Early detection is key to successful treatment of glaucoma

Gov. David Paterson's recent diagnosis and treatment for acute-angle closure glaucoma drew attention
Dr. Sai B. Gandham, glaucoma specialist at the Lions Eye Institute of Albany Medical Center, checks the eye pressure of Albany resident Nancy Fischer, who has glaucoma.
PHOTOGRAPHER:
Dr. Sai B. Gandham, glaucoma specialist at the Lions Eye Institute of Albany Medical Center, checks the eye pressure of Albany resident Nancy Fischer, who has glaucoma.

Gov. David Paterson’s recent diagnosis and treatment for acute-angle closure glaucoma drew attention to the importance of early detection and treatment of this disease.

While glaucoma is one of the leading causes of blindness in the United States, when it is caught early, proper treatment by an ophthalmologist can nearly always prevent the loss of vision associated with the disease.

Paterson was diagnosed with acute angle-closure glaucoma, which causes severe pain as one of its symptoms. However, the more common types of glaucoma usually cause no symptoms, which is why they are so dangerous.

Glaucoma refers to a group of eye diseases that damage the optic nerve, and over time, can lead to loss of vision.

Glaucoma is often referred to as the “silent thief of sight,” because most types typically cause no pain.

“There are several different kinds of glaucomas,” said Dr. Sai B. Gandham, associate professor of ophthalmology and glaucoma specialist at the Lions Eye Institute of Albany Medical Center.

Less common type

Only about 10 percent of the population with glaucoma has acute-angle closure. Symptoms occur suddenly and can include blurry vision, halos around lights, intense eye pain, nausea and vomiting.

If you have those symptoms, make sure you immediately see an eye care practitioner or visit the emergency room so steps can be taken to prevent permanent vision loss.

Open-angle glaucoma is much more common,” said Gandham. “Some 90 percent of glaucomas in the United States belong to this category.”

Open-angle glaucoma (also called chronic open-angle or primary open-angle) is the most common type of glaucoma. With this type, even though the anterior structures of the eye appear normal, aqueous fluid builds within the anterior chamber, causing intraocular pressure to become elevated.

Left untreated, this may result in permanent damage of the optic nerve and retina.

“Most open-angle glaucomas are picked up by routine eye checkups, including eye pressure checks and optic nerve examinations,” said Gandham.

Everyone is at risk for glaucoma, from babies to senior citizens. Older people are at higher risk, but babies can be born with glaucoma. Approximately one out of every 10,000 babies born in the United States is born with glaucoma.

Young adults can get glaucoma, too. Blacks in particular are susceptible at a younger age.

It is estimated that more than 4 million Americans have glaucoma, but only half of those know they have it.

Approximately 120,000 are blind from glaucoma, accounting for 9 to 12 percent of all cases of blindness in the United States.

About 2 percent of the population ages 40 to 50 and 8 percent over age 70 have elevated intraocular pressure.

Glaucoma is the second-leading cause of blindness in the world, according to the World Health Organization, and it is the leading cause of blindness among black Americans, who have a risk that is six to eight times greater than Caucasians.

Other high-risk groups include people over 60, family members of those already diagnosed, diabetics, and people who are severely nearsighted.

Estimates put the total number of suspected cases of glaucoma at around 65 million worldwide.

Glaucoma accounts for over seven million visits to physicians each year.

“In the United States, one in two patients are diagnosed with glaucoma,” said Gandham. “That means for every patient that is diagnosed one is undiagnosed. In other countries, including Africa, China and India, only one in 10 are diagnosed because health care development is not as good.”

Early diagnosis can be made by a periodic eye examination, said Dr. Robert Kennedy, chief of the department of ophthalmology at Ellis Hospital.

During a painless examination, the eye physician will determine the pressure of the eye, and using a special instrument, will examine the back of the eye to see if the optic nerve is healthy and that no damage is occurring.

“Traditionally, we use a variety of medications in the forms of drops that either help make the filtering system more efficient by letting fluid out of the eye or by turning off the gland to let less fluid in,” said Kennedy.

Most patients with glaucoma require only medication to control eye pressure.

Sometimes, several medications that complement each other are necessary to reduce the pressure adequately.

Surgery is indicated when medical treatment fails to lower the pressure satisfactorily. There are several types of procedures, some involve laser and can done in the office. Others must be performed in the operating room. The objective of any glaucoma operation is to allow fluid to drain from the eye more efficiently.

“Once the optic nerve is damaged, any nerve cells that are lost are irretrievably lost and can never be recovered,” said Kennedy. “So once patients start to have vision loss from glaucoma, it can never be restored. The whole goal of treatment at that point is to maintain whatever vision remains.”

However, the goal of medical therapy is to identify patients before any such damage has occurred so no vision loss will ever develop.

To protect your vision, have your eyes examined on a regular basis.

“It’s a very insidious disease,” said Kennedy. “The only way to detect glaucoma is to walk into an eye physician’s office and have your eyes examined.

“Screening is key. Even if you are a poorly sighted person like Governor Paterson or an elderly patient who is legally blind with macular degeneration, you still need to have your eyes examined for glaucoma.”

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