What is glaucoma?
Glaucoma is a group of eye diseases that can cause vision loss and blindness by damaging a nerve in the back of your eye called the optic nerve.
The symptoms can start so slowly that you may not notice them. The only way to find out if you have glaucoma is to get a comprehensive dilated eye exam.
There’s no cure for glaucoma, but early treatment can often stop the damage and protect your vision.
What are the types of glaucoma?
There are many different types of glaucoma, but the most common type in the United States is called open-angle glaucoma — that’s what most people mean when they talk about glaucoma. Other types of glaucoma are less common, like angle-closure glaucoma and congenital glaucoma.
Primary glaucomas
When experts don’t know what causes a type of glaucoma, that type is called a primary glaucoma.
Open-angle glaucoma
Treatments: Medicines, laser treatment, surgery
Open-angle glaucoma is the most common type in the United States, where 9 in 10 people with glaucoma have the open-angle type. Many people don’t have any symptoms until they start to lose their vision, and people may not notice vision loss right away.
Experts aren’t sure what causes open-angle glaucoma, but it may be caused by pressure building up in your eye. If the fluid in your eye can’t drain fast enough, it creates pressure that pushes on a nerve in the back of your eye (the optic nerve).
Over time, the pressure damages the optic nerve, which affects your vision. This can eventually lead to blindness — in fact, open-angle glaucoma causes almost 2 in 10 cases of blindness in African Americans. People with high blood pressure are also at higher risk for this type.
Normal-tension glaucoma
Treatments: Medicines, laser treatment, surgery
Normal-tension glaucoma is a type of open-angle glaucoma that happens in people with normal eye pressure. About 1 in 3 people with open-angle glaucoma have the normal-tension type.
You may be at higher risk for normal-tension glaucoma if you:
- Are of Japanese ancestry
- Have a family history of normal-tension glaucoma
- Have had certain heart problems, like an irregular heartbeat
- Have low blood pressure
Experts don’t know what causes normal-tension glaucoma, but research shows that treatments that lower eye pressure can help slow the disease and stop vision loss.
Angle-closure glaucoma
Treatments: Medicines, laser treatment
Angle-closure glaucoma, also called narrow-angle or acute glaucoma, is a medical emergency. Go to the doctor or emergency room immediately if you suddenly have:
- Intense pain in your eye
- Nausea
- Red eyes
- Blurred vision
In this type of glaucoma, the outer edge of the iris (the colored part of your eye) blocks fluid from draining out of the front of the eye. The fluid builds up quickly, causing a sudden increase in eye pressure. If it’s not treated, angle-closure glaucoma can cause blindness in just a few days.
A doctor can use laser treatment and give you medicine to help the fluid drain. This can lower eye pressure and protect your vision. Your doctor might treat both eyes to prevent future problems, even if you only have angle-closure glaucoma in one eye.
Another type of angle-closure glaucoma, sometimes called slow or chronic angle-closure glaucoma, happens more slowly and might not have any symptoms. Your doctor can treat this type with medicines, laser treatments, or surgery.
Congenital glaucoma
Treatments: Medicines, surgery
Some babies are born with glaucoma — this is called congenital glaucoma. About 1 out of 10,000 babies born in the United States have a defect (problem) in the eye that keeps fluid from draining normally.
In these cases, you can usually notice the symptoms right away. Children with congenital glaucoma:
- Have cloudy eyes
- Are sensitive to light
- Make extra tears
- May have eyes that are larger than normal
Surgery works very well to treat congenital glaucoma. If a doctor does surgery early enough, children with congenital glaucoma usually won’t have any permanent vision loss.
Several other types of glaucoma can also develop in children. Any glaucoma that affects babies or children is called pediatric glaucoma.
Secondary glaucomas
Neovascular glaucoma
Treatments: Medicines, laser treatment, surgery
Neovascular glaucoma happens when the eye makes extra blood vessels that cover the part of your eye where fluid would normally drain. It’s usually caused by another medical condition, like diabetes or high blood pressure.
If you have neovascular glaucoma, you may notice:
- Pain or redness in your eye
- Vision loss
This type of glaucoma can be hard to treat. Doctors need to treat the underlying cause (like diabetes or high blood pressure) and use glaucoma treatments to lower the eye pressure that results from it.
Pigmentary glaucoma
Treatments: Medicines, laser treatment, surgery
Pigment dispersion syndrome happens when the pigment (color) from your iris (the colored part of your eye) flakes off. The loose pigment may block fluid from draining out of your eye, which can increase your eye pressure and cause pigmentary glaucoma.
Young, white men who are near-sighted are more likely to have pigment dispersion syndrome than others. If you have this condition, you may have blurry vision or see rainbow-colored rings around lights, especially when you exercise.
Doctors can treat pigmentary glaucoma by lowering eye pressure, but there currently isn’t a way to prevent pigment from detaching from the iris.
Exfoliation glaucoma
Treatments: Medicines, laser treatment, surgery
Exfoliation glaucoma (sometimes called pseudoexfoliation) is a type of open-angle glaucoma that happens in some people with exfoliation syndrome, a condition that causes extra material to detach from parts of the eye and block fluid from draining.
Recent research shows that genetics may play a role in exfoliation glaucoma. You are at higher risk if someone else in your family has exfoliation glaucoma.
This type of glaucoma can progress faster than primary open-angle glaucoma, and often causes higher eye pressure. This means that it’s especially important for people who are at risk to get eye exams regularly.
Uveitic glaucoma
Treatments: Medicines, surgery
Uveitic glaucoma can happen in people who have uveitis, a condition that causes inflammation (irritation and swelling) in the eye. About 2 in 10 people with uveitis will develop uveitic glaucoma.
Experts aren’t sure how uveitis causes uveitic glaucoma, but they think that it may happen because uveitis can cause inflammation and scar tissue in the middle of the eye. This may damage or block the part of the eye where fluid drains out, causing high eye pressure and leading to uveitic glaucoma.
In some cases, the medicines that treat uveitis may also cause uveitic glaucoma, or make it worse. This is because corticosteroid medicines may cause increased eye pressure as a side effect.
What are the symptoms of glaucoma?
At first, glaucoma doesn’t usually have any symptoms. That’s why half of people with glaucoma don’t even know they have it.
Over time, you may slowly lose vision, usually starting with your side (peripheral) vision — especially the part of your vision that’s closest to your nose. Because it happens so slowly, many people can’t tell that their vision is changing, especially at first.
But as the disease gets worse, you may start to notice that you can’t see things off to the side anymore. Without treatment, glaucoma can eventually cause blindness.
Am I at risk for glaucoma?
Anyone can get glaucoma, but some people are at higher risk. You’re at higher risk if you:
- Are over age 60
- Are African American or Hispanic/Latino and over age 40
- Have a family history of glaucoma
Talk with your doctor about your risk for glaucoma, and ask how often you need to get checked.
What causes glaucoma?
Scientists aren’t sure what causes the most common types of glaucoma, but many people with glaucoma have high eye pressure (intraocular pressure) — and treatments that lower eye pressure help to slow the disease.
How can eye pressure damage the optic nerve?
Research shows that higher eye pressure increases your risk for damage to the optic nerve. The pressure in your eye goes up if fluid can’t drain normally out of the front of your eye.
Between the cornea (clear front layer of the eye) and the iris (colored part of the eye), there’s a space called the “anterior chamber.” Fluid normally flows through this space and out of an opening where the iris and cornea meet. The opening has spongy tissue in it. The fluid passes through this spongy tissue as it drains out of the eye.
Not everyone with higher eye pressure will develop glaucoma. Whether you develop glaucoma depends on the amount of pressure your optic nerve can take without being damaged. This amount is different for each person.
Getting regular comprehensive dilated eye exams can help your eye doctor figure out what level of eye pressure is normal for you.
What causes open-angle glaucoma?
In people with open-angle glaucoma, the fluid passes too slowly through the spongy tissue in the opening where the iris and cornea meet. This causes fluid to build up in your eye, which increases the pressure inside of your eye.
Experts believe that when the pressure inside your eye gets too high, it can damage the optic nerve and cause vision loss. Studies show that lowering eye pressure can help stop vision loss from glaucoma — that’s why it’s important to control the pressure inside your eyes.
What causes normal-tension glaucoma?
It’s possible for your optic nerve to get damaged and cause vision loss without high eye pressure. This is called normal-tension glaucoma or low-tension glaucoma.
Experts don’t know why this happens, but it may be that your optic nerve is more sensitive than most people’s. In this case, even though the pressure in your eye is normal, lowering it can slow down or prevent more damage to your eye.
What causes angle-closure glaucoma?
Angle-closure glaucoma can cause these sudden symptoms:
- Intense eye pain
- Upset stomach (nausea)
- Red eye
- Blurry vision
If you have these symptoms, go to your doctor or an emergency room immediately.
What causes congenital glaucoma?
In congenital glaucoma, babies are born with a problem in their eye that makes fluid drain more slowly than normal. The good news is that if a child with congenital glaucoma gets surgery soon after they are diagnosed, they have a high chance of developing good vision.
Can other health problems cause glaucoma?
Yes — you can develop different types of glaucoma that are called secondary glaucomas.
Health problems that can cause glaucoma include:
- Complications from medical conditions like diabetes or high blood pressure
- Cataract
- Certain eye tumors
- Inflammation of your eye
- Serious eye injuries
- A reaction to steroids used to treat some diseases
How will my eye doctor check for glaucoma?
Eye doctors can check for glaucoma as part of a comprehensive dilated eye exam. The exam is simple and painless — your doctor will give you some eye drops to dilate (widen) your pupil and then check your eyes for glaucoma and other eye problems. The exam includes a visual field test to check your peripheral (side) vision.
What is a dilated eye exam?
A dilated eye exam is the best thing you can do for your eye health! It’s the only way to check for eye diseases early on, when they’re easier to treat — and before they cause vision loss.
The exam is simple and painless. Your eye doctor will check for vision problems that make it hard to see clearly, like being nearsighted or farsighted. Then your doctor will give you some eye drops to dilate (widen) your pupil and check for eye diseases.
Since many eye diseases have no symptoms or warning signs, you could have a problem and not know it. Even if you think your eyes are healthy, getting a dilated eye exam is the only way to know for sure.
How often do I need to get a dilated eye exam?
How often you need a dilated eye exam depends on your risk for eye disease. Talk to your doctor about what’s right for you.
Get a dilated eye exam every 1 to 2 years if you:
- Are over age 60
- Are African American and over age 40
- Have a family history of glaucoma
If you have diabetes or high blood pressure, ask your doctor how often you need an exam. Most people with diabetes or high blood pressure need to get a dilated eye exam at least once a year.
What happens during a dilated eye exam?
The exam includes:
- A visual acuity test to check how clearly you see. Your doctor will ask you to read letters that are up close and far away.
- A visual field test to check your peripheral (side) vision. Your doctor will test how well you can see objects off to the sides of your vision without moving your eyes.
- An eye muscle function test to check for problems with the muscles around your eyeballs. Your doctor will move an object around and ask you to follow it with your eyes.
- A pupil response test to check how light enters your eyes. Your doctor will shine a small flashlight into your eyes and check how your pupils react to the light.
- A tonometry test to measure the pressure in your eyes. Your doctor will use a machine to blow a quick puff of air onto your eye, or gently touch your eye with a special tool. Don’t worry — it doesn’t hurt!
- Dilation to check for problems with the inner parts of your eye. Your doctor will give you some eye drops to dilate (widen) your pupil. This helps the doctor see inside your eye.
Depending on your needs, your doctor may include other tests too. Ask your doctor if you have questions.
How does dilation work?
Dilating your pupil lets more light into your eye — just like opening a door lets light into a dark room. Dilation helps your eye doctor check for many common eye problems, including diabetic retinopathy, glaucoma, and age-related macular degeneration (AMD).
What happens after a dilated eye exam?
For a few hours after a dilated eye exam, your vision may be blurry and you may be sensitive to light. Ask a friend or family member to drive you home from your appointment.
If your eye doctor finds refractive errors in your vision, you may get a prescription for eyeglasses or contact lenses to help you see more clearly.
What’s the treatment for glaucoma?
Doctors use a few different types of treatment for glaucoma, including medicines (usually eye drops), laser treatment, and surgery.
If you have glaucoma, it’s important to start treatment right away. While it won’t undo any damage to your vision, treatment can stop it from getting worse.
Medication
What types of eye drops can help glaucoma?
There are many medicines available to treat glaucoma. Before you start taking glaucoma medicines, tell your doctor about other medicines, supplements, or vitamins you take. Eye drops for glaucoma may affect how those other medicines work.
Some types of eye drops work by helping fluid drain from your eye, which lowers eye pressure. Examples include:
- Prostaglandins, like latanoprost, travoprost, tafluprost, and bimatoprost
- Rho kinase inhibitor, like netarsudil
- Nitric oxides, like latanoprostene bunod
- Miotic or cholinergic agents, like pilocarpine
Other types of eye drops work by lowering the amount of fluid your eye makes. Examples include:
- Alpha-adrenergic agonists, like apraclonidine and brimonidine
- Beta blockers, like timolol and betaxolol
- Carbonic anhydrase inhibitors, like dorzolamide and brinzolamide
What are the side effects?
Most people don’t have problems with glaucoma medicines. But there’s a small chance that you could develop:
- Stinging, itching, burning, and redness in your eye
- Blurry vision
- Changes in your eye color or the skin around your eye
- Headaches
- Dry mouth
- Changes in your energy level, heartbeat, or breathing
The specific side effects depend on which medicine you’re taking. If you notice any side effects, talk to your doctor. You may be able to take a different dose (amount) or a different medicine.
How long will I need to use glaucoma eye drops?
As long as the medicine is working, your doctor will probably want you to keep using it every day.
If eye drops don’t lower the pressure in your eye enough, your doctor may recommend prescription pills as well — but this is uncommon.
Your doctor may also suggest other treatment options, like surgery.
Laser Treatment
Laser treatment or trabeculoplasty is a simple procedure that your eye doctor can do in the office. It works by using a laser to help the fluid in your eye drain away, which can help to lower the pressure inside your eye. Ask your eye doctor if laser treatment is right for you.
Do I need laser treatment for my glaucoma?
Laser trabeculoplasty is used to treat open-angle glaucoma. There are other types of laser surgery that can treat other types of glaucoma.
Ask your eye doctor about all your glaucoma treatment options, including medicines, laser treatment, and surgery. You and your doctor can work together to make a treatment plan that’s right for you.
What happens during laser treatment for glaucoma?
Before the treatment, your doctor will put drops in your eye to make it numb. Most people feel little or no pain or discomfort during the treatment.
During the treatment, you will sit in front of a laser machine. Your doctor will aim a laser (a strong beam of light) into your eye using a special lens.
The doctor will use the laser to try to help fluid drain from your eye. You may see flashes of bright green or red light during the treatment.
If you have glaucoma in both eyes, your doctor may treat both eyes on the same day, or they may treat 1 eye and schedule treatment for your other eye a few days or a few weeks later.
Are there any side effects?
Laser treatment can cause side effects, just like any procedure.
You may have some swelling or soreness. Sometimes the laser can scratch the cornea (the clear front layer of the eye) or make the cornea very dry. This can be painful, but the pain usually goes away quickly as the cornea heals. Your doctor can give you eye drops to help.
How long does it take to recover?
Most people can go back to their normal daily activities the day after their laser treatment.
Right after the treatment, your eye may be irritated and your vision might be blurry, so you’ll need someone to give you a ride home from the doctor’s office.
Will I need more treatment?
Laser treatment works very well for most people, but it doesn’t work for everyone. You’ll need to wait 4 to 6 weeks to find out if the treatment worked.
Most people will need to keep taking glaucoma medicine even after laser treatment. You’ll also need a few follow-up visits so your doctor can check your eye pressure.
Because the treatment wears off over time, some people may need to get laser treatment more than once. Your doctor may also suggest other treatment, like surgery.
Surgery
If glaucoma medicines and laser treatment haven’t helped to treat your glaucoma, your doctor may recommend surgery. Surgery can’t cure glaucoma or undo vision loss, but it can help protect your vision and stop it from getting worse.
There are a few different types of surgery for glaucoma that can help lower the pressure in your eye:
- Trabeculectomy (“tra-BECK-yoo-LECK-toh-mee”)
- Glaucoma implant surgery
- Minimally invasive glaucoma surgery (MIGS)
If you need glaucoma surgery in both eyes, your doctor will only do surgery on one eye at a time.
What is trabeculectomy?
This type of surgery is usually used to treat open-angle glaucoma. It’s done in a hospital and usually takes less than an hour.
The surgeon will create a tiny opening in the top of your eye, under your eyelid where no one will see it. This opening allows extra fluid in your eye to drain away, lowering pressure in your eye.
Usually, you’ll be awake during this surgery — but you’ll get numbing medicine and medicine to help you relax. You can usually go home the same day, but you’ll need someone to drive you home.
What is glaucoma implant surgery?
This type of surgery is used to treat several types of glaucoma, including congenital glaucoma, neovascular glaucoma, and glaucoma caused by an injury. It’s done in a hospital and usually takes 1 to 2 hours.
In this operation, the surgeon implants a tiny tube, or shunt, onto the white of your eye. The tube helps extra fluid drain out of your eye, lowering your eye pressure.
Usually, you’ll be awake during this surgery — but you’ll get numbing medicine and medicine to help you relax. You can usually go home the same day, but you’ll need someone to drive you home.
What is minimally invasive glaucoma surgery (MIGS)?
If you have mild glaucoma, your doctor may recommend a new approach called minimally invasive glaucoma surgery (MIGS). This also lowers eye pressure but it’s safer and helps you recover faster.
There are different types of MIGS, so ask your eye doctor about whether MIGS may be an option for you.
What happens after surgery?
Your doctor will prescribe eye drops to help prevent swelling and infections, and you’ll need to use them for several weeks. These eye drops are different from other glaucoma eye drops you may already use.
While you recover, you may need to avoid some activities for 2 to 4 weeks, like lifting anything heavy. You’ll also need check-ups with your doctor to make sure your eye is healing well.
Will I need surgery again?
For some people, the benefits of surgery last a long time. For others, the opening in the eye begins to close up and they need surgery again. You’ll need regular check-ups with your doctor to test your eye pressure. That way, your doctor will be able to act fast if you need more treatment.
Research shows that trabeculectomy lowers eye pressure in 6 to 8 out of 10 people who have it. It may work best in people who haven’t had eye surgery — like surgery for glaucoma, retina surgery, eye muscle surgery, or some types of cataract surgery — or eye trauma.
What are the side effects of surgery for glaucoma?
Glaucoma surgery can have side effect s, just like any operation. For example, your eye may be swollen and sore for a while.
Other possible risks include:
- Cataract
- Problems with the cornea (the clear surface layer of your eye)
- Eye pressure that’s too low
- Vision loss
Talk over the pros and cons of surgery with your doctor. Together, you can make a treatment plan that’s right for you.
Sources:
https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma
https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma/glaucoma-surgery
https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma/treatment
https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma/glaucoma-medicines
https://www.nei.nih.gov/learn-about-eye-health/healthy-vision/get-dilated-eye-exam
https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma/types-glaucoma
https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma/causes
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