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Glaucoma (adult)
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Jill A. Smith, MD
Massachusetts Eye and Ear Infirmary, Harvard Medical School
October 15, 2002

What is Glaucoma?
Glaucoma is a GROUP of disorders. What they all have in common is an increase in the pressure inside the eye. When the pressure is too high, damage occurs to the optic nerve. The optic nerve is made up of a bundle of nerve fibers which sends signals to the brain. Damage to the optic nerve can initially cause blind spots at the outer edges of the field of vision called peripheral or side vision. This is the main sign of glaucoma. As damage to the optic nerve gets worse, the visual field can shrink leading to tunnel vision or even loss of central vision affecting a patients ability to read. Fortunately, this occurs only in patients with very severe disease.

Who gets Glaucoma?
Glaucoma is an important cause of blindness in the United States. At least two million Americans have glaucoma. Almost 900,000 of these people are visually impaired due to their glaucoma. Almost 80,000 Americans are legally blind due to their glaucoma, with legal blindness being a visual acuity of 20/200 or worse with correction in the better eye. It is the most frequent cause of blindness in black Americans.

The genetic inheritance of glaucoma is still unclear. However, a family history of glaucoma has been found in up to 50% of patients with the most common type of glaucoma, known as primary open-angle glaucoma.

One type of glaucoma occurs in people who have had a history of being hit in the eye (e.g. soccer ball). Not only can they get a rise in pressure initially after the injury, but they also may develop glaucoma years later. All of these things stress the importance of regular eye exams.

How do I know if I have glaucoma?
Unfortunately glaucoma is typically associated with painless and progressive loss of vision that may escape detection by the patient. This once again stresses the importance of a thorough eye history and examination, especially in patients with a family history of glaucoma. Only one type of glaucoma called angle-closure glaucoma is associated with a red, painful eye with blurred vision and even possibly nausea and vomiting. This is due to very high pressures resulting FROM a block in the drainage system of the eye. Most patients at risk for this type of glaucoma have structural differences in their eye which could be identified prior to an attack and preventative treatment could be performed. Rarely do patients with other types of glaucoma develop pressure high enough to have pain and redness.

How is glaucoma treated?
The primary goal of treatment is to preserve vision. The typical first line of treatment is eye drops which lower the intraocular pressure by helping fluid leave the eye or by reducing the amount of fluid produced in the eye. Some patients may need to take multiple different types of eye drops or even eye drops plus medications in pill form to effectively lower the pressure. In addition, there are laser treatments for both angle closure and open angle glaucoma. Laser treatment for angle closure glaucoma is usually performed to prevent an acute attack as described above; while laser treatment for open angle glaucoma is performed when medications are not effective enough or the patient has difficulty taking medications. Surgery, which involves making a drainage system for the fluid in the eye, is usually performed when medications and lasers are ineffective.

Who diagnoses and treats glaucoma?
Eye physicians and surgeons (ophthalmologists) are medical doctors (M.D.'s), who have undergone specialized training in ORDER to treat eye diseases and to perform surgery. They are best qualified to diagnose glaucoma. Some ophthalmologists undergo subspecialty training in glaucoma and are the best qualified to treat advanced glaucoma. The Harvard Medical School Department of Ophthalmology, located at the Massachusetts Eye and Ear Infirmary, has many staff ophthalmologists who are experienced in screening patients for glaucoma, as well as glaucoma specialists who are experienced in treating patients diagnosed with glaucoma.

How do I get more information?
Please call your local ophthalmologist for more information about glaucoma. To arrange for an appointment in the New England area with an ophthalmologist call the Massachusetts Eye and Ear Infirmary, General Eye Service at (617) 573-3202.
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The information and recommendations appearing on these pages are informational only and is not intended to be a basis for diagnosis, treatment or any other clinical application. For specific information concerning your personal medical condition, the DJO suggests that you consult your physician.