eye exam: This involves enlarging the pupils to examine the optic nerve at the back of the eyes.
• Visual field test (perimetry): This checks for changes in peripheral vision, evaluating the ability to see objects to the side.
• Ocular pressure test (tonometry): This measures intraocular pressure.
• Slit-lamp exam: Using a slit lamp, the doctor examines the inside of the eye.
• Gonioscopy: This test examines the angle where the iris and cornea meet.
• Optical coherence tomography (OCT): This assesses changes in the optic nerve that could indicate glaucoma.
• Pachymetry: This measures corneal thickness.
• Visual acuity test (eye charts): This assesses potential vision loss.

Treatment

The damage caused by glaucoma is irreversible, but the progression of vision loss can be slowed or prevented through treatment and regular checkups, especially when the disease is detected early. The primary approach to glaucoma treatment involves reducing intraocular pressure, with options including prescription eye drops, oral medications, laser treatment, surgery, or a combination of these interventions. Regular monitoring and timely intervention are crucial for managing the condition effectively.

These treatments aim to reduce intraocular pressure:

Eyedrops: Glaucoma treatment often begins with prescription eye drops, aimed at reducing eye pressure. These drops fall into several categories:

• Prostaglandins: Enhance fluid outflow, reducing eye pressure. Examples include latanoprost, travoprost, tafluprost, bimatoprost, and latanoprostene bunod. Side effects may include eye redness, stinging, darkening of iris, eyelashes, or eyelid skin, and blurred vision. Typically, used once daily.
• Beta blockers: Decrease fluid production to lower eye pressure. Examples are timolol and betaxolol. Side effects may include difficulty breathing, slowed heart rate, lower blood pressure, impotence, and fatigue. Prescribed once or twice daily.
• Alpha-adrenergic agonists: Reduce fluid production and increase outflow. Examples include apraclonidine and brimonidine. Possible side effects are irregular heart rate, high blood pressure, fatigue, red or itchy eyes, and dry mouth. Typically used twice daily.
• Carbonic anhydrase inhibitors: Reduce fluid production. Examples include dorzolamide and brinzolamide. Side effects may include metallic taste, frequent urination, and tingling in fingers and toes. Usually prescribed twice daily.
• Rho kinase inhibitor: Lowers eye pressure by suppressing enzymes responsible for fluid increase. Available as netarsudil (Rhopressa), prescribed once daily. Possible side effects include eye redness and discomfort.
• Miotic or cholinergic agents: Increase fluid outflow. An example is pilocarpine. Side effects may include headache, eye ache, smaller pupils, blurred or dim vision, and nearsightedness. Typically used up to four times a day.

To minimize systemic side effects, close your eyes for 1-2 minutes after applying drops and press lightly at the tear duct. Wait at least five minutes between different drops. If using multiple eye drops, artificial tears may also be necessary.

Oral medications: Eye drops alone might not sufficiently reduce eye pressure, prompting your eye doctor to prescribe oral medication, typically a carbonic anhydrase inhibitor. Potential side effects include increased urination, tingling in extremities, depression, stomach discomfort, and the formation of kidney stones.

Surgery and other therapies: Alternative treatments include laser therapy and surgery to manage eye pressure:

• Laser Therapy: Laser trabeculoplasty is an option for those unable to tolerate eye drops or when medication fails to slow disease progression. This in-office procedure uses a small laser to enhance drainage at the iris and cornea junction. Full effects may take a few weeks.
• Filtering Surgery (Trabeculectomy): This surgical procedure involves creating an opening in the white part of the eye (sclera) to provide another route for fluid drainage, lowering eye pressure.
• Drainage Tubes: A tube is inserted into the eye to facilitate excess fluid drainage, reducing eye pressure.
• Minimally Invasive Glaucoma Surgery (MIGS): MIGS procedures, often combined with cataract surgery, aim to lower eye pressure with less risk than traditional surgeries. Your eye doctor will discuss suitable MIGS techniques.

Post-procedure, regular follow-up exams are crucial, and additional interventions may be necessary if eye pressure increases or other changes occur.

Treating acute angle-closure glaucoma: Acute angle-closure glaucoma is a medical emergency necessitating immediate intervention. Treatment typically involves a combination of medication and laser or surgical procedures. A laser peripheral iridotomy, creating a small hole in the iris, is often performed. This facilitates fluid flow, opens the drainage angle of the eye, and rapidly alleviates eye pressure.