Topic Overview
What is glaucoma?
Glaucoma is the name for a group of eye diseases that damage the
optic nerve. The optic nerve, which carries information from the eye to the
brain, is in the back of the eye. When the nerve is damaged, you can lose your
vision.
At first, people with glaucoma lose side (peripheral)
vision. But if the disease is not treated, vision loss may get worse. This can
lead to total blindness over time.
There are three types of
glaucoma.
- Open-angle glaucoma is the most common
form in the United States. In this type of glaucoma, the optic nerve is damaged
bit by bit. This slowly leads to loss of eyesight. One eye may be affected more
than the other. Sometimes much of your eyesight may be lost before you notice
it.
- Closed-angle glaucoma is less common.
About 10% of all glaucoma cases in the United States are closed-angle. In this
type of glaucoma, the colored part of the eye (iris) and the lens block
movement of fluid between the chambers of your eye. This causes pressure to
build up and the iris to press on the drainage system of the eye. (See a
picture of the
iris and lens.) A related type is sudden (acute) closed-angle glaucoma. It is
often an emergency. If you get this acute form, you will need medical care
right away to prevent permanent damage to your eye.
- Congenital glaucoma is a rare form of
glaucoma that some infants have at birth. Some children and young adults can
also get a type of the disease.
Finding and treating glaucoma early is important to
prevent blindness. If you are at high risk for the disease, be sure to get
checked by an eye specialist (ophthalmologist) even if you have no
symptoms.
Your risk for glaucoma rises after age 40. Race is also a factor. Blacks are more likely than whites
to get the disease. You are also at risk if you have diabetes or if a close
family member has had glaucoma.
What causes glaucoma?
Damage to the optic nerve is
often caused by increased pressure in the eye (intraocular pressure). This can
happen when extra fluid builds up in the eye, such as when the eye makes too
much fluid or does not drain well. But some cases of glaucoma aren't caused by
increased pressure. In these cases, the cause may not be found.
You can get glaucoma after an eye injury, after eye surgery, or because
of an eye tumor. Some medicines (corticosteroids) that are used to treat other diseases
may cause glaucoma.
What are the symptoms?
If you have open-angle glaucoma, the only symptom you are likely to notice
is loss of vision. You may not notice this until it is serious. That’s because,
at first, the eye that is not affected makes up for the loss. Side vision is
often lost before central vision.
Symptoms of closed-angle glaucoma can be mild, with symptoms like blurred
vision that last only for a short time. Severe signs of closed-angle glaucoma
include longer-lasting episodes of blurred vision or pain in or around the eye.
You may also see colored halos around lights, have red eyes, or feel sick to
your stomach and vomit.
In congenital glaucoma, signs
can include watery eyes and sensitivity to light. Your baby may rub his or her
eyes, squint, or keep the eyes closed much of the time.
How is glaucoma diagnosed?
Your doctor will ask
questions about your symptoms and do a physical exam. If your doctor thinks you
have glaucoma, you will be sent to an ophthalmologist for more tests. This may
take more than one visit.
An ophthalmologist or an optometrist can diagnose and treat glaucoma. An
optician cannot diagnose or treat this disease.
See your doctor if you notice blind spots in your vision or if
over time you are having more trouble seeing. It's also a good idea to be
checked for the disease if you have a family history of open-angle glaucoma,
are age 40 or older, have diabetes, or have other risk factors for glaucoma.
How is it treated?
Glaucoma is usually treated
with medicine such as eyedrops. Be sure to follow a daily schedule for your
eyedrops so that they work the way they should. You will likely need to take
medicine for the rest of your life. You may also need laser treatment or
surgery.
In adults, treatment can't bring back vision that has
been lost, but it can keep your vision from getting worse. Treatment aims to
stop more damage to the optic nerve by lowering the pressure in the eyes.
How do you cope with glaucoma?
Learning that you
have glaucoma can be hard, since much of your vision may be gone by the time it
is detected. With counseling and training, you can find ways to keep your
quality of life. You can use vision aids, such as large-print items and special
video systems, to help you cope with reduced eyesight. You can also create a
support group of people who can help with tough tasks.
Frequently Asked Questions
Learning about glaucoma: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Living with glaucoma: | |
Cause
Glaucoma is a
group of eye diseases that cause blindness by damaging the nerve cells located
in the back of the eye (the
optic nerve). In many cases this damage to the optic nerve is thought to be
caused in part by increased pressure in the eye (intraocular pressure, or IOP) that results from the buildup of fluid inside the eye.
But damage often occurs without increased IOP.
Get more
information on
eye anatomy and function.
Open-angle glaucoma
In
open-angle glaucoma (OAG), the cause of damage to the
optic nerve is not well understood. Normally, the shape of the front part of
the eye (anterior chamber) is maintained by a fluid called
aqueous humor, which is produced in and removed from
the eye to maintain a constant pressure. Sometimes the aqueous humor does not
drain out of the eye normally, but the reason this occurs is not known. When
this happens, fluid builds up inside the eye, causing increased pressure within
the eye (IOP). Most people with open-angle glaucoma have higher-than-normal
IOP. The increased pressure inside the eye damages the optic nerve, resulting
in progressive loss of vision.
But not all people with open-angle
glaucoma have increased pressure inside the eye. Estimates vary, but as many as
40% to 50% of people with OAG may occur without increased IOP, and most people
with elevated pressures will never get glaucoma.1, 2 The first signs of this type of
glaucoma, referred to as normal or low-tension glaucoma, are changes within the
eye (enlarged cup-disc ratio) rather than increased pressure in the eye and
side (peripheral) vision loss.
Closed-angle glaucoma
Closed-angle glaucoma (CAG) occurs when
an already narrow
drainage angle for fluid in the eye becomes blocked.
This may occur when:
- The colored part of the eye (iris) and the lens
block the movement of fluid between the chambers of the eye. The blockage of
fluid causes pressure to build up in the eye and makes the iris press on the
eye's drainage system (trabecular meshwork). (See a picture of
the iris and lens.) The increased pressure can cause damage to the optic nerve,
leading to vision loss and possible blindness.
- Defects in the iris
cause it to fall forward, blocking the drainage angle. Other factors, such as a
tumor, can force the iris forward, closing the drainage angle.
See a picture of
closed-angle glaucoma.
Congenital and infantile glaucoma
Glaucoma that
is present at birth (congenital glaucoma) or that develops in the first few years of life (infantile
glaucoma) is often caused by certain birth defects. A birth defect may develop
because of an infection in the mother during pregnancy, such as
rubella, or because of an inherited condition such as
neurofibromatosis.
Secondary glaucoma
Glaucoma may also develop as a
result of another condition. This is called secondary glaucoma.
- Glaucoma may develop after an eye injury, after
eye surgery, from the growth of an eye tumor, or as a complication of a medical
condition such as diabetes.
- Certain medicines (corticosteroids)
used to treat eye inflammation or other diseases may cause
glaucoma.
- Glaucoma may develop as a result of the breakdown and
flaking off of the colored material (pigment) found in the colored part of the
eye (iris). This type of secondary glaucoma is called pigmentary glaucoma.
Another flaky material (of unknown origin) that can deposit in the anterior
part of the eye can cause a similar type of secondary glaucoma called
exfoliation syndrome (pseudoexfoliation).
- A
cataract that causes swelling of the lens can cause
glaucoma (phacomorphic glaucoma). As the cataract develops, the eye's lens
thickens and closes the drainage angle, leading to an increase in intraocular
pressure (IOP). Medicines and possibly surgery may be used to relieve the
pressure. Removal of the cataract is usually necessary to treat phacomorphic
glaucoma.
Symptoms
Symptoms of
glaucoma vary according to the type of glaucoma you
have.
If you have
open-angle glaucoma (OAG), the only symptom you are
likely to notice is vision loss. Side (peripheral) vision is usually lost
before central vision.
You may not notice side vision loss until
it becomes severe because the less affected eye makes up for the loss. The loss
of sharpness of vision (visual acuity) may not become apparent until late in
the disease. By that time, significant vision loss has occurred.
Closed-angle glaucoma (CAG) may cause no apparent
symptoms or only mild symptoms. You may experience short episodes of symptoms
(subacute closed-angle glaucoma) that usually occur in the evening and are over
by morning, or you may have severe (acute) symptoms that require immediate
medical attention. Symptoms of closed-angle glaucoma usually affect only one
eye at a time and often include:
- Sudden, severe blurring of
vision.
- Severe pain. The pain may occur in the eye itself or in
certain areas immediately around the eye. See a picture of possible
areas of pain associated with CAG.
- Colored halos around
lights.
- Redness of the eye.
- Nausea and vomiting.
Symptoms of glaucoma present at birth (congenital glaucoma) and glaucoma that develops in the
first few years of life (infantile glaucoma) may include:
- Watery eyes. The baby may also appear to be
sensitive to light.
- An eye or eyes that look cloudy, indicating
that the clear front surface of the eye (cornea) has been
damaged.
- Eyes that look larger than normal because the eyeballs
have become enlarged as a result of high pressure. This symptom does not occur
in adults.
- Rubbing the eyes, squinting, or keeping the eyes closed
much of the time.
What Happens
Glaucoma
usually affects side (peripheral) vision first. If glaucoma is not treated,
vision loss will continue, resulting in total blindness over time. If glaucoma
is identified early and treated appropriately, good eyesight can usually be
maintained.
Open-angle glaucoma, the most common
type of glaucoma in the United States and Canada, usually affects both eyes at the same
time. But one eye may be affected more than the other. In open-angle glaucoma,
vision changes so slowly that much of your eyesight may be affected before you
notice the condition.
- Increased pressure and other factors gradually
damage the optic nerve.
- Side (peripheral) vision is affected first.
Blind spots from each side of the field of vision gradually meet, increasing
the area of blindness. Central vision, used for reading and seeing details, is
affected last.
- If untreated, open-angle glaucoma affects central
vision, leading to permanent total blindness.
Closed-angle glaucoma is less common
and usually affects only one eye at a time. About half of people who have
closed-angle glaucoma develop the condition in the other eye within 5
years.3
Acute closed-angle glaucoma
develops suddenly and is an emergency medical situation.
- The blockage of fluid drainage from the eye
causes a sudden rise of pressure in the eye.
- If not treated
promptly, the pressure in the eye leads to rapid, permanent damage to the
optic nerve.
- Severe and permanent vision loss can develop within
hours or days after symptoms develop.
You may have short episodes of closed-angle glaucoma.
Without treatment, these recurrent episodes can develop into an emergency
situation (acute closed-angle glaucoma) or become a long-term problem (chronic
closed-angle glaucoma). If chronic closed-angle glaucoma is not treated, you
will gradually lose your sight and you may become completely blind.
Glaucoma that is present at birth (congenital glaucoma) or that develops within the first few years of life (infantile
glaucoma) is rare. But it can be very serious. If congenital glaucoma is left
untreated, permanent blindness can develop rapidly.
Treatment for
any type of glaucoma may delay or prevent further vision loss, but it cannot
reverse vision loss that has already occurred. In a few rare cases of
congenital glaucoma, some reversal of the damage to the optic nerve has been
seen.
If you have glaucoma, normal use of your eyes (such as for
reading or watching television) will not speed up vision loss or make the
condition worse.
How significantly your life will be affected
depends on the severity of vision loss and your lifestyle. For information on
how to live with low vision, see the Home Treatment section of this
topic.
What Increases Your Risk
Factors that increase your
risk for
glaucoma vary according to the different types of
glaucoma.
Risk factors for
open-angle glaucoma (OAG) include:
- High pressure in the eyes. Open-angle glaucoma is
often associated with higher-than-normal pressure in the eyes (intraocular pressure, or IOP). But not all people with
open-angle glaucoma have increased pressure inside the eye. Estimates vary, but
as many as 40% to 50% of people with glaucoma have normal IOP, and most people
with elevated pressures will never get glaucoma.1, 2High pressure in the eyes is the one treatable risk factor for open-angle
glaucoma. But raised pressure in the eyes alone is not enough to diagnose
glaucoma and does not always require treatment. If you have elevated pressure
in your eyes but you do not have glaucoma, you will still need to be followed
carefully by your doctor.
- Age. The risk for glaucoma increases rapidly after
age 40.
- Race. Blacks are
more likely than whites to have glaucoma.
- Family history of glaucoma. Relatives of people
with open-angle glaucoma that is not caused by another condition (called
primary open-angle glaucoma) have about a 9 times greater risk of developing
glaucoma.4 Changes within the eye (enlarged cup-disc
ratio)—not increased pressure in the eye—may be the first sign of glaucoma in
these cases.
- Prior loss of vision in one eye from glaucoma. Damage in one eye from glaucoma is associated with a higher risk
of future damage in the other eye. If glaucoma is not treated, the risk that
damage will occur in the other eye within 5 years is about 29%.4
- Diabetes. People with diabetes tend to have higher
pressure in their eyes than those without the disease. People with diabetes are
also at risk for a type of secondary glaucoma where new blood vessels grow into
and block the drainage angle of the eye (trabecular meshwork).
Risk factors for developing
closed-angle glaucoma include:
- Race. People from East Asia or with East Asian
ancestry, as well as Canadian, Alaskan, and Greenland Inuit peoples, are more
likely than other people to develop closed-angle glaucoma.3
- Age. People over age 40 are at increased risk for
closed-angle glaucoma.
- Sex. Older women are more likely than older men to
develop closed-angle glaucoma.
- Birth defects. People who are born with narrow
drainage angles in their eyes may develop closed-angle
glaucoma if their pupils stay wide open (dilated). How much the pupil is
dilated and how long it stays dilated, causing an attack of closed-angle
glaucoma, varies from person to person.
- Farsightedness. People who are farsighted are more
likely to develop this condition because their eyes are smaller and the
drainage angles of the eyes tend to be narrower, allowing them to become
blocked more easily.
- Family history. People with a family history of
closed-angle glaucoma are more likely to develop the condition.
- Having closed-angle glaucoma in one eye. Having
closed-angle glaucoma in one eye increases the risk of developing the condition
in the other eye. About half of the people who have had acute closed-angle
glaucoma in one eye develop closed-angle glaucoma in the second eye within 5
years.3
Risk factors for developing
congenital glaucoma include:
- Infection in the mother during pregnancy. Babies
born to mothers who have certain viral infections such as
rubella during pregnancy are at a higher risk for
congenital glaucoma.
- Family history. About 10% of infants with
congenital glaucoma inherit the condition.5
When To Call a Doctor
Call 911 or other emergency services immediately if you have these symptoms of sudden (acute)
closed-angle glaucoma:
- Sudden, severe blurring of vision in one
eye
- Severe pain in the affected eye
- Redness of the
affected eye
- Nausea and vomiting
- Colored halos
surrounding light sources
Call your doctor if you:
- Notice blind spots in your
vision.
- Notice that over time you are having more difficulty
seeing.
- Have a family history of open-angle glaucoma, are age 40 or
older, and have not had an eye exam in more than a year. You may need to be
examined by an eye specialist (ophthalmologist or
optometrist) for signs of glaucoma.
- Have
glaucoma and develop symptoms of side effects from the glaucoma medicines
that you are taking. See the Medications section of this topic.
Watchful waiting
Watchful waiting is not appropriate if you have
symptoms of sudden (acute) closed-angle glaucoma. See the When to Call a Doctor
section of this topic.
If your doctor detects that you have a
slight increase in the pressure in your eyes (intraocular pressure, or IOP) and you have no other risk factors for glaucoma, your
doctor may not treat it right away. But you will need to have the pressure in
your eyes checked regularly, and you will need regular eye exams to make sure
you are not developing glaucoma.
Who to see
The following doctors can diagnose
glaucoma:
Decisions about treatment for glaucoma need to be made
with the help of an ophthalmologist.
An
optician cannot diagnose or treat glaucoma.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
A doctor evaluating
possible
glaucoma will take a
medical history and do a
physical exam. If glaucoma is suspected, you
will usually be referred to an eye specialist (ophthalmologist) for further testing and treatment.
Early detection and treatment of
open-angle glaucoma (OAG) are important for
controlling the condition and preventing blindness. Emergency treatment may be
needed for sudden (acute)
closed-angle glaucoma (CAG).
The
ophthalmologist will look for
signs of damage caused by glaucoma in the back of the
eyes to help determine whether the disease is present and to determine its
severity. Your medical history and the results of the following tests help
determine the severity of glaucoma:
- Ophthalmoscopy. Ophthalmoscopy is used
to examine the inside structures of the eye. In glaucoma, it is used to examine
the area where the optic nerve leaves the eye (optic disc).
Damage to the optic nerve related to glaucoma can be diagnosed by
ophthalmoscopy. People who have damage to the optic nerve related to glaucoma
will also have loss of side vision.
- Gonioscopy. Gonioscopy uses a special
lens to examine the drainage angles of the eyes. This is a very common test in
the initial evaluation of suspected glaucoma.
- Tonometry. Tonometry measures the
pressure in the eye (intraocular pressure, or IOP). Normal intraocular
pressure is usually between 10 and 21 millimeters of mercury (mm Hg). People
with glaucoma sometimes have above-normal IOP.
- Slit lamp exam. The slit lamp exam is
used to get a magnified view of all parts of the eye. Gonioscopy and tonometry
can be done as part of a slit lamp exam.
- Vision tests. Visual acuity testing
measures how clearly you are able to see details. Visual field testing (also
called
perimetry testing) can detect loss of side
(peripheral) vision and central vision that may indicate damage to the optic
nerve caused by glaucoma. This is the best test for evaluating damage caused by
open-angle glaucoma. Perimetry testing is also usually done as part of
follow-up exams for glaucoma. Perimetry testing is expensive and time-consuming
and thus is not used as a regular screening test or performed as often as other
tests for glaucoma.
- Cornea thickness. Tests such as ultrasound
pachymetry measure the thickness of the clear front surface of the eye (cornea). Cornea thickness, along with intraocular
pressure, helps determine your risk of developing glaucoma.6
After glaucoma is diagnosed, eye exams (including
tonometry and ophthalmoscopy) are done on a regular basis to monitor the
disease. Perimetry testing is usually done once a year after open-angle
glaucoma is diagnosed.
If you have glaucoma and have already
experienced a significant loss of vision, your doctor may also perform a
low-vision evaluation to help find ways you can make
the most of your remaining vision and maintain your quality of life.
Early detection
Because people with glaucoma may have normal
pressures in their eyes, measuring eye pressure (tonometry) should not be used
as the sole screening test for glaucoma. It should be combined with other tests
before glaucoma can be diagnosed.
If you are younger than 40 and have no known risk factors for glaucoma, the American Academy of Ophthalmology (AAO) recommends that you have a complete eye exam every 5 to 10 years. This includes tests that check for
glaucoma.7 The AAO suggests more frequent routine eye exams as you age.
The AAO also suggests that people who are at risk for glaucoma have complete eye exams according to the schedule below:
- Ages 40 to 54, every 1 to 3 years
- Ages 55 to 64, every 1 to 2 years
- Ages 65 and older, every 6 to 12 months
People at increased risk for glaucoma include those who:8
- Are middle-aged and older. The chance of getting glaucoma gets higher as you age, especially after age 40.
- Have a
family history of glaucoma.
- Have high eye pressure (high intraocular pressure).
- Are African Americans (for OAG),
East Asians, and people with East Asian ancestry (for CAG).
- Are
farsighted (greater risk of developing CAG).
- Have had an eye injury or eye surgery, such as
cataract surgery.
- Have
diabetes.
- Have high blood pressure (hypertension).
- Have been taking
corticosteroid medicines.
After reviewing all of the research, the U.S. Preventive
Services Task Force
(USPSTF) has not recommended for or against routine glaucoma
screening for all adults.9
Treatment Overview
Treatment for
glaucoma focuses on preserving eyesight by slowing the
damage to the nerve located in the back of the eye (optic nerve). In adults,
treatment cannot restore eyesight that has already been lost as a result of
glaucoma. But in certain children, some of the damage caused by
congenital glaucoma can be reversed.
Most treatment for glaucoma is directed at lowering the
pressure in the eyes (intraocular pressure, or IOP). Optic nerve damage can
occur at any level of eye pressure, even within the normal range. Lowering the
IOP often can help protect the optic nerve from further damage.
Treatment options include medicines, laser treatments, and surgery. In
the United States and Canada, treatment usually begins with medicines. When treatment with
medicines does not successfully lower pressure in the eyes, laser or surgery
treatments need to be considered. But in some instances it may be appropriate
to use laser or surgical treatments first, particularly in moderate to severe
cases. Studies indicate that treatment with medicine or surgery are both
effective, but the risks and benefits may differ depending on the type of
glaucoma, age, race, and other factors.10 If you have
glaucoma, ask your doctor about all the possible treatment options and which
treatments may be better for your particular condition.
Initial treatment
If you are diagnosed with
glaucoma, a
target eye pressure for each eye is established. The
target is based on the amount of damage to the optic nerve and the pressure in
the eyes (intraocular pressure, or IOP) at which the damage
occurred. The target eye pressure level is approximately 20% to 30% less than
the prior eye pressure. During treatment, the target eye pressure is adjusted
as needed to prevent damage to the optic nerve.
If you have high
IOP but no other signs of glaucoma, you will need to be checked regularly by an
eye specialist (ophthalmologist). If the pressure is high enough, you
may be treated with medicines to lower the pressure and prevent vision loss.
But the decision to start treatment in the absence of optic nerve damage is a
serious one, as it exposes you to the risks and expenses of long-term
treatment.
Treatment for
open-angle glaucoma may involve medicines (eyedrops)
that lower the pressure inside the eye, laser treatment, or other surgery. In
the United States and Canada, eyedrops that lower the IOP are usually tried first.
Decreasing eye pressure in open-angle glaucoma slows the progression of the
disease and helps prevent further vision loss. But other treatments (laser or
surgery) may sometimes be considered as an initial form of treatment if you
have moderate or severe open-angle glaucoma.
Closed-angle glaucoma can be an emergency situation
(acute closed-angle glaucoma), because blockage of fluid in the eye causes a
sudden increase in pressure, resulting in rapid damage to the optic nerve.
Acute closed-angle glaucoma usually causes significant pain in the eye. Acute
closed-angle glaucoma needs
immediate care, including medicines to lower IOP,
monitoring of the
drainage angle, and often surgery. If it is not
treated immediately, blindness can develop rapidly.
Congenital glaucoma almost always requires surgery to
correct the defect. Medicine may sometimes be used, but it usually does not
work over time.
If you have already experienced a significant
vision loss from glaucoma, your doctor will also conduct a
low-vision evaluation. The evaluation will help you
and your doctor find ways to make the best use of your remaining vision. It
also can include suggestions for counseling and training on dealing with
reduced vision.
Because glaucoma can lead to a significant loss of
vision before it is detected, learning that you have glaucoma can be difficult.
You may feel saddened and become
depressed. Your doctor can refer you to counselors who
specialize in helping people adjust to living with low vision.
Ongoing treatment
After you start treatment for
glaucoma, you will need regular eye exams by an
ophthalmologist. During these exams, the pressure
inside the eyes (intraocular pressure, or IOP) is usually measured. You
may need to see the doctor every day until the
target eye pressure is reached. After the target
pressure is reached, you may need to see the doctor every 3 to 6 months. The
ophthalmologist will examine your eyes for changes in the optic nerve that
indicate the disease is getting worse despite treatment and will adjust the
target eye pressure if needed.
If the pressure in the eye
continues to be high or if damage to the optic nerve gets worse despite
treatment with eyedrops, laser treatment may be done.
If you have
narrow
drainage angles, you are more likely to develop
closed-angle glaucoma. If you are diagnosed with
closed-angle glaucoma, you will need regular evaluations to check your drainage
angles and eye pressure. You may need laser treatment to prevent sudden closure
of the angle.
Medicines, usually eyedrops, are used to lower IOP
by either decreasing the amount of fluid produced by the eye or increasing the
amount of fluid that drains out of the eye. It is important to understand that
treatment for glaucoma will most likely continue for the rest of your life.
Home treatment can help you live with the effects of glaucoma.
You can use
vision aids and adaptive technologies, such as video
enlargement systems and large-print items, to help you function better with
reduced vision. You can develop a support network of people who can help you with
difficult tasks. And you can get counseling and training to help you cope with
reduced vision and maintain your quality of life.
Treatment if the condition gets worse
Surgery for
glaucoma usually is needed only if you continue to
lose vision and the pressure in your eyes (intraocular pressure, or IOP) cannot be lowered with medicines or laser treatment.
In some countries, such as Great Britain, surgery is done early in the disease
process.
Surgery may be done to make another opening for fluid to
leave the eye. Sometimes, surgery to destroy part of the eye that produces the
fluid (ciliary body) may also be used to decrease fluid production. This type
of surgery is usually done only for advanced cases of glaucoma in which other
forms of treatment have not been effective.
What to Think About
Glaucoma cannot be cured, but
the pressure inside the eye (intraocular pressure, or IOP) can be controlled
with medicines, surgery, or both. In adults, treatment for glaucoma cannot
restore eyesight that has been lost because of the condition, but it can
prevent further damage to the optic nerve and save remaining eyesight. In
certain children with congenital glaucoma, some of the optic nerve damage
caused by the disease can be reversed with treatment.
Medicines
(most often eyedrops) are usually needed to treat glaucoma. In most cases, they
have to be used every day for the rest of your life. Putting eyedrops in the
eye at specific times of the day may be inconvenient. For some people, eyedrops
can also cause discomfort. You will need to follow the prescribed daily
schedule for your eyedrops in order for them to work properly.
Unlike some chronic diseases in which failure to take medicines causes
noticeable symptoms, not using your glaucoma medicines as prescribed will not
usually cause any obvious symptoms. But it may cause slow, often unnoticed loss
of eyesight that is permanent and that could eventually lead to
blindness.
Because glaucoma can't be cured and treatment does not
always prevent further loss of vision, people may try alternative
unproven treatment methods, such as acupuncture or
marijuana. But most of these alternative treatments either have not been
studied or have not been proven to work. Such treatments may be expensive, and
some can be hazardous to your health.
Prevention
Most of the risk factors (such as age,
race, and family history) for
glaucoma are beyond your control. If you are under age 40 and have no known risk factors, you need to have an eye exam that includes tests for glaucoma every 5 to 10 years.7 These tests may be done by an
optometrist or an
ophthalmologist. If there is a history of glaucoma in
your family or if you have other risk factors for glaucoma, talk with your
doctor about having more frequent exams. If you are at increased
risk, you need to have regular eye exams by an ophthalmologist.
Home Treatment
The success of treatment for
glaucoma depends on your learning about the disease,
using your medicines as prescribed, and getting routine checkups to monitor the
condition and prevent complications. By doing so, you can decrease your chance
of losing your eyesight.
- Use your glaucoma medicines as prescribed by your doctor. Use color-coded bottle caps on your medicines to help you
remember when to take them. If you need reminders for using your medicines, use
alarm clocks or watches, notes on mirrors or tables, and other cues. If you
have problems using your medicine according to the prescribed schedule, talk
with your doctor. Some
tips to decrease the side effects of glaucoma medicines, such as the proper way to insert eyedrops, may help you use
your medicines as prescribed. If you notice side effects from your glaucoma
medicine, notify your doctor. Your medicine may need to be
changed.
- Check with a doctor before taking any nonprescription medicines. If you have narrow
drainage angles and are at risk for
closed-angle glaucoma, your doctor may warn you about
medicines that widen (dilate) the pupil. When the pupil dilates, the drainage
angles can become blocked, causing closed-angle glaucoma. There are some
medicines that you need to avoid, such as certain
antihistamines and motion sickness medicines. Also, tell your eye specialist
what other prescription medicines you are taking. Make sure all your doctors know that you have glaucoma.
- Carry a wallet card or other identification that states that you have glaucoma. The card needs to list all medicines you are
taking, including glaucoma medicines.
Living with reduced vision
Reduced vision from
glaucoma can affect a person's life in many ways. How much you will be
affected depends on the severity of your vision loss, what kinds of activities
you do, and your lifestyle. Work with your doctor to find ways to make the best
use of your remaining vision. You can use
vision aids such as video enlargement systems and
large-print items, develop a support network, and receive counseling and
training to help you cope with reduced vision and maintain your quality of
life.
Because glaucoma often leads to a significant loss of
vision, learning that you have glaucoma can be difficult. You may feel anger or
fear, or you may feel saddened and become
depressed. These feelings are perfectly normal. If you
need help in dealing with them, talk to your doctor and to your family and
friends. Your doctor can also refer you to counselors who specialize in helping
people adjust to living with low vision. Because glaucoma is a lifelong
disease, it may be helpful for you to join a support group for people who have
the disease.
Glaucoma: Living With Reduced Vision
For additional information on support groups,
products, and services related to glaucoma and living with low vision, see the
Other Places to Get Help section of this topic.
Medications
Medicines to lower the pressure inside
the eye (intraocular pressure, or IOP) are used
to treat all types of
glaucoma. They work either by reducing the amount of
fluid (aqueous humor) that is produced by the eye or by
increasing the amount of fluid that drains out of the eye. These medicines may
be given as eyedrops; as pills; in liquid form by mouth; or, in emergency
situations, through a vein. In most cases, eyedrops are used first.
In a sudden (acute) attack of
closed-angle glaucoma, medicines may be used to lower
the pressure in the eye. Medicines that close (constrict) the pupil may be used
to open the
drainage angle. If medicines lower the eye pressure
after an episode of acute closed-angle glaucoma, laser treatment is usually
done soon afterwards to prevent such an episode from occurring again. If the
medicines do not lower the pressure in the eye, laser treatment will need to be
done immediately.
In
congenital glaucoma, medicines may be used to reduce
the pressure in the eyes and decrease the cloudiness of the clear front surface
(cornea) of the eye. Medicines usually do not work over a long period of time
and are usually used only until surgery can be done.
In the media,
much has been said about the possibility of using
marijuana to treat glaucoma. Inhaled marijuana smoke
has been shown to result in an average 25% reduction in intraocular pressure
(IOP), but the effect lasts only for about 3 to 4 hours. Also, not all people
who use marijuana have this reduction in IOP; it only occurs in about 60% to
65% of users. The smoke also has toxic effects on other parts of the body,
particularly the lungs, and substances in the smoke cause changes in mental
state. The amount of marijuana a person needs to smoke to keep eye pressure
down would cause significant side effects. Because of these toxic and
psychoactive effects, along with the short duration of the beneficial effect of
lowering pressure in the eye, marijuana is considered a poor treatment option
and is not recommended for glaucoma.11
Medication Choices
Medicines used to treat glaucoma lower the pressure in
the eyes (intraocular pressure, or IOP) by either decreasing the amount of
fluid produced by the eyes or increasing the amount of fluid that drains out of
the eyes.
Medicines that decrease the amount of fluid produced by
the eye include:
- Beta-blockers (such as Betagan,
Betimol, Betoptic, Ocupress, OptiPranolol, and Timoptic).
- Adrenergic agonists (such as Alphagan, Epifrin,
Iopidine, and Propine).
- Carbonic anhydrase inhibitors (such as Azopt, Diamox,
Neptazane, and Trusopt).
- Hyperosmotics (such as Osmitrol,
Osmoglyn, and Ureaphil).
Medicines that increase the amount of fluid that drains
out of the eye include:
- Cholinergics (such as Carboptic, Isopto
Carpine, Phospholine, Pilocar, Pilopine, and
Pilostat).
- Adrenergic agonists (such as Alphagan,
Epifrin, Iopidine, and Propine).
- Prostaglandin analogs (such as Lumigan, Travatan, and Xalatan).
Some medicines have two different medicines mixed into
one bottle. Examples include Cosopt, which contains both a carbonic anhydrase
inhibitor and a beta-blocker, and Combigan, which contains both an adrenergic
agonist and a beta-blocker.
What to Think About
When medicines are used to treat
glaucoma, the goal is to prevent further damage to the optic nerve by lowering
the pressure in the eyes. The level of pressure in the eye needed to damage the
optic nerve varies from one person to another. For this reason, a single
target eye pressure cannot be used for everyone. Your
target pressure may need to be adjusted if the optic nerve shows further damage
despite treatment.
When glaucoma has already caused vision loss,
further vision loss may develop even after the pressure in the eye is lowered
to the normal range with medicine.
In most cases, medicines used
to treat glaucoma must be continued daily for the rest of your life. Putting
eyedrops in the eye at specific times of the day may be inconvenient. Eyedrops
may also cause discomfort. You need to follow the prescribed daily schedule for
your eyedrops in order for them to work properly.
- Discuss the goals of treatment, how long the
medicine will be tried, and the possible side effects with your health
professional. Eye medicines can cause symptoms throughout the body. Report side
effects to your eye doctor.
- Knowing how to correctly insert your
eyedrops can make the medicine work better and may help you avoid side effects.
A medicine card stating which medicines need to be taken at different times of
the day can be helpful in reminding you to take medicines. Use multicolored
bottle caps to help you tell different medicines apart.
- You will
need follow-up visits with your doctor shortly after starting a
new medicine to determine whether it is working as well as it should be and
to discuss any side effects or medicine schedule problems.
Medicines for glaucoma can be expensive. Some
cost-saving tips such as using a measured-dose
dispenser may help.
Let all your doctors know that
you are taking glaucoma medicines. Other medicines that you are taking may need
to be adjusted or stopped to prevent side effects.
While there are
fewer complications from the new surgical procedures for glaucoma, medicine
treatment still usually has fewer side effects than surgery. Many people who
use glaucoma medicines may never need surgery for glaucoma.
Surgery
Surgery is not always necessary to treat
glaucoma. Medicines can often control the pressure in
the eyes, preventing further vision loss and blindness. Medicine will usually
be tried first before surgery is considered.
Doctors can use
either a surgical cutting tool or a very focused beam of light, called a laser,
to perform surgery for glaucoma.
Laser surgery is usually tried first when glaucoma
medicines do not lower the pressure in the eyes (intraocular pressure, or IOP). If laser surgery does not help, your doctor may try
conventional surgery.
Surgery may be needed for:
- Sudden (acute)
closed-angle glaucoma. Laser treatment can create an
opening in the colored part of the eye (iris) that will let fluid drain from
the eye. People who have had closed-angle glaucoma in one eye usually need to
have laser treatment on the other eye to prevent the same condition from
developing. Also, people who have narrow
drainage angles may need laser treatment to prevent
acute closed-angle glaucoma. If laser treatment is not successful, then
conventional surgery, such as surgical iridectomy or trabeculectomy, would be
needed.
- Open-angle glaucoma, if the pressure in
the eyes stays high or if damage to the optic nerve continues despite
medication. Laser treatment may be needed early on to treat open-angle
glaucoma, especially in people who have very high intraocular pressure and
severe glaucoma. You may have laser surgery before you try medicine. In some
cases, early surgery in open-angle glaucoma may be more effective than eyedrops
at reducing the pressure in the eyes and preventing
blindness.
- Infants with
congenital glaucoma. They may need surgery as soon as
possible to prevent blindness.
The primary goal of surgery for glaucoma is to preserve
eyesight by:
- Maintaining the health of the optic
nerve.
- Reducing the pressure in the eyes by opening blocked
drainage angles or creating a new opening that fluid (aqueous humor) can
flow through to leave the eye.
In some cases surgery may be done to relieve pain caused by
glaucoma.
Surgery Choices
There are three basic types of surgery for glaucoma in
adults.
Surgery to increase drainage of fluid from the eye
This type of surgery involves making a trapdoor that allows fluid to
drain from the eye. The surgeon can use either a laser or a surgical cutting
tool to do this. In severe glaucoma, surgery also may involve putting in a
filtering device (seton), usually made of plastic, that drains fluid away from
the front part of the eye to a place where it can drain out of the eye. These
procedures are used to treat open-angle glaucoma and long-term (chronic)
closed-angle glaucoma.
- Trabeculectomy
removes a piece of tissue to allow fluid to drain from the
eye.
- Tube-shunt surgery (seton glaucoma surgery) places a
tube in the eye to allow fluid to drain.
- Laser trabeculoplasty burns tissue to create an
opening that allows fluid to drain from the eye.
- Laser sclerostomy removes a piece of the white part of the eye to allow fluid
to drain.
Surgery to prevent closure of the drainage angle
Both laser and conventional surgeries can be used to prevent closure of
the drainage angle. These procedures involve making a new opening in the
colored part of the eye (iris) that allows fluid to flow through the eye. They
are used to treat sudden (acute) closed-angle glaucoma and will prevent
closed-angle glaucoma in people who have narrow drainage angles. Laser
iridotomy can usually be done instead of surgical iridectomy. But some people
with complicated or severe glaucoma may need to have surgical iridotomy.
Surgery to decrease the amount of fluid produced in the eye
When other surgery fails to improve the flow of fluid from
the eye, procedures to destroy the part of the eye that produces fluid (ciliary
body) can be done. These procedures are also used when scar tissue has formed
after a previous surgery.
Destroying the ciliary body decreases
the amount of fluid produced in the eye, reducing the pressure in the eye.
Procedures that decrease fluid in the eye are only used for people with severe
glaucoma that has not gotten better after they have tried medicines or other
forms of surgery.
Surgery for congenital glaucoma
For congenital
glaucoma, there are two slightly different procedures that both attempt to open
the drainage angle directly. They are equally successful in children, but they
are not used for adults. If these procedures fail in a child, then
trabeculectomy or tube-shunt (seton glaucoma) surgery may be tried.
What to Think About
Clouding of the lens (cataract) can develop after surgery for glaucoma and
is one reason that surgery is not usually used first to treat open-angle
glaucoma.
Cataracts may occur in people who also have glaucoma. This commonly occurs in older people. Surgery to remove the cataract may be
done at the same time as surgery for glaucoma. If
surgery for glaucoma and a cataract are done at the
same time, you may notice improved eyesight after surgery.
The
decision whether or not to have surgery is often more difficult in glaucoma
than in many other conditions because:
- In many instances, the person is not in pain
and often does not notice any vision loss.
- Surgery often causes a
person's eyesight to get worse immediately after surgery. Vision may be
affected for weeks or months after surgery. For some people, their eyesight is
never as good as it was before the surgery. Surgery is not a complete cure for
glaucoma. But surgery can decrease the chance of losing even more eyesight
later on.
- Not everyone who has laser surgery will have lower
intraocular pressure after the surgery. For some people, the lower pressure
will last only a few years. Others may have an increase in their eye pressure.
Certain types of open-angle glaucoma respond better to laser surgery than
others.
- The effects of some laser treatments are not long-lasting.
Repeat laser treatments, medicines, or other surgeries may be needed later
on.
As with any other surgery, you and your doctor should
make the decision to operate based on the risks and benefits of having the
surgery. One factor to consider is
which eye should be operated on first. There are other
questions about glaucoma surgery that you should
discuss with your doctor before making a decision.
Procedures to destroy the structures in the eye that produce fluid
(cyclodestructive procedures) are usually used when other treatments, including
other surgeries for glaucoma, have failed.4 Several
treatments over time can destroy too much of the ciliary body, causing too
little fluid to be produced. This can cause the eyeball to soften and lead to
clouding of the lens (cataract).
Other Treatment
Glaucoma causes blindness by damaging the nerve cells
located in the back of the eye and often occurs without increased pressure in
the eye. Many doctors believe glaucoma is a neurodegenerative disease, rather
than just a disease of high intraocular pressure. There is interest in
treatments that help protect the nerve cells in the eye from damage caused by
glaucoma (neuroprotective therapy). Although a number of neuroprotective
therapies are being investigated, none has yet been proved to be both safe and
effective in the treatment of glaucoma.
Because glaucoma can't be
cured and treatment does not always prevent further loss of vision, people may
try alternative
unproven treatment methods, such as acupuncture or
marijuana. Some alternative or complementary treatments have been tried for
glaucoma, but most either have not been studied or have not been proved to
work. Some unproven treatment methods for glaucoma can be expensive and
time-consuming.
Other Places To Get Help
Organizations
| American Optometric Association
(AOA) |
| 243 North Lindbergh Boulevard |
| St. Louis, MO 63141-7881 |
| Phone: | 1-800-365-2219 |
| Web Address: | www.aoanet.org |
| |
The American Optometric Association (AOA), which is a
national organization of optometrists, can provide information on eye health
and eye problems. |
|
| EyeCare America |
| P.O. Box 429098 |
| San Francisco, CA 94142-9098 |
| USA |
| Phone: | 1-877-887-6327 toll-free |
| Fax: | (415) 561-8567 |
| Email: | pubserv@aao.org |
| Web Address: | www.eyecareamerica.org |
| |
EyeCare America is a public service program of the
Foundation of the American Academy of Ophthalmology that raises awareness about
eye diseases and eye care. This site provides educational materials and
information about how to get medical eye care. |
|
| Glaucoma Research Foundation
|
| 251 Post Street |
| Suite 600 |
| San Francisco, CA 94108 |
| |
| Phone: | 1-800-826-6693
|
| Fax: | (415) 986-3763 |
| TDD: | |
| Email: | question@glaucoma.org |
| Web Address: | www.glaucoma.org |
| |
The Glaucoma Research Foundation is a non-profit organization dedicated to finding a cure for glaucoma. Their website provides education about glaucoma and how to live with and treat the disease. |
|
| Lighthouse International |
| 111 East 59th Street |
| New York, NY 10022-1202 |
| Phone: | (212) 821-9200
1-800-829-0500 |
| Fax: | (212) 821-9707 |
| TDD: | (212) 821-9713 (TTY) |
| Web Address: | www.lighthouse.org |
| |
Lighthouse International is a not-for-profit
organization dedicated to helping people of all ages to overcome vision
impairment through vision rehabilitation services, education, research, and
advocacy. |
|
| National Eye Institute, National Institutes of
Health |
| Information Office |
| 31 Center Drive MSC 2510 |
| Bethesda, MD 20892-2510 |
| Phone: | (301) 496-5248 |
| Email: | 2020@nei.nih.gov |
| Web Address: | www.nei.nih.gov |
| |
As part of the U.S. National Institutes of Health, the National Eye
Institute provides information on eye diseases and vision research.
Publications are available to the public at no charge. The Web site includes
links to various information resources. |
|
| National Glaucoma Research (from American Health Assistance Foundation)
|
| 22512 Gateway Center Drive |
| Clarksburg, MD 20871 |
| |
| Phone: | 1-800-437-2423
|
| Fax: | (301) 948-4403 |
| TDD: | |
| Email: | info@ahaf.org |
| Web Address: | www.ahaf.org/glaucoma |
| |
The American Health Assistance Foundation works to find cures, preventions and improved treatments for glaucoma. Their Web site provides information about glaucoma and how it is treated. |
|
References
Citations
- Shah R, Wormald R (2009). Glaucoma, search date November 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Trobe JD (2006). Principal ophthalmic conditions.
Physician's Guide to Eye Care, 3rd ed., chap. 6, pp.
107–111. San Francisco: American Academy of Ophthalmology.
- American Academy of Ophthalmology (2005).
Primary Angle Closure (Preferred Practice Pattern). San
Francisco: American Academy of Ophthalmology. Also available online:
http://www.aao.org/ppp.
- American Academy of Ophthalmology (2005).
Primary Open-Angle Glaucoma, Limited Revision (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology.
Also available online: http://www.aap.org/ppp.
- Kipp MA (2003). Childhood glaucoma. Pediatric Clinics of North America, 50(1): 89–104.
- Gordon MO, et al. (2002). The ocular hypertension
treatment study: Baseline factors that predict the onset of primary open-angle
glaucoma. Archives of Ophthalmology, 120(6):
714–720.
- American Academy of Ophthalmology (2010). Comprehensive Adult Medical Eye Evaluation, Preferred Practice Pattern. San Francisco: American Academy of Ophthalmology. Available online: http://one.aao.org/CE/PracticeGuidelines/PPP.aspx.
- American Academy of Ophthalmology (2010). Primary Open-Angle Glaucoma Suspect (Preferred Practice Pattern). San Francisco. American Academy of Ophthalmology. Also available online: http://aao.org/ppp.
- U.S. Preventive Services Task Force (2005). Screening
for glaucoma: Recommendation statement. Annals of Family Medicine, 3(2): 171–172. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsglau.htm.
- Lichter PR, et al. (2001). Interim clinical outcomes
in the Collaborative Initial Glaucoma Treatment Study comparing initial
treatment randomized to medications or surgery. Ophthalmology, 108(11): 1943–1953.
- American Academy of Ophthalmology (2003). Marijuana in the treatment of glaucoma (complementary therapy assessment). San Francisco: American Academy of Ophthalmology. Also available online: http://one.aao.org/CE/PracticeGuidelines/Therapy_Content.aspx?cid=9871fa42-cf40-4c1f-b05c-c816d5f93126.
Other Works Consulted
- American Academy of Ophthalmology (2007).
Vision Rehabilitation for Adults (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also
available online:
http://one.aao.org/CE/PracticeGuidelines/PPP.aspx.
- Trobe JD (2006). The red eye. Physician's Guide to Eye Care, 3rd ed., chap. 4, pp. 47–51.
San Francisco: American Academy of Ophthalmology.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Christopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology |
|---|
| Last Revised | August 2, 2011 |
|---|
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