Glaucoma, the Silent, Sightless Disease

5/5/2021
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Dr. Moss Fenberg with Southwest Eye Consultants explains just what glaucoma is and why it's so important to get treatment. Sponsored by Southwest Eye Consultants.

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Healthy Living in the Four Corners is brought to you by Southwest Eye Consultants. If you recently had an eye exam, chances are that you had an eye pressure test to detect glaucoma. Glaucoma is a condition that affects more than three million Americans. And if left untreated, it can lead to permanent blindness.

Glaucoma is a silent disease. Unlike retinal detachments, unlike strokes of the eye, unlike some of the other conditions we've talked about, you can't tell. Glaucoma is silent. And the ultimate damage is your peripheral visual field is slowly lost. Unfortunately, there are many cases where visual blindness occurs because a patient has missed, has just not followed up, not checked in.

Glaucoma is a disease that damages the optic nerve from the buildup of fluid in the front part of the eye. As the fluid builds up, it presses on the vitreous humor, the substance inside the eye. As a result, the vitreous humor presses against the optic nerve, cutting off blood flow. Think of it like fast water running through a ditch. The water pressure, if left unchecked, will begin to erode the sides of a ditch.

When we think about glaucoma, the fluid is produced by this structure here called the ciliary body. The ciliary body has little finger-like projections similar to other places in the body that produce the fluid that fills this anterior portion of the eye. It's produced here behind the iris, but anterior to the lens. And then the fluid flows through the pupil out into the front of the eye and then back into this drainage area here called the trabecular meshwork. And so you have this circular flow of fluid production and fluid drainage. And although it's not very large in this image, this is referred to as the angle of the eye. And this angle structure has, if you look microscopically at it, there is what is referred to as the trabecular meshwork. And that's where the fluid releases, and it goes into a vascular system called episcleral vessels here, and then drains essentially back into your venous system through a channel and pathway here underneath the eye.

Treatment for glaucoma usually starts with application of eye drops that reduces the production of fluid in the front of the eye to alleviate pressure. Your ophthalmologist may prescribe one medication or a combination of medications to address the issue. If the drops don't work or you hate dealing with eye drops, your doctor may suggest laser therapy.

With laser, patients are unaware. It does not hurt. They don't feel it. They come in for about a 10-minute laser procedure. They sit down at a slit, not at a slit lamp, but like a slit lamp. And we place a small lens on the eye that has a special mirror, essentially a prism, and allows us to see around the corner and to see this trabecular meshwork. The laser will allow you to treat that area of the trabecular meshwork. And you go through a 10-minute process here in the clinic. You go home, there's no drops afterwards. There is no special precautions. It's a fairly easy, straightforward treatment.

If your condition worsens or you're not a candidate for laser therapy, your doctor may insert micro stents or a larger implant to help drain the fluid.

These stents, these micro stents, are placed here in the angle of the eye and just go in just a millimeter or so to this trabecular meshwork area, and then allow that fluid that's then produced to go into that drain essentially and to make it out to the venous system of the eye.

Glaucoma, like high blood pressure, is a silent disease. And just as you should get regular physical checkups to monitor your blood pressure, you should monitor your eyesight with an annual eye exam whether or not you wear glasses.

Even when you don't need glasses, you should have routine ophthalmic exams. And beyond the age of 40, 45 or so, all of us should be having a routine yearly check.

If you'd like to know more about cataract surgery and the options available to you, contact Southwest Eye Consultants.com. I'm Deborah Uroda for Healthy Living.

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