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Glaucoma
What You Need to Know

Glaucoma is the most common cause of adult blindness in the United States. Various studies have found the frequency of this disease to be as high as 3 to 4 percent in people over the age of 40. Major problems with glaucoma are that the onset of the disease is usually without symptoms and it is progressive in nature. Glaucoma is a disease of the eyes in which the pressure within the eye is high enough to cause nerve damage in the back of the eye and result in visual loss. This pressure may have sudden rises, intermittent rises or may always be too high. There is no pressure that is considered safe for everybody.  Instead an individual may have visual loss at a pressure that is considered normal in another individual. In fact, most visual loss occurs when the pressure is within a range that once was thought to be normal.

When Glaucoma occurs, the site of damage is where the optic nerve leaves the eye and begins its course back to the brain. Visual loss is caused by the death of the nerve fibers at this location. However, not all glaucoma is the same.  There are three major types of glaucoma: open angle, narrow angle, and combined mechanism. Each of these stems from differing abnormal pressures, which vary depending on the type of glaucoma that one may have. In open angle, the production rate of fluid in the front of the eye is greater than the rate at which fluid can leave through outflow passageways and results in increased pressure within the eye. In narrow angle, the iris blocks the outflow passageway when it is pushed up against the outflow pathway. This is caused by an abnormal relationship between the lens of the eye and the iris. Combined mechanism is a result of both previously discussed mechanisms occurring in the same eye.

Each individual’s optic nerve has a different ability to resist pressure within the eye.  The ability of the optic nerve to resist damage from this pressure is a major factor in the course and development of visual loss in glaucoma. The individual variation of this resistance is why some people have no loss of vision at high pressures and others have visual loss at pressures that were once thought to be normal.

The diagnosis of glaucoma requires careful evaluation of each patient as an individual, looking for signs of glaucoma on clinical examination, visual fields, and pressure readings. A visual field is a test that records a person’s visual responses and can document actual visual loss and follow progression of these losses.

The goal of treatment in glaucoma is to keep pressure within the eye low enough to prevent visual loss. Methods of treatment include eye drops, oral medicine, laser surgery and surgery without lasers. Adequate control of pressure requires careful follow-up of patients for years and a commitment of the patient to follow up on doctor’s orders.

With your help, glaucoma may no longer be a leading cause of blindness in the United States.

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