Is Glaucoma Preventable?

We are people of knowledge, people of science. We thrive on information and knowing what’s behind most of the hows and what ifs is what makes us feel at peace with the material we have at hand. We are people who believe in facts over feelings. So I am going to give you all the information I can before I tell you if glaucoma is preventable. And if it is, how?

Glaucoma is not a single disease process but a group of disorders characterised by a progressive optic neuropathy. To put it in simple and fewer words- it is a multifactorial optical neuropathy. This damage is often caused by an abnormally high pressure in your eye. This damage to the optic nerve results in a characteristic appearance of the optic disc and sometimes irreversible visual field defects that are related frequently but not always invariably with the rise in the pressure within your eye.

Glaucoma is one of the leading causes of blindness in people over the age of 60 years. It can occur at any age but is more common in older adults.

Many forms of glaucoma have no warning signs. The effect is so gradual that you may not notice a change in vision until the condition is at an advanced stage. Sometimes, the first symptom to appear is a change in the visual field- which is the advanced stage.

Glaucoma is not preventable, but blindness due to glaucoma is. It is important that you get your eyes examined regularly. This includes getting your intra-ocular pressure (IOP) frequently measured so an early diagnosis can be made and treatment be started at the earliest.

If glaucoma is recognised and diagnosed early, the loss of vision can be prevented and/or slowed. If you have the condition, you’ll generally need treatment for the rest of your life.

What causes glaucoma?

Glaucoma is the result of damage to the optic nerve. As this nerve gradually deteriorates, blind spots develop in your visual field. This nerve damage is usually related to increased pressure in the eye which in turn applies pressure on the optic nerve.

Elevated eye pressure is due to a build-up of a fluid (aqueous humor) that flows throughout the inside of your eye. This internal fluid normally drains out through a tissue called the trabecular meshwork at the angle where the iris and cornea meet. When fluid is overproduced or the drainage system doesn’t work properly, the fluid can’t flow out at its normal rate thus leading to the rise in the eye pressure. Depending on whether the angle is occluded or not, glaucoma can be of 2 types broadly:

– Open-angle glaucoma: It is the most common form of the disease. The drainage angle formed by the cornea and iris remains open, but the trabecular meshwork is partially blocked. This causes pressure in the eye to gradually increase. This pressure damages the optic nerve. It happens so slowly that you may lose vision before you’re even aware of a problem.

– Angle-closure glaucoma: It is also called closed-angle glaucoma, occurs when the iris bulges forward to narrow or block the drainage angle formed by the cornea and iris. As a result, fluid can’t circulate through the eye and pressure increases. Some people have narrow drainage angles, putting them at increased risk of angle-closure glaucoma.

Angle-closure glaucoma may occur suddenly (acute angle-closure glaucoma) or gradually (chronic angle-closure glaucoma). Acute angle-closure glaucoma is a medical emergency.

Some other forms of glaucoma include:

• Normal-tension glaucoma
• Glaucoma in children
• Pigmentary glaucoma

Here are the symptoms you need to look out for:-

– Open angle glaucoma: Some of the symptoms you might present with include- 

• Sometimes the patient can be asymptomatic, which is why regular visits to your ophthalmologists are advised.
• Patchy blind spots on the sides of your visual field (peripheral) or central vision, frequently in both the eyes
• Headache and eye ache 
• Difficulty in reading and close work- often progresses
• Some patients may even complaint of frequent changes in the presbyopic glasses.
• Tunnel vision- loss of peripheral vision with retention of the central vision, in the advanced stages

– Acute angle-closure glaucoma

• Pain- usually acute, sudden in onset and very severe pain in the eye
• Severe headache
• Nausea and vomiting
• Rapidly progressing impairment in the vision 
• Blurred vision
• Halos around lights
• Eye redness
• Photophobia and lacrimation

If left untreated, glaucoma will eventually cause blindness. Even with treatment, about 15 percent of people with glaucoma become blind in at least one eye within 20 years.

When to see a doctor?

You will need to seek immediate medical attention in case you experience any of the symptoms of acute angle-closure glaucoma, such as severe headache, eye pain and blurred vision.

Risk factors

Because chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, beware of these risk factors. Individuals in the list under are at a higher risk:

• Having high internal eye pressure (intraocular pressure)- visit your ophthalmologist every 6 months
• Age over 60 years
• Race: Black, Asian or Hispanic
• A positive family history of glaucoma can put you at a greater risk as compared to someone who has no relevant family history
• Having certain medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anemia
• Having corneas that are thin in the centre
• Being extremely nearsighted or farsighted
• Any previous history of injury to the eye or certain types of eye surgery
• Taking corticosteroid medications, especially eye drops, for a long time

Here are a few things you can do to prevent and derail the process in the early stages of glaucoma itself thereby slowing the process and progression of loss of vision:

• Get regular dilated eye examinations. Regular comprehensive eye exams can help detect glaucoma in its early stages, before significant damage occurs. As a general rule, the American Academy of Ophthalmology recommends having a comprehensive eye exam every five to 10 years if you’re under 40 years old; every two to four years if you’re 40 to 54 years old; every one to three years if you’re 55 to 64 years old; and every one to two years if you’re older than 65. If you’re at risk of glaucoma, you’ll need more frequent screening. You can ask your doctor to recommend the right screening schedule for you.
• Know your family’s eye health history. Glaucoma tends to run in families. If you’re at increased risk, you may need more frequent screening.
• Exercise safely and regularly. Regular, moderate exercise may help prevent glaucoma by reducing eye pressure. 
• Take the prescribed eye drops regularly. Glaucoma eye drops can significantly reduce the risk. To be effective, eye drops prescribed by your doctor need to be used regularly even if you have no symptoms.
• Wear eye protection. Serious eye injuries can lead to glaucoma. Wear eye protection when using power tools or playing high-speed racket sports in enclosed courts.

Glaucoma is treated by lowering your eye pressure (intraocular pressure). Depending on your situation, your options may include prescription eye drops, oral medications, laser treatment, surgery or a combination of any of these.