See why it is important to get your eyesight tested regularly. DESIGN BY MARYAM RASHID
In a 2007 study conducted by the Pakistan National Eye Survey Study Group, glaucoma was found to be the fourth major cause for blindness in subjects tested across Pakistan. Glaucoma is a condition that causes gradual damage to your eyes optic nerve and worsens over time. It is often associated with a buildup of pressure inside the eye, whereby the eye fluid is not circulating normally in the eye and excess fluid is not being drained effectively a condition known as intraocular pressure.
This increase in pressure in the eye can damage the optic nerve, which is responsible for transmitting images to the brain. If glaucoma goes undiagnosed for a long time, it causes permanent loss of vision within a few years. Although the direct cause of this blockage is still unknown, it is known that it can be inherited. Therefore, doctors advise that if a family member is diagnosed with glaucoma, you should regularly visit an eye doctor for an eye exam. The less common causes of glaucoma include a blunt or chemical injury to the eye, a severe eye infection, a blockage of blood vessels in the eye, inflammatory conditions and occasionally, eye surgery to correct another condition.
Glaucoma is usually known to occur in both eyes, but it may affect each eye to a different extent. There are usually few or no symptoms of glaucoma, but the first sign is often the loss of peripheral or side vision, which can go unnoticed until later in the disease. Increasing pressure in the eye can cause sudden eye pain, headache, blurred vision or the appearance of halos around lights. If you experience any of these symptoms, it is important that you immediately visit an eye specialist. Making a diagnosis:
It is very rare that a patient will come to us and tell us that they are experiencing symptoms of glaucoma, as this is a disease often accidentally diagnosed when a patient comes to us complaining about some other eye related issue, says associate professor Dr Tanveer Chaudhry of Aga Khan University Hospital in Karachi. The disease is diagnosed through a test called Optical Coherence Tomography, a non-invasive imaging test that uses light waves to take cross-section pictures of your retina. A Visual Field Test, which measures how far up, down, left and right the eye sees without moving and how sensitive vision is in different parts of the visual field, is also used to diagnose glaucoma. Treatment:
There are three different forms of treatment available for the disease, including eye drops, laser surgery and microsurgery. While eye drops reduce the formation of fluid in the front of the eye or increase the outflow, laser surgery slightly increases the outflow of the fluid from the eye or eliminates fluid blockage. Meanwhile, microsurgery a minimally invasive operation for creating a new channel to drain the eye fluid reduces the intraocular pressure of the eye. The surgery has an 80% success rate and in some cases, must be redone.
Most people with glaucoma do not go blind if they follow their treatment plan and get regular eye exams. The most important thing is to increase awareness about the importance of regular eye checkups, explains Dr Chaudhry. It is not enough to go to your optician and get your spectacles updated. You need to visit an eye specialist at least once a year. Hurmat Majid is a subeditor at The Express Tribune. She tweets @bhandprogramme Published in The Express Tribune, Sunday Magazine, April 5[SUP]th[/SUP], 2015. Express Tribune
Facts About Glaucoma
This information was developed by the National Eye Institute to help patients and their families search for general information about glaucoma. An eye care professional who has examined the patients eyes and is familiar with his or her medical history is the best person to answer specific questions.
[h=2]Glaucoma Defined[/h] [h=3]What is Glaucoma?[/h] Glaucoma is a group of diseases that damage the eyes optic nerve and can result in vision loss and blindness. However, with early detection and treatment, you can often protect your eyes against serious vision loss.
The optic nerve
The optic nerve is a bundle of more than 1 million nerve fibers. It connects the retina to the brain. (See diagram above.) The retina is the light-sensitive tissue at the back of the eye. A healthy optic nerve is necessary for good vision.
[h=3]How does the optic nerve get damaged by open-angle glaucoma?[/h] Several large studies have shown that eye pressure is a major risk factor for optic nerve damage. In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid leaves the chamber at the open angle where the cornea and iris meet. (See diagram below.) When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye.
In open-angle glaucoma, even though the drainage angle is open, the fluid passes too slowly through the meshwork drain. Since the fluid builds up, the pressure inside the eye rises to a level that may damage the optic nerve. When the optic nerve is damaged from increased pressure, open-angle glaucoma-and vision lossmay result. Thats why controlling pressure inside the eye is important. Another risk factor for optic nerve damage relates to blood pressure. Thus, it is important to also make sure that your blood pressure is at a proper level for your body by working with your medical doctor.
Fluid pathway is shown in teal.
[h=3]Can I develop glaucoma if I have increased eye pressure?[/h] Not necessarily. Not every person with increased eye pressure will develop glaucoma. Some people can tolerate higher levels of eye pressure better than others. Also, a certain level of eye pressure may be high for one person but normal for another. Whether you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. This level is different for each person. Thats why a comprehensive dilated eye exam is very important. It can help your eye care professional determine what level of eye pressure is normal for you.
[h=3]Can I develop glaucoma without an increase in my eye pressure?[/h] Yes. Glaucoma can develop without increased eye pressure. This form of glaucoma is called low-tension or normal-tension glaucoma. It is a type of open-angle glaucoma.
[h=4]Who is at risk for open-angle glaucoma?[/h] Anyone can develop glaucoma. Some people, listed below, are at higher risk than others:
African Americans over age 40
Everyone over age 60, especially Mexican Americans
People with a family history of glaucoma
A comprehensive dilated eye exam can reveal more risk factors, such as high eye pressure, thinness of the cornea, and abnormal optic nerve anatomy. In some people with certain combinations of these high-risk factors, medicines in the form of eyedrops reduce the risk of developing glaucoma by about half.
[h=2]Glaucoma Symptoms[/h] At first, open-angle glaucoma has no symptoms. It causes no pain. Vision stays normal. Glaucoma can develop in one or both eyes. Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. As glaucoma remains untreated, people may miss objects to the side and out of the corner of their eye. They seem to be looking through a tunnel. Over time, straight-ahead (central) vision may decrease until no vision remains.
Normal Vision.
The same scene as viewed by a person with glaucoma.
[h=3]How is glaucoma detected?[/h] Glaucoma is detected through a comprehensive dilated eye exam that includes the following: Visual acuity test. This eye chart test measures how well you see at various distances.
Visual field test. This test measures your peripheral (side vision). It helps your eye care professional tell if you have lost peripheral vision, a sign of glaucoma.
Dilated eye exam. In this exam, drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
Tonometry is the measurement of pressure inside the eye by using an instrument called a tonometer. Numbing drops may be applied to your eye for this test. A tonometer measures pressure inside the eye to detect glaucoma.
Pachymetry is the measurement of the thickness of your cornea. Your eye care professional applies a numbing drop to your eye and uses an ultrasonic wave instrument to measure the thickness of your cornea.
[h=3]Can glaucoma be cured?[/h] No. There is no cure for glaucoma. Vision lost from the disease cannot be restored.
[h=2]Glaucoma Treatments[/h] Immediate treatment for early-stage, open-angle glaucoma can delay progression of the disease. Thats why early diagnosis is very important.
Glaucoma treatments include medicines, laser trabeculoplasty, conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma.
Medicines. Medicines, in the form of eyedrops or pills, are the most common early treatment for glaucoma. Taken regularly, these eyedrops lower eye pressure. Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye. Before you begin glaucoma treatment, tell your eye care professional about other medicines and supplements that you are taking. Sometimes the drops can interfere with the way other medicines work.
Glaucoma medicines need to be taken regularly as directed by your eye care professional. Most people have no problems. However, some medicines can cause headaches or other side effects. For example, drops may cause stinging, burning, and redness in the eyes. Many medicines are available to treat glaucoma. If you have problems with one medicine, tell your eye care professional. Treatment with a different dose or a new medicine may be possible.
Because glaucoma often has no symptoms, people may be tempted to stop taking, or may forget to take, their medicine. You need to use the drops or pills as long as they help control your eye pressure. Regular use is very important.
A tonometer measures pressure inside the eye to detect glaucoma.
Make sure your eye care professional shows you how to put the drops into your eye. For tips on using your glaucoma eyedrops, see the inside back cover of this booklet.
Laser trabeculoplasty. Laser trabeculoplasty helps fluid drain out of the eye. Your doctor may suggest this step at any time. In many cases, you will need to keep taking glaucoma medicines after this procedure.
Laser trabeculoplasty is performed in your doctors office or eye clinic. Before the surgery, numbing drops are applied to your eye. As you sit facing the laser machine, your doctor holds a special lens to your eye. A high-intensity beam of light is aimed through the lens and reflected onto the meshwork inside your eye. You may see flashes of bright green or red light. The laser makes several evenly spaced burns that stretch the drainage holes in the meshwork. This allows the fluid to drain better.
Like any surgery, laser surgery can cause side effects, such as inflammation. Your doctor may give you some drops to take home for any soreness or inflammation inside the eye. You will need to make several follow-up visits to have your eye pressure and eye monitored. If you have glaucoma in both eyes, usually only one eye will be treated at a time. Laser treatments for each eye will be scheduled several days to several weeks apart
Studies show that laser surgery can be very good at reducing the pressure in some patients. However, its effects can wear off over time. Your doctor may suggest further treatment.
Conventional surgery. Conventional surgery makes a new opening for the fluid to leave the eye. (See diagram on the next page.) Your doctor may suggest this treatment at any time. Conventional surgery often is done after medicines and laser surgery have failed to control pressure.
Conventional surgery, called trabeculectomy, is performed in an operating room. Before the surgery, you are given medicine to help you relax. Your doctor makes small injections around the eye to numb it. A small piece of tissue is removed to create a new channel for the fluid to drain from the eye. This fluid will drain between the eye tissue layers and create a blister-like filtration bleb.
For several weeks after the surgery, you must put drops in the eye to fight infection and inflammation. These drops will be different from those you may have been using before surgery.
Conventional surgery is performed on one eye at a time. Usually the operations are four to six weeks apart.
Conventional surgery is about 60 to 80 percent effective at lowering eye pressure. If the new drainage opening narrows, a second operation may be needed. Conventional surgery works best if you have not had previous eye surgery, such as a cataract operation.
Sometimes after conventional surgery, your vision may not be as good as it was before conventional surgery. Conventional surgery can cause side effects, including cataract, problems with the cornea, inflammation, infection inside the eye, or low eye pressure problems. If you have any of these problems, tell your doctor so a treatment plan can be developed.
[h=3]What are some other forms of glaucoma and how are they treated?[/h] Open-angle glaucoma is the most common form. Some people have other types of the disease. In low-tension or normal-tension glaucoma, optic nerve damage and narrowed side vision occur in people with normal eye pressure. Lowering eye pressure at least 30 percent through medicines slows the disease in some people. Glaucoma may worsen in others despite low pressures.
A comprehensive medical history is important to identify other potential risk factors, such as low blood pressure, that contribute to low-tension glaucoma. If no risk factors are identified, the treatment options for low-tension glaucoma are the same as for open-angle glaucoma.
In angle-closure glaucoma, the fluid at the front of the eye cannot drain through the angle and leave the eye. The angle gets blocked by part of the iris. People with this type of glaucoma may have a sudden increase in eye pressure. Symptoms include severe pain and nausea, as well as redness of the eye and blurred vision. If you have these symptoms, you need to seek treatment immediately.
This is a medical emergency. If your doctor is unavailable, go to the nearest hospital or clinic. Without treatment to restore the flow of fluid, the eye can become blind. Usually, prompt laser surgery and medicines can clear the blockage, lower eye pressure, and protect vision.
In congenital glaucoma, children are born with a defect in the angle of the eye that slows the normal drainage of fluid. These children usually have obvious symptoms, such as cloudy eyes, sensitivity to light, and excessive tearing. Conventional surgery typically is the suggested treatment, because medicines are not effective and can cause more serious side effects in infants and be difficult to administer. Surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision.
Conventional surgery makes a new opening for the fluid to leave the eye.
Secondary glaucomas can develop as complications of other medical conditions. For example, a severe form of glaucoma is called neovascular glaucoma, and can be a result from poorly controlled diabetes or high blood pressure. Other types of glaucoma sometimes occur with cataract, certain eye tumors, or when the eye is inflamed or irritated by a condition called uveitis. Sometimes glaucoma develops after other eye surgeries or serious eye injuries. Steroid drugs used to treat eye inflammations and other diseases can trigger glaucoma in some people. There are two eye conditions known to cause secondary forms of glaucoma.
Pigmentary glaucoma occurs when pigment from the iris sheds off and blocks the meshwork, slowing fluid drainage.
Pseudoexfoliation glaucoma occurs when extra material is produced and shed off internal eye structures and blocks the meshwork, again slowing fluid drainage.
Depending on the cause of these secondary glaucomas, treatment includes medicines, laser surgery, or conventional or other glaucoma surgery.
[h=3]What research is being done?[/h] Through studies in the laboratory and with patients, NEI is seeking better ways to detect, treat, and prevent vision loss in people with glaucoma. For example, researchers have discovered genes that could help explain how glaucoma damages the eye. NEI also is supporting studies to learn more about who is likely to get glaucoma, when to treat people who have increased eye pressure, and which treatment to use first.
[h=2]What You Can Do[/h] If you are being treated for glaucoma, be sure to take your glaucoma medicine every day. See your eye care professional regularly. You also can help protect the vision of family members and friends who may be at high risk for glaucoma-African Americans over age 40; everyone over age 60, especially Mexican Americans; and people with a family history of the disease. Encourage them to have a comprehensive dilated eye exam at least once every two years. Remember that lowering eye pressure in the early stages of glaucoma slows progression of the disease and helps save vision. Medicare covers an annual comprehensive dilated eye exam for some people at high risk for glaucoma. These people include those with diabetes, those with a family history of glaucoma, and African Americans age 50 and older.
[h=3]What should I ask my eye care professional?[/h] You can protect yourself against vision loss by working in partnership with your eye care professional. Ask questions and get the information you need to take care of yourself and your family.
[h=3]What are some questions to ask?[/h] About my eye disease or disorder
What is my diagnosis?
What caused my condition?
Can my condition be treated?
How will this condition affect my vision now and in the future?
Should I watch for any particular symptoms and notify you if they occur?
Should I make any lifestyle changes?
About my treatment
What is the treatment for my condition?
When will the treatment start and how long will it last?
What are the benefits of this treatment and how successful is it?
What are the risks and side effects associated with this treatment?
Are there foods, medicines, or activities I should avoid while Im on this treatment?
If my treatment includes taking medicine, what should I do if I miss a dose?
Are other treatments available?
About my tests
What kinds of tests will I have?
What can I expect to find out from these tests?
When will I know the results?
Do I have to do anything special to prepare for any of the tests?
Do these tests have any side effects or risks?
Will I need more tests later?
Other suggestions
If you dont understand your eye care professionals responses, ask questions until you do understand.
Take notes or get a friend or family member to take notes for you. Or, bring a tape recorder to help you remember the discussion.
Ask your eye care professional to write down his or her instructions to you.
Ask your eye care professional for printed material about your condition.
If you still have trouble understanding your eye care professionals answers, ask where you can go for more information.
Other members of your healthcare team, such as nurses and pharmacists, can be good sources of information. Talk to them, too.
Today, patients take an active role in their health care. Be an active patient about your eye care.
[h=2]Loss of Vision[/h] If you have lost some sight from glaucoma, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments.
[h=2]How should I use my glaucoma eyedrops?[/h] If eyedrops have been prescribed for treating your glaucoma, you need to use them properly, as instructed by your eye care professional. Proper use of your glaucoma medication can improve the medicines effectiveness and reduce your risk of side effects. To properly apply your eyedrops, follow these steps:
Wash your hands.
Hold the bottle upside down.
Tilt your head back.
Hold the bottle in one hand and place it as close as possible to the eye.
With the other hand, pull down your lower eyelid. This forms a pocket.
Place the prescribed number of drops into the lower eyelid pocket. If you are using more than one eyedrop, be sure to wait at least 5 minutes before applying the second eyedrop.
Close your eye OR press the lower lid lightly with your finger for at least 1 minute. Either of these steps keeps the drops in the eye and helps prevent the drops from draining into the tear duct, which can increase your risk of side effects.
The National Eye Institute (NEI) is part of the National Institutes of Health (NIH) and is the Federal governments lead agency for vision research that leads to sight-saving treatments and plays a key role in reducing visual impairment and blindness.
[h=1]Glaucoma [/h] By Mayo Clinic Staff Glaucoma is a group of eye conditions that damage the optic nerve, which is vital to good vision. This damage is often caused by an abnormally high pressure in your eye. Glaucoma is one of the leading causes of blindness in the United States. It can occur at any age but is more common in older adults. The most common form of glaucoma has 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. Vision loss due to glaucoma can't be recovered. So it's important to have regular eye exams that include measurements of your eye pressure. If glaucoma is recognized early, vision loss can be slowed or prevented. If you have the condition, you'll generally need treatment for the rest of your life. The signs and symptoms of glaucoma vary depending on the type and stage of your condition. For example: Open-angle glaucoma
Patchy blind spots in your side (peripheral) or central vision, frequently in both eyes
Tunnel vision in the advanced stages
Acute angle-closure glaucoma
Severe headache
Eye pain
Nausea and vomiting
Blurred vision
Halos around lights
Eye redness
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.
[h=3]When to see a doctor[/h] [h=3]Seek immediate medical care[/h] Promptly go to an emergency room or an eye doctor's (ophthalmologist's) office if you experience some of the symptoms of acute angle-closure glaucoma, such as severe headache, eye pain and blurred vision.
[h=3]Schedule eye exams[/h] Open-angle glaucoma gives few warning signs until permanent damage has already occurred. Regular eye exams are the key to detecting glaucoma early enough to successfully slow or prevent vision loss. The American Academy of Ophthalmology recommends glaucoma screening:
Every four years beginning at age 40 if you don't have any glaucoma risk factors
Every two years if you're at high risk or over 65
Glaucoma is the result of damage to the optic nerve. As this nerve gradually deteriorates, blind spots develop in your visual field. For reasons that doctors don't fully understand, this nerve damage is usually related to increased pressure in the eye. Elevated eye pressure is due to a buildup of a fluid (aqueous humor) that flows throughout your eye. This fluid normally drains into the front of the eye (anterior chamber) through tissue (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 and pressure builds up. Glaucoma tends to run in families. In some people, scientists have identified genes related to high eye pressure and optic nerve damage. The types of glaucoma include the following:
[h=3]Open-angle glaucoma[/h] Open-angle glaucoma 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.
[h=3]Angle-closure glaucoma[/h] Angle-closure glaucoma, 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 glaucoma is a medical emergency. It can be triggered by sudden dilation of your pupils.
[h=3]Normal-tension glaucoma[/h] In normal-tension glaucoma, your optic nerve becomes damaged even though your eye pressure is within the normal range. No one knows the exact reason for this. You may have a sensitive optic nerve, or you may have less blood being supplied to your optic nerve. This limited blood flow could be caused by atherosclerosis the buildup of fatty deposits (plaques) in the arteries or other conditions that impair circulation.
[h=3]Glaucoma in children[/h] It's possible for infants and children to have glaucoma. It may be present from birth or developed in the first few years of life. The optic nerve damage may be caused by drainage blockages or an underlying medical condition.
[h=3]Pigmentary glaucoma[/h] In pigmentary glaucoma, pigment granules from your iris build up in the drainage channels, slowing or blocking fluid exiting your eye. Activities such as jogging sometimes stir up the pigment granules, depositing them on the trabecular meshwork and causing intermittent pressure elevations. Because chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, be aware of these risk factors:
Having high internal eye pressure (intraocular pressure)
Being over age 60
Being black or Hispanic
Having a family history of the condition
Having certain medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anemia
Having certain eye conditions, such as nearsightedness
Having had an eye injury or certain types of eye surgery
Early estrogen deficiency, such as can occur after removal of both ovaries (bilateral oophorectomy) before age 43
Taking corticosteroid medications, especially eyedrops, for a long time
Glaucoma usually doesn't cause any noticeable symptoms until it has caused permanent damage. Ask your primary care doctor how often you need to see an eye doctor (ophthalmologist) for a comprehensive eye exam and follow that schedule. If you have any new eye symptoms or vision problems, make an appointment with your ophthalmologist or ask your doctor for a referral. Here's some information to help you get ready for your appointment.
[h=3]What you can do[/h] Before your appointment make a list of:
Symptoms you've been having, and for how long
All medications, supplements and vitamins you take, including the doses
Any eye problems you've had in the past, such as vision changes or eye discomfort
Questions to ask your doctor
Some basic questions to ask your doctor include:
Do I have signs of glaucoma?
What tests do I need to confirm a diagnosis?
What treatment approach do you recommend?
What are the alternatives to the primary approach you're suggesting?
Do I need to follow any activity restrictions?
What other self-care measures might help me?
What is the long-term outlook in my case?
How often do I need to return for follow-up visits?
Do I need to see an additional specialist?
I have these other health conditions. How can I best manage them together?
[h=3]What to expect from your doctor[/h] A doctor who sees you for possible glaucoma is likely to ask you a number of questions, such as:
Have you had any eye discomfort or vision problems?
Do you have any other signs or symptoms that concern you?
Do you have any family history of glaucoma or other eye problems?
What eye screening tests have you had and when?
Have you been diagnosed with any other medical conditions?
Are you using any eyedrops?
Are you using any vitamins or supplements?
Your doctor will review your medical history and conduct a comprehensive eye examination. He or she may perform several tests, including:
Measuring intraocular pressure (tonometry)
Testing for optic nerve damage
Checking for areas of vision loss (visual field test)
Measuring corneal thickness (pachymetry)
Inspecting the drainage angle (gonioscopy)
The damage caused by glaucoma can't be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially in you catch the disease in its early stage. The goal of glaucoma treatment is to lower pressure in your eye (intraocular pressure). Depending on your situation, your options may include eyedrops, laser treatment or surgery.
[h=3]Eyedrops[/h] Glaucoma treatment often starts with prescription eyedrops. These can help decrease eye pressure by improving how fluid drains from your eye or by decreasing the amount of fluid your eye makes. Prescription eyedrop medications include:
Prostaglandins. These increase the outflow of the fluid in your eye (aqueous humor) and reduce pressure in your eye. Examples include latanoprost (Xalatan) and bimatoprost (Lumigan). Possible side effects include mild reddening and stinging of the eyes, darkening of the iris, changes in the pigment of the eyelashes or eyelid skin, and blurred vision.
Beta blockers. These reduce the production of fluid in your eye, thereby lowering the pressure in your eye (intraocular pressure). Examples include timolol (Betimol, Timoptic) and betaxolol (Betoptic). Possible side effects include difficulty breathing, slowed heart rate, lower blood pressure, impotence and fatigue.
Alpha-adrenergic agonists. These reduce the production of aqueous humor and increase outflow of the fluid in your eye. Examples includeapraclonidine (Iopidine) and brimonidine (Alphagan). Possible side effects include an irregular heart rate; high blood pressure; fatigue; red, itchy or swollen eyes; and dry mouth.
Carbonic anhydrase inhibitors. Rarely used for glaucoma, these drugs may reduce the production of fluid in your eye. Examples include dorzolamide (Trusopt) and brinzolamide (Azopt). Possible side effects include a metallic taste, frequent urination, and tingling in the fingers and toes.
Miotic or cholinergic agents. These increase the outflow of fluid from your eye. An example is pilocarpine (Isopto Carpine). Side effects include smaller pupils, possible blurred or dim vision, and nearsightedness.
[h=3]Oral medications[/h] If eyedrops alone don't bring your eye pressure down to the desired level, your doctor may also prescribe an oral medication, usually a carbonic anhydrase inhibitor. Possible side effects include frequent urination, tingling in the fingers and toes, depression, stomach upset, and kidney stones.
[h=3]Surgery and other therapies[/h] Other treatment options include laser therapy and various surgical procedures. Possible complications include pain, redness, infection, inflammation, bleeding, abnormally high or low eye pressure, and loss of vision. Some types of eye surgery may speed the development of cataracts. You'll need to see your doctor for follow-up exams. And you may eventually need to undergo additional procedures if your eye pressure begins to rise or other changes occur in your eye. The following techniques are intended to improve the drainage of fluid within the eye, lowering pressure:
Laser therapy. Laser trabeculoplasty (truh-BEK-u-low-plas-tee) is an option for people with open-angle glaucoma. It's done in your doctor's office. He or she uses a laser beam to open clogged channels in the trabecular meshwork. It may take a few weeks before the full effect of this procedure becomes apparent.
Filtering surgery. With a surgical procedure called a trabeculectomy (truh-bek-u-LEK-tuh-me), your surgeon creates an opening in the white of the eye (sclera) and removes part of the trabecular meshwork.
Drainage tubes. In this procedure, your eye surgeon inserts a small tube in your eye.
Electrocautery. Your doctor may suggest a minimally invasive procedure to remove tissue from the trabecular meshwork using a small electrocautery device called a Trabecutome.
[h=3]Treating acute angle-closure glaucoma[/h] Acute angle-closure glaucoma is a medical emergency. If you're diagnosed with this condition, you'll need urgent treatment to reduce the pressure in your eye. This generally will require both medication and laser or other surgical procedures. You may have a procedure called a laser peripheral iridotomy in which the doctor creates a small hole in your iris using a laser. This allows fluid (aqueous humor) to flow through it, relieving eye pressure.
[h=3]Emerging therapies[/h] Researchers are evaluating the effectiveness of new drugs, drug delivery methods, surgical procedures and devices (iStent, others). These tips may help you control high eye pressure or promote eye health.
Eat a healthy diet. Eating a healthy diet can help you maintain your health, but it won't prevent glaucoma from worsening. Several vitamins and nutrients are important to eye health, including those found in dark, leafy greens and fish high in omega-3 fatty acids.
Exercise safely. Regular exercise may reduce eye pressure in open-angle glaucoma. Talk to your doctor about an appropriate exercise program.
Limit your caffeine. Drinking beverages with large amounts of caffeine may increase your eye pressure.
Sip fluids frequently. Drink only moderate amounts of fluids at any given time during the course of a day. Drinking a quart or more of any liquid within a short time may temporarily increase eye pressure.
Sleep with your head elevated. Using a wedge pillow that keeps your head slightly raised, about 20 degrees, has been shown to reduce intraocular eye pressure while you sleep.
Take prescribed medicine. Using your eyedrops or other medications as prescribed can help you get the best possible result from your treatment. Be sure to use the drops exactly as prescribed. Otherwise, your optic nerve damage could get even worse. Because some of the eyedrops are absorbed into your bloodstream, you may experience some side effects unrelated to your eyes. To minimize this absorption, close your eyes for one to two minutes after putting the drops in. Or press lightly at the corner of your eye near your nose to close the tear duct for one or two minutes. Wipe off any unused drops from your eyelid.
Some alternative medicine approaches may help your overall health but none are effective glaucoma remedies. Talk with your doctor about their possible benefits and risks.
Herbal remedies. A number of herbal supplements, such as bilberry and ginkgo, have been advertised as glaucoma remedies. But further study is needed to prove their effectiveness. Don't use herbal supplements in place of proven therapies.
Relaxation techniques. Stress may trigger an attack of acute angle-closure glaucoma. If you're at risk of this condition, find healthy ways to cope with stress. Meditation and other techniques may help.
Marijuana. Research shows that marijuana lowers eye pressure in people with glaucoma, but only for three to four hours. Other, standard treatments are more effective. The American Academy of Ophthalmology doesn't recommend marijuana for treating glaucoma.
When you receive a diagnosis of glaucoma, you're facing lifelong treatment, regular checkups and the possibility of progressive vision loss.
Meeting and talking with other people with glaucoma can be very helpful, and many support groups exist. Check with hospitals and eye care centers in your area to find local groups and meeting times. Several online resources, including support groups, are available. You may not be able to prevent glaucoma. But these self-care steps can help you detect it early, limit vision loss or slow its progress.
Get regular eye care. Regular comprehensive eye exams can help detect glaucoma in its early stages before irreversible damage occurs. As a general rule, have comprehensive eye exams every four years beginning at age 40 and every two years from age 65. You may need more frequent screening if you're at high risk of glaucoma. 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. Regular, moderate exercise may help prevent glaucoma by reducing eye pressure. Talk with your doctor about an appropriate exercise program.
Take prescribed eyedrops regularly. Glaucoma eyedrops can significantly reduce the risk that high eye pressure will progress to glaucoma. To be effective, eyedrops 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 on enclosed courts.