Glaucoma is sometimes called the silent thief,
slowly stealing your sight before you realize
anything's wrong. The most common form of glaucoma
develops gradually, giving no warning signs. Many
people aren't even aware they have an eye problem
until their vision is extensively damaged.
If your doctor determines that you have elevated intraocular pressure ,
an excavated optic disk and loss of visual field, you'll likely be
treated for glaucoma. If you have only slightly elevated eye pressure,
an undamaged optic nerve and no visual field loss, you may not need
treatment, but your doctor may advise more frequent examinations to
detect any future changes. If you have signs of optic nerve damage and
visual field loss, even if your eye pressure is in the normal range, you
may need treatment to lower eye pressure further, which may help slow
the progression of glaucoma.
Glaucoma can't be cured, and damage caused by the disease can't be
reversed. But with treatment, glaucoma can be controlled. Eyedrops, oral
medications and surgical procedures can prevent or slow further damage.
Having glaucoma means you'll need to continue treatment for the rest of
your life. Because the disease can progress or change without your being
aware of it, your treatment may need to be changed over time. Regular
checkups and adherence to a treatment plan may seem burdensome, but
they're essential to prevent vision loss.
Keeping your eye pressure under control can prevent further damage to
the optic nerve and continued loss of your visual field. Your eye doctor
may focus on lowering your intraocular pressure to a level that's
unlikely to cause further optic nerve damage. This level is often
referred to as the target pressure and will probably be a range rather
than a single number. Target pressure differs for each person, depending
on the extent of the damage and other factors. Your target pressure may
change over the course of your lifetime.
Topical medications are the most common early treatment for glaucoma.
Standard practice has been to move on to surgery if medications are
ineffective. However, surgery is also an option as a relatively safe and
effective initial treatment.
Glaucoma treatment often starts with medicated eyedrops. Doctors
prescribe several types of drops. Be sure to use the drops exactly as
prescribed to control your intraocular pressure . Skipping even a few
doses can cause damage to the optic nerve to worsen. Some drops need to
be applied several times each day, and others must be used just once a
day. Inform your doctor of all other medications you're taking, to avoid
any undesirable drug interactions.
Because some of the eyedrops are absorbed into your bloodstream, you may
experience side effects unrelated to your eyes. To minimize this
absorption, close your eyes for one to two minutes after putting the
drops in. Press lightly at the corner of your eye near your nose to
close the tear duct, and wipe off any unused drops from your eyelid.
Your doctor may prescribe more than one type of eyedrop. If you're using
more than one, ask your doctor how long to wait between applications.
The types of eyedrops that doctors most commonly prescribe include:
These reduce the production of aqueous humor. Examples include
levobunolol (Betagan ), timolol (Betimol, Timoptic ), carteolol (Ocupress),
betaxolol (Betoptic) and metipranolol (OptiPranolol ). Possible side
effects include difficulty breathing, slowed pulse, hair loss, lower
blood pressure, impotence, fatigue, weakness, depression and memory
loss. If you have asthma, bronchitis or emphysema, or if you have
diabetes and use insulin, medications other than beta blockers are
These reduce the production of aqueous humor. Examples include
apraclonidine (Iopidine) and brimonidine (Alphagan). Possible side
effects include increased blood pressure; dizziness; red, itchy or
swollen eyes; dry mouth; and allergic reactions.
These medications, which include dorzolamide (Trusopt), reduce the
amount of aqueous humor. Possible side effects include frequent
urination and a tingling sensation in the fingers and the toes, but
these occur more frequently when a carbonic anhydrase inhibitor is
taken orally. If you're allergic to sulfa drugs, this type of
medication shouldn't be used unless no alternative is possible, and
then only with great care.
These eyedrops increase the outflow of aqueous humor. These
hormone-like substances, which include latanoprost (Xalatan), may be
used in conjunction with a drug that reduces production of aqueous
humor. Possible side effects include mild reddening and stinging of
the eyes and darkening of the iris, changes in the pigment of the
eyelid skin, and mild swelling of the central retina (a condition
known as cystoid macular edema).
These include bimatoprost (Lumigan). They increase the outflow of
aqueous humor. Possible side effects include mild to moderate
reddening of the eyes and itchy eyes.
Miotics, such as pilocarpine (Isopto Carpine, Pilocar) increase the
outflow of aqueous humor. Possible side effects include pain around
or inside the eyes, brow ache, blurred or dim vision,
nearsightedness, allergic reactions, a stuffy nose, sweating,
increased salivation and occasional digestive problems.
These also increase the outflow of aqueous humor. Possible side
effects include red eyes, allergic reactions, palpitations, an
increase in blood pressure, headache and anxiety.
If eyedrops alone don't bring your eye pressure down to the desired
level, your doctor may also prescribe an oral medication. Carbonic
anhydrase inhibitors, such as acetazolamide and methazolamide, are
commonly prescribed oral medications for glaucoma. Take these pills with
meals to reduce side effects. You can help to minimize the potassium
loss that these medications can cause by adding bananas and apple juice
to your diet.
When you first start taking these oral medications, you may experience a
frequent need to urinate and a tingling sensation in your fingers and
your toes. After several days, these symptoms usually disappear. Other
possible side effects of carbonic anhydrase inhibitors include rashes,
depression, fatigue, kidney stones, lethargy, stomach upset, a metallic
taste in carbonated beverages, impotence and weight loss.
You may need surgery to treat glaucoma if you can't tolerate medications
or if they're ineffective. Doctors use several types of surgery to treat
In the last couple of decades, a procedure called trabeculoplasty (truh-BEK-u-lo-plas-te)
has been used increasingly in the treatment of open-angle glaucoma.
The doctor uses a high-energy laser beam to shrink part of the
trabecular meshwork, which causes other parts of the meshwork to
stretch and open up. This helps aqueous humor drain more easily from
This type of laser
surgery is an office procedure that takes 10 to 20 minutes. You'll
be given an anesthetic eyedrop, seated at a slit lamp and fitted
with a special lens on your eye. The doctor aims the laser through
the lens at the trabecular meshwork and applies burns to it. You
will see bright flashes of light.
After the surgery
you can immediately resume normal activities without discomfort. The
doctor will usually check your eye pressure one to two hours after
the procedure and several times in the following weeks. He or she
may prescribe anti-inflammatory eyedrops for you to use for a few
days following trabeculoplasty. It may take a few weeks before the
full effect of the surgery becomes apparent.
In almost all
cases, laser surgery for glaucoma initially lowers intraocular
pressure. However, its effects may wear off over time.
If eyedrops and laser surgery aren't effective in controlling your
eye pressure, you may need an operation called a filtering
procedure, usually in the form of a trabeculectomy (truh-bek-u-LEK-tuh-me).
This procedure is done in a hospital or an outpatient surgery
center. You'll receive medication to help you relax and eyedrops and
usually an injection of anesthetic to numb your eye. Using delicate
instruments under an operating microscope, your surgeon creates an
opening in the sclera — the white of your eye — and removes a small
piece of the trabecular meshwork. The aqueous humor can now freely
leave the eye through this hole. As a result your eye pressure will
be lowered. The hole is covered by the conjunctiva, so there's not
an open hole in your eye.
Your doctor will
check your eye in several follow-up visits. You'll use antibiotic
and anti-inflammatory eyedrops for some time after the operation to
fight infection and scarring of the newly created drainage opening.
Scarring is a particular problem for young adults, blacks and people
who have had cataract surgery. This procedure works best if you
haven't had any previous eye surgery.
surgery may preserve current vision, it can't restore already lost
vision. Sometimes a single surgical procedure may not lower eye
pressure enough, in which case you'll need to continue using
glaucoma drops or have another trabeculectomy operation.
Another type of operation, called drainage implant surgery, may be
an option for people with secondary glaucoma or for children with
trabeculectomy, drainage implant surgery is performed at a hospital
or an outpatient clinic. You'll be given medication to help you
relax and eyedrops and an anesthetic to numb the eye. Then the
doctor inserts a small silicone tube in your eye to help drain
After the surgery
you'll wear an eye patch for 24 hours and use eyedrops for several
weeks to fight infection and scarring. Your doctor will check your
eyes several times in the weeks that follow.
Complications from glaucoma surgery may include infection, bleeding, eye
pressure that remains too high or too low, and, potentially, loss of
vision. Having eye surgery may also speed up the development of
cataracts. Most of these complications can be effectively treated.
Treating acute angle-closure glaucoma
Acute angle-closure glaucoma is a medical emergency. When you come in
with this condition, doctors may administer several medications to
reduce eye pressure as quickly as possible. You'll also likely have a
laser procedure called iridotomy. In this procedure, a
laser beam creates a small hole in your iris to allow aqueous humor to
flow more freely into the anterior chamber where it then has normal
access to the trabecular meshwork. Once aqueous humor can reach the
trabecular meshwork again, the fluid can drain as it normally does. Many
doctors recommend an iridotomy on the other eye at a later date because
of the high risk that it too will have an attack within the next few
Until recently, there was no proven way to prevent glaucoma. But in June
2004, a large multi-center trial, supported by the National Eye
Institute, found that when glaucoma eye drops were given daily to people
with elevated eye pressure (above 24 mm Hg), they reduced eye pressure
an average of 22 percent. More important, the researchers discovered
that daily use of eye drops can reduce the risk of developing glaucoma
by nearly half in blacks with elevated eye pressure.
Another study, published in the Archives of Ophthalmology in June
2004, found that cholesterol-lowering medications reduced the risk of
open-angle glaucoma, especially for people who already have
cardiovascular disease. While this may be an added benefit for those
already taking these medications to reduce their cholesterol levels,
more studies need to be done to confirm the reduction in risk of
Regular checkups can help detect the disease in its early stages before
irreversible damage has occurred. As a general rule, have eye exams
every two to four years if you're between the ages of 40 and 65, and
every one to two years if you're older than 65.
Your doctor will likely recommend more frequent monitoring if you're at
increased risk of developing glaucoma. For example, a family history of
glaucoma puts you at increased risk for developing glaucoma and is a
reason for more frequent monitoring. You may also need even more
frequent checkups if you have received a diagnosis of abnormally high
intraocular pressure or have a history of serious eye injury.
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