Glaucoma

What is glaucoma?

Glaucoma is a group of common eye diseases that damage the eye nerve (optic nerve). There are 70 million glaucoma patients across the world. It usually happens when there is a build up of fluid in the eye causing high eye pressure. But sometimes eye pressure can be normal and this is called normal tension glaucoma.

The exact cause of glaucoma is not fully understood, but glaucoma has dysfunction or blockage of drain, which sits in the angle of iris (dark part of the eye) and cornea (front skin). Primary open angle glaucoma is the most common type of glaucoma. A less common type is called primary angle closure glaucoma.

What are the symptoms of glaucoma?

Unfortunately, there are no warning signs or symptoms in the early stages of most glaucoma. Usually the peripheral (side) vision is affected first and changes are only noticed when damage to the optic nerve is severe and central vision is involved.

However, symptoms of acute angle closure, when eye pressure suddenly rise, can include severe pain in the eye, redness of the eye, blurred vision, seeing rainbows or halos, headache, feeling nauseous and vomiting. The acute attack of angle closure requires immediate medical attention to prevent permanent vision damage.

Even though people can go blind from glaucoma, it’s uncommon. Vision loss due to glaucoma is irreversible, so early detection and treatment are important.

How is glaucoma treated?

Glaucoma is treated by lowering eye pressure (intraocular pressure) and treatment will depend on the type and stage of your glaucoma. Each glaucoma patient requires lifelong management. Glaucoma can’t be cured, and vision that has already been lost can’t be restored, but further sight loss can be prevented via medication (eyedrops), laser or surgery.

Glaucoma treatment often starts with eyedrops. These can help decrease eye pressure by improving how fluid drains from your eye or by decreasing the amount of fluid your eye makes. Because some of the eyedrops is absorbed into your bloodstream, you may experience some side effects unrelated to your eyes. To minimize this absorption, you can press lightly at the corner of your eyes near your nose to close the tear duct for one or two minutes and wipe off any unused drops from your eye lid. If you have been prescribed multiple eyedrops, you need to wait at least five minutes in between types of drops.

Lasers called peripheral iridotomy and Selective Laser Trabeculoplasty (SLT) may sometimes be recommended. Read more about laser click here.

Traditionally surgery is usually recommended for glaucoma uncontrolled by eyedrops or laser. MIGS can be performed at the same time of your cataract surgery to treat early glaucoma.

How is glaucoma surgery done?

There are a range of surgical options for glaucoma.

Filtering surgery. With a surgical procedure called Trabeculectomy, your surgeon creates an opening in the white of the eye (sclera) and removes part of the drain (trabecular meshwork) to create an artificial filtering channel.

Drainage tube. In this procedure, your surgeon inserts a small tube shunt in your eye to drain away excess fluid to lower your eye pressure.

Minimally invasive glaucoma surgery (MIGS). A MIGS procedure may be suggested if you have open angle glaucoma. These procedures generally require less immediate postoperative care and have less risks than trabeculectomy or installing a drainage tube. They are often combined with cataract surgery. There are three MIGS techniques available in Australia: iStent, Hydrus and XEN

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