Glaucoma overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Glaucoma is a group of diseases of the optic nerve involving loss of retinal ganglion cells in a characteristic pattern of optic neuropathy. Although raised intraocular pressure is a significant risk factor for developing glaucoma, there is no set threshold for intraocular pressure that causes glaucoma. One person may develop nerve damage at a relatively low pressure, while another person may have high eye pressure for years and yet never develop damage. Untreated glaucoma leads to permanent damage of the optic nerve and resultant visual field loss, which can progress to blindness. Glaucoma has been nicknamed "the silent sight thief".
Screening
Screening for glaucoma is usually performed as part of a comprehensive eye examination performed by ophthalmologists and optometrists. Those at risk for glaucoma are advised to have a dilated eye examination at least once a year.[1]
Treatment
Medical Therapy
Although intraocular pressure is only one major risk factors of glaucoma, lowering it via pharmaceuticals or surgery is currently the mainstay of glaucoma treatment. In Europe, Japan, and Canada laser treatment is often the first line of therapy. In the U.S., adoption of early laser has lagged, even though prospective, multi-centered, peer-reviewed studies, since the early '90s, have shown laser to be at least as effective as topical medications in controlling intraocular pressure and preserving visual field. Some studies suggest that acupuncture can be very helpful in the treatment of glaucoma[2].
Surgery
Glaucoma is a group of diseases affecting the optic nerve that results in vision loss and is frequently characterized by raised intraocular pressure (IOP). There are many glaucoma surgeries, and variations or combinations of those surgeries, that facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower IOP by decreasing the production of aqueous.
Primary Prevention
There is no way to prevent open-angle glaucoma, but one can prevent vision loss from the condition. Early diagnosis and careful management are the keys to preventing vision loss. Most people with open-angle glaucoma have no symptoms. Everyone over age 40 should have an eye examination at least once every 5 years, and more often if in a high-risk group. Those in high-risk groups include people with a family history of open-angle glaucoma and people of African heritage. Such high-risk groups should have a comprehensive dilated eye exam at least once every two years. People at high risk for acute glaucoma may opt to undergo iridotomy before having an attack.
Secondary Prevention
Patients who have had an acute episode in the past may have iridotomy to prevent a recurrence.
References
- ↑ National Institutes of Health
- ↑ Clinical application of acupuncture in ophthalmology. Dabov S; Goutoranov G; Ivanova R; Petkova N Acupunct Electrother Res 1985, 10 (1-2) p79-93