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03 January 2007
Glaucoma Awareness Month a Good Time for an Eye Exam
Ophthalmologists at Emory Eye Center advise annual eye exams to prevent damage from undiagnosed glaucoma. For those with a family history and over the age of 45, annual check-ups are even more important.

January is national Glaucoma Awareness Month, and ophthalmologists at Emory Eye Center and across the nation urge Americans who may be at risk for this potentially blinding disease to get a complete eye examination from an "Eye MD."

According to the National Eye Institute (NEI), glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. Glaucoma occurs when the normal fluid pressure inside the eyes slowly rises. However, with early treatment, you can often protect your eyes against serious vision loss.

Glaucoma is an eye condition that develops when too much fluid pressure builds up inside of the eye. Increased intraocular (inside the eye) pressure can damage the optic nerve, which transmits images to the brain. If damage to the optic nerve caused by elevated eye pressure continues, glaucoma will worsen one's vision. Without treatment, glaucoma can cause blindness within a few years, though most do not go completely blind from the disease.

Because most people with glaucoma have no early symptoms or pain from this increased pressure, it is important to see an eye MD regularly. Currently, glaucoma affects more than 3 million Americans.

Early diagnosis leads to early intervention. In fact, a 2002 study found that eye drops used to treat elevated pressure inside the eye can be effective in delaying the onset of glaucoma. These results mean that treating people at higher risk for developing glaucoma may delay — and possibly prevent — the disease. These findings were reported in the June 2002 issue of Archives of Ophthalmology.

At the Emory Eye Center in Atlanta, where 85 patients were followed for five years, Allen Beck, MD, a principal investigator in the study, was encouraged by the results.

"Glaucoma, when caught and treated early, can be managed for the remainder of one's lifetime," says Beck. "Because symptoms can come on gradually, they are often overlooked, and by the time we see patients, their disease has progressed to a more serious point. If these patients had been checked early on, their prognosis would be much better."

Additionally, findings also show that the burgeoning Latino population is at higher risk than expected for this disease, along with African Americans. A 2004 study, the Los Angeles Latino Eye Study (LALES), the largest and most comprehensive epidemiological analysis of visual impairment in Latinos in the United States, found that population to have high rates of open-angle glaucoma, a disease that damages the optic nerve. In fact, the rate of glaucoma in Latinos ages 70 to 79 was 15 percent higher than those in Caucasians and similar to that of African Americans in this country.

Similarly, glaucoma also occurs about five times more often in African Americans, and blindness from glaucoma is about six times more common. In addition to this higher frequency, glaucoma often occurs earlier in life in African Americans - on average, about 10 years earlier than in other ethnic populations. Studies have found that there may be a greater susceptibility to optic nerve damage, which causes vision loss for African Americans with glaucoma. Therefore, ophthalmologists recommend visual field testing to check for optic nerve damage. Ironically, a recent survey found that just over 16 percent of African Americans were unfamiliar with glaucoma.

According to the NEI, within the 3 million Americans who have glaucoma, only half of them are unaware they have the potentially blinding disease because they have no symptoms. As the disease progresses, any of the following symptoms may appear:

- Loss of peripheral vision

- Difficulty focusing on objects

- Presence of haloes around lights

- Blurred vision

The America n Academy of Ophthalmology recommends eye examinations at least every one to two years for:

- African Americans and Latinos over age 40

- People over age 65

- People with a family history of glaucoma

- Individuals who have experienced a serious eye injury

- People with diabetes (yearly exams are recommended)

Facts about Glaucoma

Symptoms of Glaucoma

At first, there are no symptoms. Vision stays normal, and there is no pain.

However, as the disease progresses, a person with glaucoma may notice his or her side vision gradually failing. That is, objects in front may still be seen clearly, but objects to the side may be missed.

As glaucoma remains untreated, people may miss objects to the side and out of the corner of their eye. Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. They seem to be looking through a tunnel. Over time, straight-ahead vision may decrease until no vision remains.

Glaucoma can develop in one or both eyes.

The Two Main Types: The Two Angles

- Open-angle glaucoma: Also called wide-angle glaucoma, this is the most common type of glaucoma. The structures of the eye appear normal, but fluid in the eye does not flow properly through the drain of the eye, called the trabecular meshwork.

- Angle-closure glaucoma. The fluid at the front of the eye cannot reach the angle and leave the eye. The angle gets blocked by part of the iris. People with this type of glaucoma have a sudden increase in eye pressure. Symptoms include severe pain and nausea, as well as redness of the eye and blurred vision. If you have these symptoms, you need to seek treatment immediately.

Although there are other types of glaucoma: low-tension, congenital and secondary glaucomas, the two above are the most common.

How Is Glaucoma Diagnosed?

An ophthalmologist will conduct a dilated eye exam, checking the patient's vision and optic nerve. He or she also will perform a procedure called tonometry to check for eye pressure. Visual field testing (checking the peripheral or side vision) is performed in suspected cases. Glaucoma tests are painless and take very little time.

How Is Glaucoma Treated?

This condition may include prescription eye drops, laser or microsurgery.

- Eye drops for Glaucoma: These either reduce the formation of fluid in the front of the eye or increase its outflow. There may be side effects to the drops, so patients need to completely discuss other medical conditions or prescriptions with the ophthalmologist.

- Laser surgery for Glaucoma: Laser surgery for glaucoma slightly increases the outflow of the fluid from the eye in open-angle glaucoma or eliminates fluid blockage in angle-closure glaucoma. Types of laser surgery for glaucoma include trabeculoplasty, in which a laser is used to pull open the trabecular meshwork drainage area; iridotomy, in which a tiny hole is made in the iris, allowing the fluid to flow more freely; and cyclophotocoagulation, in which a laser beam treats areas of the ciliary body, reducing the production of fluid.

- Microsurgery for Glaucoma: A new channel is created to drain the fluid thereby reducing intraocular pressure that causes glaucoma. Sometimes this form of glaucoma surgery fails and must be redone. Other complication of microsurgery for glaucoma include some temporary or permanent loss of vision, as well as bleeding or infection. Open-angle glaucoma is most commonly treated with various combinations of eye drops, laser trabeculoplasty, and microsurgery. Traditionally in the U.S., medications are used first, but there is increasing evidence that some people with glaucoma may respond better with early laser surgery or microsurgery.

Patients need to talk with their ophthalmologist to determine which treatment option is best for their particular case.


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