Glaucoma
Glaucoma is defined as a disease of the optic nerve, in which the nerve cells in the front of the optic nerve die. The process is irreversible. Glaucoma is a leading cause of blindness. Intraocular pressure is an important risk factor. Other risk factors for glaucoma include: positive family history, advanced age, and racial background. Recommendation for glaucoma screening is as follows: Everyone over 60 and African-Americans over 40 should have a complete eye exam every 1-2 years and everyone else should have a complete eye exam every 3 years. There are two types of glaucoma: open-angle glaucoma and closed-angle glaucoma.
Open-angle glaucoma is the more common type of glaucoma. It is essentially a plumbing problem. It is bilateral more common in elderly and African-American patients. Usually patients are asymptomatic until late in the disease process, at which point decreased peripheral and/or central vision may be noted. Goal of treatment is to reduce intraocular pressure and consists of medications, laser procedure, and surgery. In general surgery is used as last resort and includes trabeculectomy and drainage implants. The goal of surgery is to decrease intraocular pressure to reduce further vision loss. Complications of surgery are: infection, bleeding, cataracts, hypotony (low intraocular pressure), and reduced vision.
Closed-angle glaucoma is responsible for 15% of all cases and can be acute or chronic. Closed-angle glaucoma is more common in far-sighted patients, women, and Asians. There are two types of glaucoma: open-angle glaucoma and closed-angle glaucoma. In acute closed-angle glaucoma, the patient can present with pain, blurred vision, rainbow-like halos around light, frontal headache, nausea and vomiting. Acute closed-angle glaucoma is a medical emergency. It can cause permanent vision damage if the high intraocular pressure is not treated right away. Definitive treatment for acute closed-angle glaucoma is iridectomy. This can be achieved with laser or in rare cases with surgery. Laser iridectomy is an office procedure. The most common side effects of laser iridectomy are: increased intraocular pressure, and anterior uveitis.
