Understanding the Risks of Glaucoma
Glaucoma refers to a group of eye diseases that progressively damage the eye's optic nerve. The damage caused by glaucoma is permanent and is the leading cause of blindness in the United States. However, vision loss can often be prevented through early diagnosis and treatment.
The most common form of glaucoma, open-angle glaucoma, presents no symptoms until the damage is advanced. Open-angle glaucoma accounts for approximately 85 percent of adult glaucoma cases in the United States.
Angle-closure glaucoma—an acute form of glaucoma that requires immediate medical attention—accounts for most of the rest of the cases.
What causes glaucoma?
The eye continuously produces a clear fluid that circulates around the eye, nourishing it and removing waste products. The fluid drains through a channel and empties into the blood stream. In a healthy eye, this process of fluid production and draining maintains normal pressure.
Often, glaucoma develops as a result of the eye's decreased ability to drain this fluid, resulting in a build-up of pressure throughout the entire eye. This pressure causes damage to the optic nerve and eventually leads to loss of vision. In cases of open-angle glaucoma, damage occurs very slowly and is usually not detected until the damage is advanced.
In cases of angle-closure glaucoma, the build-up of fluid and increased eye pressure happens very rapidly. Immediate medical care is needed as angle-closure glaucoma can cause blindness in a matter of days.
Who is at risk?
Open-angle glaucoma tends to affect the following groups of people who:
- Are over age 40
- Are African American
- Have a family history of glaucoma
- Have systemic diseases (such as diabetes or heart disease)
Angle-closure glaucoma is common in people of Asian descent.
My vision seems fine—why should I get tested?
In most cases of glaucoma, loss of vision first affects peripheral, or “side,” vision. Because this occurs very slowly, many patients are not aware they are losing their sight. Central vision, which is used to view objects directly in front of the eye, usually is not affected until very late in the course of the disease.
Often, by the time someone notices a vision problem, the glaucoma is advanced. The key to successfully treating glaucoma is early diagnosis before extensive damage has occurred. Periodic eye check-ups are very important, especially for those at risk for developing glaucoma.
Glaucoma treatment at Penn
In the majority of glaucoma patients, treatment can prevent loss of vision. Even in advanced cases, treatment can often prevent further vision loss. Depending on the needs of the patient and type of glaucoma, treatment may include a combination of medication, laser therapy and surgery.
“We are very excited about the potential of two surgical techniques used to treat glaucoma—filtration surgery and aqueous shunt surgery,” says Prithvi S. Sankar, MD, assistant professor of clinical ophthalmology at the University of Pennsylvania Health System and ophthalmologist at Scheie Eye Institute, located at Penn Presbyterian Medical Center.
The aqueous shunt procedure involves a device that is implanted in the eye. A tube is connected to the shunt and inserted in the channel allowing fluid to drain. Glaucoma-causing pressure is released as excess fluid is removed from the eye.
Filtration surgery involves making an opening in the eye and a bubble (or “bleb”) forms, keeping eye pressure low and preserving vision.
Dr. Sankar and Penn ophthalmology researchers are exploring all possible scenarios for which aqueous shunt surgery and filtration surgery can be utilized.
“These are technologically advanced procedures that exist as a subspecialty of ophthalmology. With glaucoma, early detection and prevention are key, and there are new technologies that allow for the earlier detection of glaucoma. For advanced cases, we research and test new techniques that will improve the quality of life for our patients,” says Dr. Sankar.
Penn Eye Care provides complete diagnostic and treatment services in comprehensive ophthalmology as well as subspecialty areas. Services range from routine eye examinations to advanced ocular surgery.
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