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New Treatments Address Glaucoma Symptoms

Breaking News - October 2005 - Week 1

(Oct 5, 2005)

Healthcare in  the News

-- October is National Glaucoma Awareness Month and physicians are taking this opportunity to urge individuals to have their eyes checked early and often for signs of the disease.

Picture of piece of eye equipment used to examine the front of the eye

Experts say at first a person does not notice a thing.

But what is not understood is that the pressure of fluid inside the eyeball has increased, and is causing damage to the optic nerve.

Experts Define Glaucoma's Destruction

Still, a person does not feel a thing, and vision is not affected. When a person finally does realize something is wrong, he or she could have lost a good deal of peripheral vision.

Such is the sinister nature of glaucoma, a disease that affects more than 2.2 million Americans over the age of 40, according to the National Institutes of Health (NIH).

As many as 120,000 Americans are blind due to glaucoma, states the NIH. Each year, there are more than 300,000 new cases of glaucoma and approximately 5,400 more people suffer complete blindness.

Glaucoma is the common name of a group of diseases that cause damage to the optic nerve, causing blind spots in the victim's visual field. These blind spots usually start in the peripheral vision, but can spread and eventually cause complete blindness in one or both eyes.

"The early stages of glaucoma have absolutely no symptoms," says Dr. Mildred M.G. Olivier, president and CEO of the Midwest Glaucoma Center and a board member of Prevent Blindness America.

"That's why we call it 'the silent thief of sight,'" she says. "By the time someone feels like something is wrong with their vision, their glaucoma already is very advanced."

"Most people wrongly think of glaucoma as only a disease of high eye pressure," says Dr. Kuldev Singh, a professor of ophthalmology at Stanford University. "It's really the most common optic nerve disease in the world."

Screening, New Treatments Help

Since the disease has no early symptoms, regular screening is the only way to detect and prevent it.

Dr. Olivier recommends that people have their ophthalmologist perform a dilated eye examination, so the physician can take a direct look at the optic nerve andassess it for damage.

Other tests include tonometry, in which an instrument measures pressure inside the eye, and pachymetry, in which a physician uses ultrasonic waves to measure the thickness ofthe cornea.

Anyone can develop glaucoma, but physicians have identified several key groups of people who have a higher risk of contracting the disease:

  • everyone over age 60
  • African Americans over age 40
  • persons with a family history of glaucoma
  • persons suffering from nearsightedness
  • individuals who have suffered an eye injury or have undergone eye surgery
  • persons with high blood pressure or diabetes
  • persons who must frequently take certain medications such as steroids

"If you have any of the risk factors, you're never too young to be screened for glaucoma," Dr. Olivier says.

Genetics, in particular, is a strong risk factor that should be taken into account, Dr. Singh notes. "If you have a family member with glaucoma, you should have yourself screened regularly."

There is no cure for glaucoma, but there are several treatment options that can stem the damage done by the disease. They include medicines, laser trabeculoplasty, and surgery.

All of these treatments are aimed at reducing eye pressure, a symptom that accompanies most forms of glaucoma.

"There's only one risk factor that can be treated, and that's eye pressure," Dr. Singh explains. "So pressure is important in treatment."

Early detection and treatment of increased eye pressure can have a marked affect on the ability to treat glaucoma, he says.

"The studies have overall shown that lowering eye pressure not only decreases the chances of getting glaucoma, but also reduces the likelihood of patients progressing to the point where they suffer symptoms," says Dr. Singh.

Medications come in the form of eyedrops or pills. Some cause the eye to make less fluid, while others lower pressure by helping fluid drain from the eye, Dr. Singh says.

"Early in the course of the disease, medicine is the treatment we prefer," he explains.

Laser trabeculoplasty helps fluid drain out of the eye by sending energy waves into the drainage system of the eye, increasing the amount of fluid that naturally seeps from the eye.

Studies have shown that such surgery is good at reducing pressure in some patients, but its effects can wear off over time. Patients often must keep taking glaucoma medication after treatment, experts say.

Conventional surgery often is done after medications and laser surgery have failed to control pressure. In the surgery, physicians remove tissue from the eye to create a new drainage channel for fluid.

However, such surgery has its risks. Patients must monitor their eyes for signs of infection, and if the incision accelerates drainage too much, the "eye can collapse," says Dr. Singh.

A new procedure used at Duke Medical Center and other medical institutions uses a glaucoma implant to direct the fluid within the front part of the eye to a space just outside the eye. The glaucoma implant helps to lower the pressure within the eye.

Always consult your physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.

More about Glaucoma

According to the National Eye Institute (NEI), glaucoma is an eye disease in which the normal fluid pressure inside the eyes slowly rises, leading to vision loss - or even blindness.

Open-angle glaucoma, the most common form of the disease, is described by the NEI below.

At the front of the eye, there is a small space called the anterior chamber.

Clear fluid flows in and out of the chamber to bathe and nourish nearby tissues. In glaucoma, for still unknown reasons, the fluid drains too slowly out of the eye.

As the fluid builds up, the pressure inside the eye rises.

Unless this pressure is controlled, it may cause damage to the optic nerve and other parts of the eye and loss of vision.

The NEI states that glaucoma is a leading cause of blindness in the US. Although anyone can get glaucoma, some people are at higher risk.

They include African Americans over age 40, everyone over age 60(especially Mexican Americans), and persons with a family history of glaucoma.

Among African Americans, studies show that glaucoma is:

  • five times more likely to occur in African Americans than in Caucasians
  • about four times more likely to cause blindness in African Americans than in Caucasians
  • fifteen times more likely to cause blindness in African Americans between the ages of 45 and 64 than in Caucasians of the same age group

At first, there are no symptoms. Vision stays normal, and there is no pain, states the NEI.

However, as the disease progresses, a person with glaucoma may notice his or her side vision gradually failing.

That is, objects in front may still be seen clearly, but objects to the side may be missed. As the disease worsens, the field of vision narrows and blindness results.

Many people may know of the "air puff" test or other tests used to measure eye pressure in an eye examination.

But, this test alone cannot detect glaucoma. Glaucoma is found most often during an eye examination through dilated pupils.

This means drops are put into the eyes during the exam to enlarge the pupils.

This allows the eye care professional to see more of the inside of the eye to check for signs of glaucoma.

Studies have shown that the early detection and treatment of glaucoma, before it causes major vision loss, is the best way to control the disease.

NEI states that when persons fall into one of the high-risk groups for the disease, they should make sure to have their eyes examined through dilated pupils every two years by an eye care professional.

Always consult your physician for a diagnosis.

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