Current Glaucoma Treatment Modalities
Although glaucoma remains the second leading cause of blindness in the
United States, considerable progress has been made in its management.
The disease can be controlled effectively and sight preserved for those
patients whose condition is diagnosed and treated early.
Knowledge of the most common risk factors can help physicians identify
glaucoma "suspects" and refer for sight saving (not sight
restoration) treatment. Medical assistance in referring is critical
because the disease, in many instances, presents no symptoms to alarm the
patient.
Most persons with glaucoma, of course, are adults aged 40 or more. That
is the patient category addressed by this article. An estimated two out of
three persons with glaucoma in this mature age group exhibit elevated
intraocular pressure when tested.
Pressure remains the foremost of all risk factors, yet the patient may
not know it's anything out of the ordinary.
So insidious is the disease that the patient may experience gradual
loss of vision - central and/or peripheral - and not realize it.
A test for intraocular pressure may even prove inconclusive because
approximately one out of three persons with glaucoma suffers from the
low-pressure type of glaucoma. In these cases, the pressure may be in the
normal range of 12 to 21 millimeters of mercury.
The Optic Nerve
A definitive diagnosis can be made only by means of a thorough
examination of the optic nerve. If the disease is present, it will be
manifest in damage to nerve fibers and blood vessels.
Any long term decrease or interruption of blood flow to the optic nerve
can cause ocular damage leading to glaucoma.
This would establish as candidates for glaucoma individuals with high
or low blood pressure, blockage in the carotid, coronary disease or with a
history of migraine headaches.
Diabetics and heavy smokers are at high risk because of the negative
effects of both the disease and the habit on blood circulation.
Blacks are more at risk than whites because, for reasons unknown, their
intraocular pressure is more difficult to control and they seem to sustain
more nerve damage. They seem to scar faster after surgery, causing
premature post-op drainage problems.
Anyone with a family history of glaucoma is 25% at risk of inheriting
the disease. It should be noted also that individuals with myopia are more
inclined than others to contract glaucoma.
Treatment Modalities
In the normal eye, aqueous humor circulates freely through the anterior
and posterior chamber. The fluid, produced constantly by the ciliary body,
drains through the trabecular meshwork, back into the bloodstream.
Glaucoma develops when production of fluid increases, or filtration is
no longer adequate. Pressure rises in the eye, causing damage to the optic
nerve.
Three different treatment modalities are prescribed, each depending on
how far the disease has progressed. Drops (sometimes pills) are the first
and most conservative treatment method.
If drops do not ameliorate the condition, laser treatment is applied.
Should that approach prove unsuccessful, surgery may be necessary. All
three are designed to reduce intraocular pressure.
Conclusion
Approximately 2% of the adult population over age 40 suffers from
glaucoma, much of which is stealing sight without warning symptoms. Highly
effective treatment methods are available to manage the disease.
The challenge to physicians is to help identify individuals who, based
on various characteristics and conditions, are prime candidates to have or
contract glaucoma.
Individuals aged 40 or older and people at risk should have a professional eye examination
by an eye doctor once a year. The checkup must include a thorough
evaluation of the optic nerve. Anyone on regular medication, or with
glaucoma in the family history, should see an eye doctor more often.
For such individuals, the optic nerve examination is even more
important. Early detection and treatment will enable the ophthalmologist
to control the disease and preserve what vision remains. Lost sight cannot
be restored, but blindness can be prevented.
Last Revised: August 17, 2010 |
