Glaucoma and Laser Eye Surgery

What Is Glaucoma?

Glaucoma is actually a family of eye diseases, all of which involve damage to the optic nerve following a build up of pressure within the eye. Glaucoma in all of its forms is a progressive disease and is the second most common cause of blindness. Glaucoma can affect both eyes, but not necessarily to the same degree or at the same speed.

What Are The Causes Of Glaucoma?

Glaucoma is usually caused by a blockage within the eye, which prevents the drainage of eye fluid (aqueous humour). This in turn leads to a pressure build up within the eye, which eventually causes damage to the optic nerve and nerve fibres in the retina. The optic nerve is the connection between the eye and the brain and damage to this can eventually lead to blindness.

What Types Of Glaucoma Are There?

There are two core types of Glaucoma: open angle and closed angle. There are also a wide range of branch forms of glaucoma with a range of causes and symptoms.


Primary (Or Chronic) Open Angle Glaucoma

This is by far the most common form of glaucoma and is usually hereditary. There are about half a million sufferers in the UK and around 3 million sufferers in the USA, most of whom are elderly or past middle age. Its development is generally slow and happens as the drainage channels become gradually clogged over time. Because open angle glaucoma happens so gradually, symptoms are often missed and loss of sight goes unnoticed until the disease has progressed. This article mainly covers this type of glaucoma.

Closed Angle (Or Angle Closure) Glaucoma

Closed angle glaucoma is relatively rare and is completely different in nature to the more common open angle form. In this type of glaucoma, symptoms usually progress very quickly and lead to a rapid and very painful build up of pressure within the eye.

Other Forms Of Glaucoma

  • a) Normal Tension Glaucoma - Damage to the optic nerve without unusually high pressure.
  • b) Secondary Glaucoma - Raised eye pressure and optic nerve damage caused by another illness.
  • c) Pigmentary Glaucoma - Similar to the blockage in open angle glaucoma but caused by parts of the iris breaking off and blocking the channels.
  • d) Pseudoexfoliative Glaucoma - As above, but caused by pieces breaking off the lens of the eye.
  • e) Traumatic Glaucoma - Caused by injury to the eye.
  • f) Neovascular Glaucoma - Abnormal new blood vessels growing in the eye (usually due to diabetes).
  • g) Irido Corneal Endothelial Syndrome - Rare and caused by an overgrowth of cells on the back of the eye.
  • h) Childhood Glaucoma - Very rare in babies and children, with a variety of possible causes.

What Are The Symptoms Of Glaucoma?

Unfortunately, there are usually no early warning signs at all of the most common type of glaucoma occurring. Sadly, because the loss of eyesight is so subtle and over such a long period, and because the disease is completely painless, it is often quite advanced before diagnosis is made and treatment is made available. By this stage, the main symptom is loss of sight.

Glaucoma

Glaucoma can lead to misty vision and in severe cases vision loss in one or both eyes

Symptoms of closed angle glaucoma are much more obvious because it happens so suddenly. Symptoms include severe eye and head pain, blurred or hazy vision, nausea or vomiting alongside eye pain and sudden loss of sight. Because damage is fast and severe, you should seek immediate treatment from an ophthalmologist if you become aware of these symptoms.

Who Is At Risk From Glaucoma?

Glaucoma can affect anyone at any time; however, there are a number of known risk factors that may make you more likely to suffer from glaucoma.

At Risk Groups

  • Those with a family history of glaucoma (the most common type is hereditary).
  • Black African / Black Caribbean.
  • People over the age of 60.
  • Asians and older Hispanics.
  • Anyone with an eye injury.
  • Steroid users.

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How Can Glaucoma Be Prevented?

Currently, the only effective way of preventing glaucoma is to attend regular eye examinations with an optician. Early detection will prevent the disease from progressing, but it cannot stop it happening in the first place.

Anyone in a high risk group should arrange regular eye check-ups, even if they have no other eye problems. Those groups in particular who should attend pre-emptive eye exams include people with diabetes, people with a family history of glaucoma and those of African descent.

Exercise, particularly walking or jogging, is also thought to play a role in preventing glaucoma by reducing intraocular pressure. In addition, wearing protective eye-wear when carrying out any dangerous activities prevents or certainly lowers the risk of eye damage that could lead to other types of glaucoma.


What Treatments Are Available For Suffers Of Glaucoma?

Laser Eye Surgery for Glaucoma

There are three available treatments available for glaucoma - medicine, laser treatment and conventional surgery. However, it is important to realise that any existing damage is permanent and cannot be reversed, regardless of treatment. The available treatments for glaucoma only aim to prevent further damage by controlling the condition.

Medications

Eye drops are a common, effective and low cost way to treat glaucoma. Regular prescribed eye drop use helps to reduce the intraocular pressure, which prevents further damage to the optic nerve. Eye drops must be used continually and do sometimes cause unwanted side effects. People who wear lenses must also revert to wearing glasses because eye drop residue on the lenses can build up and damage your eyes in other ways.

Eye drops are not suitable for everyone. The ongoing need for treatment, the potential for harmful side effects and discomfort when administering drops can drive some patients to seek other treatments. Pills may also be available but must be taken multiple times per day and also carry the risk of adverse effects.

Laser Treatment

There are two forms of laser treatments for glaucoma and both are effective. Trabeculoplasty involves using the laser to unblock the drainage tubes within your eye and Cyclodiode treatment destroys some of the tissue in the eye responsible for producing aqueous humour, the build up of fluid which leads to intraocular pressure within the drainage tubes. Both types involve anaesthetising eye drops being applied prior to surgery and are mostly painless and mostly permanent. In some cases, you may need to use eye drops after treatment.

Laser treatment is a popular option because it is quick, complication free, mostly painless and often requires no further treatment.

Eye Surgery

There are four main types of conventional eye surgery available for treating glaucoma and these can be carried out under local or general anaesthetic. Surgery should be permanent but is obviously more invasive and radical than either of the other treatment options available. Following surgery, you may be prescribed anti-scarring medications to prevent scarring across your eyes.


Future Possibilities

New treatments for glaucoma are being developed all of the time, and new, non-invasive surgical procedures, as well as new laser treatment techniques are likely to be available in the near future.

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