What is Glaucoma?
Glaucoma is a group of eye diseases involving fluid in the eye and an increase in pressure. In a normal eye, fluid exits the eye in a continuous stream. But when a person has glaucoma, the fluid is blocked from exiting, causing pressure to build in the eye. Over time, this pressure damages the optic nerve. Glaucoma is the second leading cause of blindness across all age groups in the U.S. It is especially dangerous because most forms of glaucoma don’t exhibit any warning signs or symptoms until the patient already has permanent vision damage.
While glaucoma is traditionally treated with daily eye drops, there are other options. Learn more about glaucoma and your treatment options in these short videos.
Durysta™ Sustained-Release Glaucoma Treatment
MIGS (Minimally Invasive Glaucoma Surgeries)
The causes of Glaucoma
The interior of our eyes is filled with fluid, known as aqueous humor. Normally, this fluid flows through the eye and exits through an area of tissue known as the trabecular meshwork. This is located where the iris and the cornea meet.
If a person has glaucoma, the trabecular meshwork develops a blockage or other damage, or the person’s eye produces too much aqueous humor. This causes pressure to build inside the eye. If it stays elevated, this pressure begins to damage the optic nerve. This deterioration will begin to show itself as the patient will notice blind spots in his or her visual field.
At what age does glaucoma usually start to form?
One of the main risk factors for a person developing glaucoma is age. People over age 60 are at a much higher risk. Glaucoma is rare in those under 40, unless they have other health issues such as heart disease.
How quickly it can progress
Open-angle glaucoma is a slow-progressing eye disease. Damage to the retinal cells occurs quite slowly. If left untreated, it can take up to 15 years before the person becomes legally blind. But if their glaucoma is related to a chronic medical condition such as high blood pressure, the progression of glaucoma can be much faster.
This is the reason we stress regular eye exams for our Richins Eye Center patients, especially if they’re over the age of 60. We like to see patients, especially in higher risk groups, every year after they turn 40. We can see the signs of glaucoma during your regular eye exams. That’s why we perform the puff test, among others. This is so important because glaucoma doesn’t typically cause symptoms to warn the patient.
What are the Symptoms of Glaucoma?
At first, open-angle glaucoma has no symptoms. Your vision stays normal and there is no pain. But if glaucoma goes on untreated, people may notice that although they see things clearly in front of them, they miss objects to the side and out of the corner of their eye. Without treatment, people with glaucoma may find that they suddenly have no side vision. It may seem as though they are looking through a tunnel. Over time, the remaining forward vision may decrease until there is no vision left.
The risks of getting Glaucoma
Anyone can develop glaucoma, but certain factors increase a person’s risk:
- Having high intraocular pressure
- Being over age 60
- Being African-American, Asian, or Hispanic
- Having a family history of glaucoma
- Having other medical conditions, such as diabetes, high blood pressure, heart disease, or sickle cell anemia
- Having corneas that are thin in the center
- Being extremely nearsighted or farsighted
- Having had an eye injury
- Having had certain types of eye surgery
- Long-time use of corticosteroid medications, particularly eye drops
Is glaucoma painful?
Glaucoma is a sneaky robber of sight because it doesn’t cause any pain in the person who has it, even though the elevated intraocular pressure can be causing permanent damage to the optic nerve. That is true with the most common form of glaucoma, primary open-angle glaucoma.
The less common form, acute angle-closure glaucoma will cause severe headaches, eye pain, nausea, and vomiting, in addition to problems with vision such as halos around lights.
In the United States, primary open-angle glaucoma is the form of over 90 percent of those with glaucoma.
Treatment options we offer for Glaucoma
Although you will never be cured of glaucoma, treatment often can control it. This makes early diagnosis and treatment important to protect your sight.
Glaucoma medications come in the form of eye drops, pills, and an implantable 12-week sustained-release treatment called Durysta™.
Some glaucoma medications cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye. Durysta reduces intraocular pressure in patients with open-angle glaucoma, or ocular hypertension. After numbing medicine, a tiny needle is used to place the medication. As it slowly dissolves, it relieves intraocular pressure by about 30% for 12 weeks or even longer, and is covered by most insurance plans.
Minimally-Invasive Glaucoma Surgery (MIGS)
In the videos above, you can learn more about minimally-invasive glaucoma surgeries. These procedures are permanent, and can help reduce intraocular pressure, or IOP. This pressure reduction can help prevent further damage to the optic nerve.
Laser surgery helps fluid drain out of the eye. It is often done after trying medication. In many cases, you will need to keep taking glaucoma drugs even after laser surgery.
What Our Patients Have to Say
“Richens Eye Center is the BEST! Professional, courteous, complete, and knowledgeable with the most up to date technology to make you feel that you are getting the best treatment in town. Highly Recommended !!!” – Coleen A.
"Dr. Richens is one of the most caring and knowledgeable eye doctors I have ever came across in my 10 years of having eye issues and seeing multiple doctors. From start to finish my experience with her has been nothing but exceptional. I could tell she truly cared about me as a patient and went above and beyond to make sure I was being taken care of. HIGHLY recommend her for any of your eye care needs!" -Liam H.
What are the benefits of minimally invasive glaucoma surgery?
Because these methods carry lower risk of complication, they enable surgical intervention at an earlier point in treatment. In the past, this sometimes kept the patient on medications and laser treatments, rather than moving forward with traditional incisional surgery.
These are some benefits of MIGS:
- Decreases the number of patients who require more invasive glaucoma surgery
- Incisions are very tiny
- Involves little surgical manipulation of the sclera (the white)
- Involves little manipulation of the conjunctiva (the transparent outer layer)
- Shorter operation times
- More rapid recovery
- Can be combined with cataract extraction
- Lower complications and risks than traditional surgery
- Can reduce or eliminate the need for medications
How does traditional glaucoma surgery compare to minimally invasive glaucoma surgery?
MIGS procedures don’t have long-term data to use to fully compare with traditional methods, which have been used for four decades. MIGS procedures have thus far shown to be safer than traditional trabeculectomy or tube shunt surgeries. This is because they don’t have some of the associated complications from trabeculectomy and tube shunt procedures, such as overly low eye pressure and bleb infection. MIGS procedures involve shortened surgical time and that can be very important for the safety of the patient. Although MIGS procedures are safer then trabeculectomy, they are not as effective in lowering IOP, which precludes them from being used in patients needing more dramatic reduction in eye pressure.
What to expect from treatment
Whether our Richens Eye Center ophthalmologists use medications, MIGS procedures, or laser trabeculoplasties, developing glaucoma isn’t a sentence for future blindness. Our glaucoma patients can live with glaucoma for the remainder of their lives, although they will continue to need treatment throughout that time.
The goal is to keep your intraocular eye pressure under control, as this slows or stops damage to the optic nerve. Our focus is on lowering your eye pressure and keeping it down. This level is often referred to as the “target pressure” and is usually a range, not a single number. Target pressure varies between different patients, and it can change over time.
Plus, new treatments and medications are continually being developed. The newest medication is Durysta™, as shown in the video link above. MIGS procedures continue to expand, as well. This will make it easier for patients and for providers such as the team at Richens Eye Center to keep glaucoma at manageable levels, allowing people to cope more easily with this eye disease.
What are the risks of not treating glaucoma?
The risks with not having your eyes regularly checked, or not using your glaucoma pressure-reducing eyedrops once diagnosed, are straightforward. You will first lose your peripheral vision. Eventually, this will leave you with only tunnel vision, where you can only see objects directly in front of you. Continued untreated glaucoma will then lead to blindness in one or both eyes.
Glaucoma develops unbeknownst to the patient in almost all cases. That’s why maintaining a regular schedule of eye exams is important, particularly after your 40th birthday.
Is Glaucoma Preventible?
There is no known way to prevent glaucoma, and the disease may progress without showing obvious daily signs. In the most common version of glaucoma — called primary open-angle glaucoma — there are no symptoms and vision loss is slow and progressive. The vision loss first occurs in a person’s peripheral vision.
While you can’t prevent glaucoma, the team at Richens Eye Center can help you prevent significant vision damage through regular eye exams and early treatment. During your regular eye exams, we can spot glaucoma early through tests that gauge the pressure within your eye. Once diagnosed, we can work to keep the pressure from building in your eye. This will limit any damage to the optic nerve. That’s why regular eye exams and early diagnosis are key to effectively treating glaucoma.
How is Glaucoma Detected?
Most people think that they have glaucoma if the pressure in their eyes is increased. This is not always true. High pressure puts you at risk for glaucoma, but may not mean that you have the disease. Whether or not you get glaucoma depends on the level of pressure that your optic nerve can tolerate without being damaged. This level is different for each person. Although normal pressure is usually between 12-21 mm Hg, a person may have glaucoma even if the pressure is in this range. That is why an eye examination is very important. To detect glaucoma, the following tests should be performed regularly: visual acuity, visual field, pupil dilation, and tonometry.
Does Glaucoma Cause Blindness?
A diagnosis of glaucoma isn’t a guarantee of future vision loss. However, if you leave your glaucoma untreated, it will eventually lead to blindness. Glaucoma is the second leading cause of blindness in the United States, trailing only macular degeneration. Even with treatment, about 15 percent of people with glaucoma become blind in at least one eye. Early detection and treatment of glaucoma with our experienced team at Richens Eye Center is the best way to lower the pressure in the eye and stem vision loss.
What is recovery like after surgery for glaucoma?
Recovery varies depending upon the MIGS procedure used by your Richens Eye Center ophthalmologist when treating your glaucoma. In general, MIGS allows the patient to have a more rapid visual recovery than with traditional glaucoma surgery. There is far less chance of developing the complications common with traditional surgery. During your consultation with our team, we will discuss what you can expect during your recovery from the procedure we feel will fit the needs of your situation.
There isn’t any additional recovery from iStent implantation. You’ll recover as you normally would for cataract surgery, which is not a difficult recovery. As with stand-alone cataract surgery, you’ll need to refrain from strenuous activities such as sports and any heavy lifting. What you need to avoid is raising the blood pressure level to your face and eyes.
Schedule a Consultation
To schedule a consultation or to learn more information about glaucoma, contact us today at any of our three locations. We proudly serve St. George, UT, Mesquite, NV, and the surrounding areas. You can reach us at 435) 986-2020 for 161 W 200 N, ST., (435) 628-1112for 1930 W Sunset BLVD, and (702) 346-2950 for our Mesquite office.