ANSWERS TO YOUR MOST COMMON GLAUCOMA QUESTIONS

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1 For Your Eyes Only: ANSWERS TO YOUR MOST COMMON GLAUCOMA QUESTIONS /

2 Table of Contents Introduction... 3 Glaucoma Defined... 4 Symptoms of Glaucoma... 6 Treatment Options for Glaucoma... 8 Conclusions /

3 Introduction Receiving a diagnosis of glaucoma can leave you feeling scared or confused. If you re wondering about your treatment options and prognosis, this e-book is here to help by answering the most common glaucoma questions. Glaucoma is the second leading cause of blindness after cataracts, but prompt treatment can slow down further vision loss. Vision lost from glaucoma cannot be restored, which is why it s important to seek treatment as soon as possible after being diagnosed. This e-book will answer all your questions related to: The definition and causes of glaucoma The symptoms of glaucoma and what you should do if you experience them Highly effective treatment options for glaucoma /

4 Glaucoma Defined Part 1: Glaucoma Defined What is Glaucoma? Glaucoma is a disease where the optic nerve becomes damaged over time, often due to elevated eye pressure. When the optic nerve cannot tolerate the increased stress from elevated eye pressure, some of the fibers that make up the optic nerve stop working. The most common reason eye pressure rises is because the eye s internal fluid is not draining well. The eye s internal drain is called the trabecular meshwork, which is located in the angle of the eye. The picture on the left shows a healthy optic nerve. The photograph on the right shows an optic nerve with damage caused by glaucoma. Healthy Optic Nerve Optic Nerve with Glaucoma What are the Types of Glaucoma? The most common type of glaucoma in the United States is open-angle glaucoma. In open-angle glaucoma, there is nothing physically blocking the eye s drainage canal. Even though nothing is blocking the access of fluid to the trabecular meshwork, sometimes the fluid simply does not drain through the meshwork as well as it should. This results in an increased eye pressure which can then damage the optic nerve. 4 /

5 Glaucoma Defined There are some patients with glaucomatous damage to their optic nerve who never register a high eye pressure reading when measured during normal eye exams. These patients have normal-pressure glaucoma which is also known as normal-tension glaucoma or low-tension glaucoma. These patients most likely develop optic nerve damage due to poor blood flow to the optic nerve. Whether patients with open-angle glaucoma have an elevated eye pressure or a normal eye pressure, lowering the eye pressure has been shown to be an effective treatment. In patients with narrow angles of the eye, the eye pressure can become elevated if the trabecular meshwork becomes blocked. Ideally, a patient with narrow angles is identified and treated prior to the development of optic nerve damage. A sudden episode of angle closure is a medical emergency and can cause permanent visual loss. Congenital glaucoma appears at birth, often due to malformation of the trabecular meshwork. Surgery is typically performed shortly after birth to correct this issue, but the patient will still require lifelong monitoring. Certain diseases, medications, and eye trauma can also lead to glaucoma. /

6 Symptoms of Glaucoma What Factors Put Someone at High Risk for Developing Glaucoma? Elevated eye pressure African-American and Hispanic ethnicities Chronic steroid use Family history of glaucoma Individuals over the age of 60 Eye trauma Part 2: Symptoms of Glaucoma The symptoms of glaucoma vary depending upon the severity of the disease. Glaucoma in the early stages may have no symptoms. Patients with mild or moderate glaucoma often describe their vision as blurred or missing parts. Patients do not often describe their vision as looking through a dark tunnel, despite what is commonly depicted on the Internet. Severe glaucoma can cause blindness and significant visual impairment. Here are a few excerpts from a 2013 survey asking glaucoma patients to describe their vision:...there s no sort of blackness, not with me anyway... there are areas of blur and then ordinary, it s difficult to describe it sometimes......i don t often do it because it frightens me to see what I ve got missing, but the other day, when I was sitting in the garden, I looked down and I thought, oh gosh, there is a great chunk missing......i get very much blurred, like a mist, and I keep cleaning my glasses but it s not there /

7 Symptoms of Glaucoma Patients with an attack of closed-angle glaucoma may have sudden symptoms including: Blurred or hazy vision Halos around lights Eye pain or headaches (sometimes accompanied by nausea or vomiting) Eye redness Sudden loss of vision What Should I Do If I Think I Have Glaucoma? If you experience any of the above symptoms, or if you think you may have glaucoma for any reason, schedule an appointment with one of the glaucoma specialists at Kremer Eye Center as soon as possible. Your eye doctor can perform a number of tests to pinpoint a diagnosis. An examination may include measuring the eye pressure, as well as assessing the angle of the eye and the optic nerve. What are the Potential Complications of Glaucoma and the Risks to Leaving Glaucoma Untreated? Left untreated, glaucoma can lead to total blindness. How quickly this happens depends on the type of glaucoma, hereditary factors, severity upon diagnosis, and the patient s lifestyle. When treated, however, glaucoma can be managed and vision loss can often be slowed down before it progresses to a substantial loss in quality of life. Read on to find out about the best treatment options for glaucoma. /

8 Treatment Options for Glaucoma Part 3: Treatment Options for Glaucoma Treatment for glaucoma involves lowering the eye pressure in various ways. At Kremer Eye Center, your treatment strategy will be tailored to your specific type of glaucoma. Reducing eye pressure can be accomplished by eye drops, laser procedures, or surgery. Eye Drops There are several types of glaucoma eye drops. They work by either causing the eye to produce less fluid or enhancing the eye s ability to drain fluid. Modern glaucoma eye drops are often prescribed to be used once-daily, twice-daily, or three-times-daily, depending on the type of medication. Of course, no eye drop can be effective if not taken as prescribed. Intermittent use of eye drops is not an effective way to prevent vision loss from glaucoma. The following are the more common potential side effects of the different classes of glaucoma drops: Prostaglandin analogues change in iris color, eye redness, dry eye Beta blockers low blood pressure or heart rate, fatigue, shortness of breath, depression Alpha agonists burning, stinging, fatigue, drowsiness, allergy to the eye drop Carbonic anhydrase inhibitors burning, stinging, eye discomfort 8 /

9 Treatment Options for Glaucoma Laser Procedures With open-angle glaucoma, selective laser trabeculoplasty (SLT) may be recommended to lower the eye pressure. SLT is the most common form of glaucoma surgery and is successful for 80% of patients. This procedure works by applying laser energy directly to the pigment in the trabecular meshwork, causing the eye to drain fluid better. SLT can lower eye pressure by as much as 30%, which is comparable to glaucoma eye drops. It can be used as an initial treatment of glaucoma or as a supplement to eye drops. The effects of SLT typically last for multiple years and can be repeated if your eye pressure begins to rise. If you have a narrow or closed-angle glaucoma, a laser peripheral iridotomy (LPI) may be recommended. During this procedure, a small hole is created in the iris to improve your eye s angle anatomy. Side effects of glaucoma laser procedures are not common, but a temporary elevation in eye pressure can occur. This transient rise in eye pressure happens in about 5% of patients and can be managed by glaucoma eye drops. LPI and SLT are FDA-approved treatments for glaucoma and are covered by most insurance plans, as well as Medicare and Medicaid. Insurance co-pays and prices for uninsured patients may vary. LPI and SLT do not require general anesthesia or a hospital stay. In fact, they rarely have side effects and are fast procedures. Both SLT and LPI procedures are performed on an outpatient basis at Kremer Eye Center offices in Pennsylvania, New Jersey, and Delaware. What are Microinvasive Glaucoma Surgeries? Microinvasive glaucoma surgeries (MIGS) are designed to have a modest reduction in eye pressure with a good safety profile. They are often performed at the same time as cataract surgery if a patient has mild or moderate glaucoma. Endoscopic cyclophotocoagulation (ECP) and the istent are currently available MIGS surgeries with multiple other devices under investigation. Endoscopic cyclophotocoagulation (ECP) uses a laser to shrink the eye s ciliary body, which is the part of the eye that produces fluid. The istent is a device only 1 millimeter in length that creates a permanent opening to allow fluid to drain from inside the eye out through the trabecular meshwork. /

10 Conclusions What if I Do Not Respond Appropriately to Eye Drops, Lasers, or the Surgeries Previously Listed? For some patients, eye drops and lasers are not effective in lowering eye pressure enough. A trabeculectomy is a surgery that creates a new drain to reduce eye pressure. A tube shunt surgery places a small plastic tube into the eye to allow excess fluid to drain to the tissues surrounding the eye. These surgeries do carry more risk compared to the ones described above, but are recommended if the benefits outweigh the risks. Conclusions The best way to find out more about glaucoma treatments is by contacting a specialist at Kremer Eye Center. They will explain the best treatment options available to you and answer any other questions you may have about your glaucoma diagnosis. When you are ready to schedule a consultation with a Kremer specialist, click here or call EYES (3937). 10 KremerEyeCenter.com / Follow Us