Glaucoma Uncovered: A Guide for Patients

August 20, 2023

What is Glaucoma?

Glaucoma is a complex and often misunderstood eye condition characterized by increased pressure within the eye, known as intraocular pressure (IOP). This pressure can lead to damage to the optic nerve, a vital structure that transmits visual information from the eye to the brain. Over time, the damage can result in progressive, irreversible vision loss, starting with peripheral vision and potentially leading to total blindness if left untreated.

The condition isn’t a single disease but rather a group of related disorders. The complexity of glaucoma is further increased by the fact that high IOP doesn’t always necessarily lead to glaucoma, and glaucoma can sometimes occur even when IOP is within normal ranges. Early detection through regular eye examinations and a careful understanding of the risk factors, such as family history, age, and ethnicity, can lead to more effective management of the disease.

Symptoms of Glaucoma

The symptoms of glaucoma can vary significantly depending on the type and stage of the condition:

Open-Angle Glaucoma: Often no symptoms in the early stages. Gradual loss of peripheral vision, tunnel vision in advanced stages.
Angle-Closure Glaucoma: Sudden eye pain, nausea, redness, blurred vision, and halos around lights.
Normal-Tension Glaucoma: Similar to open-angle but can cause migraine-like symptoms.
Secondary Glaucoma: Symptoms depend on the underlying cause and may include those of open-angle or angle-closure glaucoma.
Childhood Glaucoma: Excessive tearing, sensitivity to light, enlarged eye in children.

If you recognize any of these symptoms, prompt medical attention is crucial to prevent further damage.

Non-Surgical Treatment Options

Eye Drops

Eye drops are a crucial component in the management of glaucoma, a condition characterized by increased intraocular pressure (IOP) that can damage the optic nerve and potentially lead to blindness. Various types of eye drops are used to lower the eye pressure by different mechanisms. Here’s a detailed overview of some commonly used eye drops for glaucoma:

Prostaglandin Analogues (Teal Cap): Increase the outflow of fluid. Examples: Latanoprost (Xalatan), Travoprost (Travatan).
Beta-Blockers (Yellow Cap): Reduce fluid production. Examples: Timolol (Timoptic), Betaxolol (Betoptic).
Alpha Agonists (Purple Cap): Reduce fluid production and increase outflow. Examples: Brimonidine (Alphagan), Apraclonidine (Iopidine).
Carbonic Anhydrase Inhibitors (Orange Cap): Reduce fluid production. Examples: Dorzolamide (Trusopt), Brinzolamide (Azopt).
Rho Kinase Inhibitors: As a newer class of drops, the cap color may vary. Example: Netarsudil (Rhopressa).
Combination Drops (Various Caps): Combinations of the above for enhanced effect. Examples: Dorzolamide-Timolol (Cosopt), Brimonidine-Timolol (Combigan).

The colors of the caps help both patients and healthcare providers quickly identify the type of drop, making daily use more straightforward.

Each of these medications has its unique mechanism of action and potential side effects. For instance, alpha agonists can cause symptoms like red or stinging eyes, blurry vision, allergy symptoms, large (dilated) pupils, headaches, dry mouth, tiredness, weakness, dizziness, increased blood pressure, fast or irregular heartbeat, and nervousness.

Beta-blockers, like Timolol, can lead to red or stinging eyes, blurry vision, breathing problems (especially in people with asthma, emphysema, or COPD), slow or irregular heartbeat, tiredness, depression, dizziness, changes in sex drive or sexual function, exercise fatigue, and difficulty noticing low blood sugar symptoms in people with diabetes.

Carbonic anhydrase inhibitors can cause stinging eyes, red eyes, blurry vision, skin rashes (especially in people allergic to sulfa drugs), taste changes, upset stomach, tiredness, decreased energy, increased urination, and tingling around the mouth and fingertips.

Prostaglandin analogs can lead to red or stinging eyes, a sensation of something being in the eye, blurry vision, permanent changes in eye color (mainly in hazel eyes), increased eyelash thickness, number, and length, darkening of the eyelid, worsening of existing angina and asthma, joint aches, light sensitivity, and eyes sinking deeper into their sockets.

It’s important to use these medications as directed by an eye doctor and report any bothersome side effects. The doctor might adjust the dosage or change the medication if necessary.

Oral Medications

Oral medications for glaucoma are typically reserved for specific cases where a significant and temporary drop in intraocular pressure (IOP) is required, and it cannot be achieved through other means. These medications are most commonly used in cases of acute angle-closure glaucoma or in situations surrounding intraocular surgery, where there can be substantial pressure spikes.

Systemic Carbonic Anhydrase Inhibitors (CAIs) such as Acetazolamide (Diamox®) are often used. The usual dosage for IOP control is 250mg every 6 hours. Acetazolamide is the most commonly administered oral CAI. It is generally reserved for short-term IOP reduction in patients with acute angle-closure glaucoma or those at significant risk of vascular occlusion due to elevated IOP. These inhibitors work by decreasing active aqueous humor secretion by blocking carbonic anhydrase in the ciliary processes. Side effects can include paresthesia (tingling and numbness), malaise, fatigue, depression, and more severe effects like metabolic acidosis and Stevens-Johnson syndrome. They are contraindicated in patients with sulfa hypersensitivity, impaired renal function, severe COPD, or pregnancy.
Systemic Osmotic Agents like Glycerol and Isosorbide are another class of oral medications for glaucoma. Their dosage is 1g/kg of body weight, with peak action within 1 hour and a duration of action up to 3 hours. These medications lower IOP by creating an osmotic gradient between the blood and the vitreous, causing water to be drawn out from the vitreous. However, they can have side effects like headache, nausea, and mental confusion, and are used with caution in patients with renal or cardiac disease.

Laser Treatment

Laser treatment has become a significant method for managing various types of glaucoma. It is usually performed as an outpatient procedure in your doctor’s office or a hospital clinic. The procedure involves numbing the eye with drops to minimize pain, and then a laser (a strong beam of light) is used to aid fluid drainage from the eye, thereby lowering the pressure inside your eye.

Here are some common types of laser treatments for glaucoma:

Selective Laser Trabeculoplasty (SLT): This is used for primary open-angle glaucoma (POAG). SLT uses a low-level laser to selectively target specific cells, leaving other areas of the trabecular meshwork intact. This specificity allows for the possibility of repeating the procedure if necessary. SLT can be an alternative for patients who haven’t responded well to other treatments like Argon Laser Trabeculoplasty (ALT) or pressure-lowering drops.
Argon Laser Trabeculoplasty (ALT): Also for treating POAG, ALT uses a laser beam to open the fluid channels in the eye, enhancing the drainage system’s effectiveness. It’s common to treat half the fluid channels first, followed by the other half in a separate session if needed. This approach helps prevent over-correction and reduces the risk of increased pressure post-surgery. ALT has been successful in lowering eye pressure in up to 75% of treated patients.
Laser Peripheral Iridotomy (LPI): This is used for narrow angles and narrow-angle glaucoma. In cases where the angle between the iris and the cornea is too small, causing the iris to block fluid drainage, LPI creates a small hole in the iris. This hole allows the iris to fall back from the fluid channel, aiding drainage and reducing intraocular pressure.
Laser Cyclophotocoagulation: This is an alternative to filtering microsurgery, typically used later in the treatment process. Various types of lasers can impair the ciliary body’s ability to produce fluid, thus lowering eye pressure. This procedure may need to be repeated to achieve lasting glaucoma control.

Side effects of laser treatment can include swelling, soreness, or scratches on the cornea, which can be painful but usually heal quickly. Eye drops may be provided to assist with healing. Recovery from laser treatment is typically quick, with most patients resuming normal activities the day after treatment. However, there can be some risks involved, such as a temporary increase in intraocular pressure or, in rare cases, a drop in pressure too low to maintain the eye’s normal metabolism and shape.

Despite the efficacy of laser treatments, most patients will still need to continue taking glaucoma medications post-procedure. The treatment’s effectiveness in lowering intraocular pressure varies depending on factors like the type of laser surgery, the type of glaucoma, age, race, and others. Some patients may require the procedure to be repeated for better control of intraocular pressure.

Lifestyle Changes

Living a healthy lifestyle can greatly complement your glaucoma treatment and may even help in controlling the disease to some extent. Here’s what you can do:

Healthy Diet: Consuming a balanced diet rich in leafy greens, colorful fruits, and fish high in omega-3 fatty acids can promote overall eye health.
Exercise Regularly: Moderate exercise, such as walking or jogging, can reduce eye pressure. It’s essential to consult your eye care professional about the exercises suitable for your condition.
Avoid Excessive Caffeine or Alcohol: Excessive consumption may alter your eye pressure. Moderation is key.
No Smoking: Smoking can affect your eye health negatively. Quitting is beneficial not just for your eyes but for your overall health.
Limit Fluid Intake: Drinking large amounts of liquid in a short time can increase eye pressure. Sip small amounts throughout the day.
Use Sunglasses: Protect your eyes from harsh UV rays that can aggravate your condition.
Sleep Position: Sleeping with your head slightly elevated can reduce eye pressure. Discuss the right position with your healthcare provider.

These changes don’t replace medical treatment but act as a supportive measure.

Monitor Regularly

Regular monitoring is vital for effective glaucoma management:

Frequent Check-ups: Scheduled visits to your optometrist will allow for timely detection of any changes or progression in the disease.
Understand Your Treatment Plan: Actively engaging with your healthcare provider, understanding your medication, their timing, and their effects helps in more effective management.
Monitoring at Home: Some individuals may benefit from home monitoring devices. Discuss this with your eye care professional.
Report Changes: If you notice any sudden changes or symptoms, don’t wait for your next appointment. Contact your healthcare provider immediately.
Family History: If glaucoma runs in your family, regular monitoring is even more critical, as you may be at higher risk.

Regular appointments and active engagement with your healthcare provider are essential in managing glaucoma effectively. It ensures that your treatment is tailored to your current condition and can be adjusted as needed.

Ready to Take Action?

Glaucoma is a serious condition, but with the right treatment plan, it’s manageable. Whether you’re newly diagnosed or looking for ongoing care, Compton Eye Associates is here to help. Our dedicated team will work with you to develop a personalized treatment plan that’s best for your eye health.

Don’t let glaucoma affect your vision. Take control of your eye health today. Schedule an appointment at Compton Eye Associates or call us at 800-936-0036. Your eyes will thank you!