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Glaucoma is a condition that causes damage to your eye’s optic nerve and gets worse over time. It’s often linked to a buildup of pressure inside your eye. Glaucoma tends to be inherited and may not show up until later in life.

The increased pressure, called intraocular pressure, can damage the optic nerve, which transmits images to your brain. If the damage continues, glaucoma can lead to permanent vision loss. Without treatment, glaucoma can cause total permanent blindness within a few years.

Most people with glaucoma have no early symptoms or pain. You need to see your eye doctor regularly so he can diagnose and treat glaucoma before long-term visual loss happens.

If you’re over age 40 and have a family history of the disease, you should get a complete eye exam from an eye doctor every 1 to 2 years. If you have health problems like diabetes or a family history of glaucoma or are at risk for other eye diseases, you may need to go more often.

Who Gets Glaucoma?

It mostly affects adults over 40, but young adults, children, and even infants can have it. African-Americans tend to get it more often, when they’re younger, and with greater vision loss.

You’re more likely to get it if you:

  • Are of African-American, Irish, Russian, Japanese, Hispanic, Inuit, or Scandinavian descent
  • Are over 40
  • Have a family history of glaucoma
  • Have poor vision
  • Have diabetes
  • Take certain steroid medications like prednisone
  • Have had trauma to the eye or eyes

What are the Symptoms?

The symptoms of Glaucoma vary by the type of glaucoma.

Open-Angle Glaucoma

If you have this, the most common type, you might not have any symptoms until you lose a significant amount of vision.

Chronic Open-Angle Glaucoma (COAG)

The first sign is often the loss of your side vision (the doctor will called this peripheral vision). It happens slowly, so you may not notice the changes.

Acute Closed- or Narrow-Angle Glaucoma

People often describe this as “the worse eye pain of my life.” Symptoms strike quickly:

  • Severe throbbing eye pain
  • Eye redness
  • Headaches (on the same side as the affected eye)
  • Blurry or foggy vision
  • Halos around lights
  • Dilated pupil
  • Nausea and vomiting

This type of glaucoma is a medical emergency. See a doctor immediately. Damage to the optic nerve may begin within a few hours and, if not treated with 6 to 12 hours, it may bring severe permanent loss of vision or blindness and even a permanently enlarged (dilated) pupil.

Secondary Glaucoma and Other Forms

Symptoms depend on what’s causing your pressure to rise. Inflammation inside your eye (the doctor will call this uveitis) can cause you to see halos. Bright lights may bother your eyes (you’ll hear the doctor call this light sensitivity or photophobia).

Eye injuries like corneal edema, bleeding, or retinal detachment can hide glaucoma symptoms.

If a cataract is the cause, your vision will have been worse for a while.

If you have had an injury to your eye, and advanced cataract, or inflammation in your eyes, your eye doctor will check often to make sure you don’t have glaucoma, too.

How Do I Know if I Have Glaucoma?

Tests are short and painless. Your eye doctor will measure your eye pressure with a gadget called a tonometer. She’ll give you drops that numb your eye so you don’t feel anything. Tell her if you’ve had refractive surgery. It can affect your eye pressure reading.

Higher than normal eye pressure doesn’t mean that you have glaucoma. In fact, some people with normal pressure can have it, while others with higher levels may not. High pressure without damage to the optic nerve is called ocular hypertension. If you have this, your doctor will want to test your eyes often. 

If she thinks you have glaucoma, your eye doctor will check your optic nerve for signs of damage. She’ll have you take a test that measures the sharpness of your side vision (she’ll call this your peripheral vision). Special images (OCT) of the nerve that form the optic nerve can give clues to the presence of glaucoma.

When to Call the Doctor

  • Your eye is painful and red. It can be a sign of acute narrow-angle glaucoma, inflammation, infection, or other serious eye conditions. You may need immediate medical attention to prevent permanent eye damage or blindness.
  • You get drowsy, tired, or short of breath after you use eye drops to treat glaucoma. It could mean the drug is aggravating a heart or lung problem.

Tell your doctor what medications you’re taking. Certain drugs, even over-the-counter medications – especially those used to treat sinus and cold congestion, and stomach and intestinal disorders – may cause an acute closed-angle glaucoma attack. Bring a list of all your medications with you the eye doctor.

You can prevent glaucoma, but you can’t get vision back once it’s gone. That’s why it’s so important to get regular exams with an eye doctor, particularly if there is a family history of glaucoma.

What Are the Treatments for Glaucoma?

Treatment of open-angle glaucoma – the most common form of the disease – requires lowering the eye’s pressure by increasing the drainage of aqueous humor fluid or decreasing the production of that fluid. Medications can accomplish both of these goals. Surgery and laser treatments are directed at improving the eye’s aqueous drainage.

If not diagnosed early, open-angle glaucoma may significantly damage vision and even cause blindness. That is why it’s so important to have your eye doctor test you regularly for glaucoma. Once diagnosed, glaucoma is usually controlled with eye drops that reduce eye pressure. Glaucoma is a life-long condition and needs continual follow-up with your eye doctor.

Both drugs and surgery have high rates of success in treating chronic open-angle glaucoma, but you can help yourself by carefully following the doctor’s treatment plan. Some patients may find it difficult to follow a regimen involving two or three different eye drops. Be candid and tell the doctor if you cannot follow the medication schedule or if the eye drops cause unwanted side effects. There are frequently alternative treatments. Because of potential drug interactions, be sure to tell your doctor about any other medical problems you have or other medications you take. If glaucoma drops causes the eyes to become chronically red, consult your doctor about switching to preservative-free glaucoma drops that may alleviate the redness from preservatives.

Acute angle-closure glaucoma is different from chronic open-angle glaucoma in several important ways: The symptoms usually occur with relative suddenness; the eye is painful and red. If the high pressure in the eye is not relieved quickly, blindness can occur.

On the other hand, treatments for acute angle-closure glaucoma – usually laser treatment – are permanent and do not require long-term therapy. For this type of glaucoma, making a hole in the iris to allow fluid to drain, called an iridectomy, is the standard treatment to cure it. The unaffected eye also is usually treated to prevent a future attack. However, it’s important to get your eyes checked regularly, as some people may develop a case of chronic angle-closure glaucoma later in life, even after laser treatment.

If the glaucoma does not respond to medication, or if you cannot tolerate the side effects, your doctor may change medications or recommend one of several surgical techniques:

  • Laser trabeculoplasty creates small laser burns in the area where the fluid drains, improving the outflow rate of aqueous fluid. This relatively brief procedure can often be done in an ophthalmologist’s clinic.
  • Trabeculectomy is a surgical procedure that creates a new channel for fluid outflow in cases in which the intraocular pressure is high and optic nerve damage progresses. Long-term results vary, but generally, the success rate is good.
  • Surgical implants that shunt fluid out of the eye may also be used to decrease pressure in the eye.

Remember, all forms of medical or surgical treatment have potential benefits and risks. Before giving your consent, always ask the surgeon to clearly explain any treatment or surgery as well as the proposed benefits, effective alternatives, and potential risks or complications.

Living with Glaucoma

When you have glaucoma, your doctor will probably prescribe drops, pills, or other treatments. There are other things you can do to keep your eyes healthy, too.

Get moving. Regular exercise may help lower eye pressure and keep blood flowing to the nerves in your eye. Talk to your doctor about the best exercise program for you. Some activities can increase pressure, so make sure to find the best plan for you.

Eat healthy. Enjoy a healthy, well-rounded diet. It won’t prevent your glaucoma from getting worse, but it’s key to keeping your body and eyes healthy. Some studies suggest that eating foods high in antioxidants can help when you have glaucoma.

Add nutrient-rich foods to your diet like:

  • Dark, leafy greens
  • Fish that’s packed with omega-3 fatty acids

Take your medicine. Be sure to take your drops or pills exactly as directed. Set a reminder on your phone or watch so you don’t forget. Missing your meds could make your glaucoma worse.

Some medicine can cause side effects. If the problems are strong and don’t go away, see your doctor. Hey may want to change what you take.

Don’t smoke. It’s important to keep your total body healthy, and nicotine takes a toll. Smoking also raises your blood pressure and eye inflammation. That can make your risk of diabetes and cataracts go up. Both are risk factors for glaucoma. If you smoke, ask your doctor for advice on how to quit.

Watch your caffeine. Watch how much soda, coffee, and tea you drink. Too much caffeine can raise your eye pressure. One study found that just a cup of coffee could make the pressure in your eye go up a significant amount for up to 90 minutes.

Elevate your head. Use a wedge pillow when you sleep. It’ll keep your head raised just a little. That should help lower your eye pressure.

Drink fluids slowly. Don’t cut back on how much you drink, but spread out your beverages through the day. If you drink a lot at once, it can strain your eyes. Don’t have more than a quart at a time. Instead, sip small amounts.

Protect your eyes. Put on protective glasses when you work in the yard or play contact sports. Wear goggles when you swim. When choosing makeup, use non-allergenic brands and replace items often. Be sure to use sunglasses outside, especially in summer or around high-glare surfaces like sand, snow and water. When you have glaucoma, your eyes can be very sensitive to glare.

Don’t rub. Glaucoma and the medicine you take might make your eyes feel itchy. But fight the urge. That can scratch them and make things worse. Ask your doctor if you can take drops if your eyes are dry.

Be careful with yoga. If you do it, you may need to reconsider some of your positions. Some head-down moves where your heart is above your eye can raise your eye pressure. You may want to avoid poses like:

  • Downward facing dog
  • Standing forward bend
  • Plow
  • Legs up the wall

Can I Prevent Glaucoma?

No. There’s no way to head off chronic open-angle glaucoma. But if you find and treat it early enough, you can prevent eye damage and preserve your sight.

The first step, get an eye exam. All adults need to be checked for glaucoma every 3 to 5 years. You’ll want to see an eye doctor – either an optometrist or an ophthalmologist. If someone in your family had glaucoma, or if you have other risk factors, your doctor may want to check you more often.

Your doctor might find out that you’re at risk during a comprehensive eye exam before you have an attack.

You might be more likely to get it if you:

  • Are of African, Hispanic, Inuit, Irish, Asian, Russian, or Scandinavian descent
  • Have a family history of glaucoma
  • Are nearsighted
  • Are farsighted enough to require thick eyeglass lenses – that means your eye is small and may be crowded inside
  • Have poor vision from a different eye problem
  • Had serious eye trauma
  • Take any form of steroid medications (pills, inhalers, eye drops) for diseases such as asthma and rheumatoid arthritis
  • Take certain drugs for bladder control, seizures, or even certain over-the-counter cold remedies

Most of the things that make you likely to get glaucoma are beyond your control. But an early diagnosis will help you protect yourself. Start with an eye exam.