Glaucoma is a condition where the pressure in the eye has risen high enough to cause damage to the weakest, and perhaps most important part of the eye – the optic nerve. Without therapy, this abnormal pressure will cause irreversible damage to the nerve fibers of the optic nerve, which in time will lead to irreversible vision loss. The basic mechanism behind this disease involves the obstruction of the fluid channels that normally drain the aqueous humor from the eye. Aqueous humor is the fluid that nourishes the lens and cornea inside the eye. As a result of age or heredity, the exit channels become clogged, the pressure builds and the damage occurs. The dangerous reality of glaucoma is that the patient can neither feel the elevated pressure, the gradual damage to the optic nerve nor the subsequent peripheral vision loss. As a result, it is estimated that half of the four million Americans who have glaucoma are undiagnosed! Glaucoma has become the second leading cause of blindness in the world and the leading cause of blindness in African-Americans.
Is Glaucoma curable?
Open Angle Glaucoma ( OAG), by far the most common type of glaucoma, is controllable
but not curable. It is a chronic (i.e. lasts forever) and progressive (i.e. it gets worse with age)
condition that must be monitored regularly and retreated throughout life. Certain groups of
people are “high-risk” for developing this disease and should be checked regularly:
• People over the age of 50
• People with hypertension
• People with a family history of glaucoma
• Highly myopic patients (very near-sighted)
• African-Americans
• People on corticosteroids
• Diabetics
• People who have had a serious eye injury
What are the different types of treatment?
I. DROPS:
Historically, drops came first and traditionally, they have been the first-line of defense in treating glaucoma. Depending on the patient, drops can be taken one, two, even four times a day, and some patients are on multiple kinds to control their pressures. Although drops are effective, there are disadvantages:
A. Cost – usually $50 – $200/month ($600 – $2400/year) and sometimes even more!
B. Compliance – it’s not easy having to remember to use eye drops on a daily basis, and for the rest of one’s life.
C. Side Effects – with time, many patients will develop red eyes, irritated skin or long eyelashes from the chronic use of eye drops. The use of multiple drops increases the likelihood of allergic reactions.
Because of these disadvantages, many patients are inclined to “cut back” on their drops to either save money or reduce irritation or other undesirable side effects. Many patients just simply forget. All of these reasons are understandable, but they are dangerous to the patient’s visual well-being, and can result in irreversible vision loss.
III. ARGON LASER:
The argon laser was introduced 33 years ago and since that time, has been the instrument of choice for OAG laser treatment. It works by causing microscopic scarring (thermal damage) to the honeycombed-like drainage system in the eye. Over time, this scarring stretches and opens the adjacent drainage channels which results in lower eye pressures. Argon laser treatment (ALT) can only be performed once on the entire eye and, since glaucoma is chronic and progressive, if the patient’s pressures continue to go up after ALT, this presents a problem because the eyes cannot be retreated.
