Next to cataracts, glaucoma is the second leading cause of vision loss. Around 2.2 million Americans age 40 and older have visually impairment because of this condition, while 120,000 became blind. It is a silent disease that only reveals itself after a significant amount of damage has already been incurred.

Glaucoma is a collection of eye disorders caused by an increased fluid pressure inside the eyes, resulting to irreversible nerve cell damage and vision loss. The nerve cells particularly affected by glaucoma are the optic nerve, a bundle of over a million of sensitive nerve fibers that transmits visual information and images from the retina to the brain.

The two most common types of glaucoma are open-angle and closed-angle glaucoma. Between the two, the open-angle type is the most common in the United States.

Our eye produces a clear fluid known as aqueous humor that flows in and out of a passage space called the anterior chamber. Normally, this fluid leaves the anterior chamber at the open angle between the cornea (clear portion of the eye, covering the iris) and the iris (colored portion of the eye). It then reaches a spongy meshwork before leaving the eye. In open-angle glaucoma, the fluid passes through this meshwork very slowly that the fluid accumulates inside the eye. This creates a pressure that damages the optic nerves. However, elevated eye pressure does not mean that you have glaucoma. Our eyes can tolerate certain levels of fluid pressure without being damaged. But once damage to the optic nerve has been incurred, a person is then said to have glaucoma. Open-angle glaucoma presents no symptoms at first as vision remains normal and no pain is felt. As the disease progresses, vision problems begin to appear. The peripheral vision is affected. It is that part of our vision outside the central field of view. Therefore, objects or images up front can be seen clearly while those to the side are not.

In closed-angle glaucoma, the angle between the cornea and the iris is blocked, preventing the fluid from leaving the eye. This results to an immediate increase in pressure and the eye can become blind in just a day or two. Thus, closed-angle glaucoma requires medical attention right away. Symptoms include blurred vision and nausea, redness of the eye, and severe pain.

Other forms of glaucoma occur as a complication of other conditions, accounting for about 10% of glaucoma cases in the United States. These include cataracts (lens of the eye become opaque and blocks the passage of light, may lead to loss of vision), neovascular glaucoma (glaucoma due to diabetes), eye injuries and tumors.

Risk Factors

Anybody who is over age 60 has a high risk of developing glaucoma. Mexican Americans have a higher risk, as well as African Americans over age 40. Genetics is also a risk factor. Corticosteroids (medicines used to treat asthma, allergies and inflammation, e.g. prednisone) can also trigger glaucoma.

Prognosis

Open-angle glaucoma has better prognosis than the closed-angle form. The rate and extent of vision impairment or loss, in general, vary depending on how early the disease is detected. Thus, early detection and treatment are critical factors for the course and outcome of the disease.

Diagnosis

Glaucoma may go undetected since no symptoms are observed at the initial stage (except close-angle glaucoma). Gradual vision loss may be mistaken for age-related issues. Only when our senior loved ones begin to complain of vision impairment or gradual vision loss that an eye care professional is consulted.

Like macular degeneration (macula of the eye is damaged resulting to loss of central vision), glaucoma can be diagnosed through eye examinations such as visual acuity test, dilated eye exam (eyes are dilated to see optic nerve damage) and tonometry (measures eye pressure). Your eye specialist may also conduct pachymetry, a test wherein a special eye drop that causes numbness is applied prior to the test. An ultrasonic wave device is then used to measure thickness of the cornea of the affected eye.

Treatment

There are several treatment options for glaucoma. However, these medical interventions can only save the remaining vision since the damage incurred with glaucoma is irreversible.

The most common treatment for glaucoma are drugs that decrease ocular pressure by promoting drainage of fluid from the eye or reducing the amount of fluid in the eye itself. These include beta-blockers, alpha-agonists, miotics and prostaglandins.

Another treatment option is laser trabeculoplasty. A high-intensity beam of light (laser) is directed into the lens of the eye that enlarges the holes in the meshwork. This results to a prompt and more efficient drainage of fluids from the eye.

Another mode of treatment that may be suggested is surgery. A new opening is made by removing some tissues in the affected eye to drain the fluid. Because of the risks associated with any surgery, this treatment option is only considered after medications and laser trabeculoplasty proved to be unsuccessful.

Closed-angle glaucoma, on the other hand, needs immediate medical treatment. Emergency treatment includes local instillation of pilocarpine 2% every 15 minutes with acetazolamide IV.

Care Plan

Eye drops may be prescribed for treatment or as aftercare. It is therefore important that senior loved ones be informed on how to properly apply eye drops at home. Their hands should be clean and dry before handling eye drop medications. Your loved one may lie on his back or tilt his head when in sitting position. The bottle is held in one hand and placed as close to the affected eye as possible. Pull lower eyelid using the other hand. Gently squeeze the bottle and place the required number of drops. Close the eye for at least a minute to give sufficient time for the medication to come in contact with the eye. Carefully return the cover of the bottle, making sure that the hands do not touch the tip of the applicator. You may consult your physician or pharmacist for more instructions on the proper handling and use of eye drop medications.

Due to vision impairment or loss, your loved ones may need assistance in their daily activities. Long-term care may be necessary, depending on the extent of damage to the optic nerves. Aside from the physical assistance, your senior loved ones also need emotional support.

Other family members should be screened for glaucoma since they are at a high risk, as well. Medicare covers an annual comprehensive eye exam for people with increased risk for glaucoma.