Glaucoma

Screening and Treatment for Glaucoma at Our North Carolina Eye Centers

Glaucoma is the second leading cause of blindness in the United States (after macular degeneration) and affects approximately 3 million Americans. It is one of the more common diabetic eye diseases and is also seen in a disproportionately high percentage of African-Americans. As part of our comprehensive array of eye and vision care services, Cape Fear Eye Associates provides screening for glaucoma as well as the latest in glaucoma treatment. At our North Carolina eye and vision centers, we help patients with glaucoma protect their vision and prevent further progression of the disease.

 

About Glaucoma

The optic nerve is a bundled structure of over 1 million nerve fibers running between the eye’s retina and the brain. It carries visual information that the brain converts into images, enabling people to see objects in their field of vision. When vital optic nerve fibers are damaged or destroyed, vision can be significantly impaired.

Glaucoma is the umbrella term for the group of diseases that damage optic nerve fibers, resulting in a process known as optic neuropathy. Damage to the optic nerve is most commonly a result of increased intraocular pressure, or pressure inside the eye. Normally, fluid flows in and out of the eye on a regular basis, nourishing the ocular tissues. However, when fluid is blocked, it can build up inside the eye, causing increased pressure and often damaging the optic nerve. This condition describes the most common type of glaucoma: open-angle glaucoma.

In the early stages of open-angle glaucoma, there are no symptoms. However, as the disease slowly progresses, peripheral or side vision begins to deteriorate, and objects that would normally be seen out of the corner of the eye are missed. Eventually, tunnel vision develops. In its most advanced stage, glaucoma causes blindness.

Other Types of Glaucoma

While open-angle glaucoma is the most common form of the disease, there are other types: low-tension glaucoma, angle-closure glaucoma, and congenital glaucoma.

Low-Tension Glaucoma

In spite of normal or even low eye pressure, damage to the optic nerve sometimes occurs. Low-tension glaucoma refers to optic neuropathy that develops unaccompanied by any increase in intraocular pressure. Prescription medication, surgery, or both may be used to treat this form of glaucoma.

Angle-Closure Glaucoma

Angle-closure glaucoma is a condition in which irregularities in the iris keep the fluid in the eye from reaching the angle that normally allows it to flow out. Symptoms appear suddenly and are typically quite severe. They include a significant increase in eye pressure as well as pain, brow ache, nausea, redness of the eyes, and blurry vision. People who experience these symptoms should seek immediate medical attention. Angle-closure glaucoma rapidly causes blindness if not treated promptly.

Congenital Glaucoma

Some children are born with an abnormal angle inside the eye, inhibiting or slowing the outflow of fluid and increasing intraocular pressure. The eyes of affected children are usually cloudy, watery, and sensitive to light. Surgery is generally successful in correcting the condition and enabling patients to develop normal vision.

Screening

In order to screen for glaucoma, our ophthalmologists in North Carolina dilate the patient’s pupils and examine the interior eye structures to look for damage to the retina or optic nerve. Numbing eyedrops are applied and instruments are used to measure the pressure inside the eyes as well as the thickness of the corneas. Peripheral vision is also measured with a visual field test. These diagnostic procedures enable our ophthalmologists to assess whether or not a patient has glaucoma as well as how much vision damage, if any, has occurred.

Treatments

Depending on the type and severity of the condition, there are numerous treatments available to effectively treat glaucoma. All three of our eye and vision care centers in North Carolina provide glaucoma treatments, including prescription pills and eyedrops, laser surgery, and drainage implant surgery.

Prescription Medication

Whether in eyedrop or pill form, prescription medication for glaucoma is designed to reduce intraocular pressure and prevent damage to the optic nerve. Several types of drugs (e.g., beta blockers, carbonic anhydrase inhibitors, and alpha-agonists) effectively reduce pressure by decreasing the production of fluid in the eye, while some medications increase the amount of fluid that flows out of the eye (e.g., prostaglandin analogues).  Still others do a combination of both. The ophthalmologists of Cape Fear Eye Associates may prescribe one or more medications if you have glaucoma or show early symptoms.

Laser Trabeculoplasty (SLT, ALT)

Performed as an outpatient procedure, laser trabeculoplasty helps to drain the fluid that has built up in the eye. During this painless procedure, the eye is numbed with drops and a high-intensity laser is used to create larger holes in the spongy meshwork of the eye, allowing fluid to flow in and out with greater ease.   The full effect of the laser may be seen six weeks after this laser treatment. The procedure may need to be repeated in some cases to maintain optimal results.

Trabeculectomy

Trabeculectomy is a surgical procedure usually reserved for glaucoma patients for whom medication and laser therapy have not proved effective. During the procedure, the eye is numbed with a local anesthetic and a small incision is made in the white of the eye. A tiny portion of the spongy meshwork is removed to improve fluid drainage, resulting in reduced eye pressure. If this procedure does not reduce eye pressure to the optimal level, medication may be necessary.

Drainage Implant Surgery

Drainage implants are small silicone tubes that are surgically placed into the eye behind the cornea. They make it easier for fluid to flow out of the eye and into adjacent capillaries and tissues, where it is reabsorbed by the body. While drainage implants do not improve vision, they can be highly effective at reducing pressure in the eye, which helps to prevent damage to the optic nerve. Drainage implant surgery is typically reserved for more complex glaucoma cases. At our North Carolina eye care centers, we perform drainage implant surgery as an outpatient procedure.

Who Is at Risk?

According to the National Eye Institute, studies show that African-Americans are five times more likely to be afflicted by glaucoma and four times more likely to develop glaucoma-related blindness compared to Caucasians. People with increased eye pressure, optic nerve abnormalities, thin corneas, and hypertension are also at risk for glaucoma, as well as diabetics and people with a history of steroid use. Those at greatest risk for glaucoma are:

  • African Americans over age 40
  • All people over age 60
  • All people with a family history of glaucoma

What You Can Do

Whether you have glaucoma or are at risk of developing the disease, there are a few things you can do to decrease eye pressure in an effort to prevent optic nerve damage and vision loss. While none of these measures alone will necessarily prevent damage from occurring, when taken together and combined with medical treatment, they will increase your chances of preserving your vision.

Exercise

Exercise has been shown to reduce intraocular pressure as well as to improve blood flow to the retina and optic nerve. In particular, aerobic exercise done for at least 20 minutes, four times a week, with a heart rate increase of 20 to 25 percent, may reduce pressure in the eyes. If you have glaucoma or are at risk, make regular aerobic exercise such as walking, jogging, swimming, or biking a part of your health regimen. Always check with your physician before beginning any course of physical activity.

Avoid Caffeine

The effects of caffeine on intraocular pressure are clinically significant, suggesting that caffeine should be limited in glaucoma patients and high-risk individuals. Research suggests that the more caffeine a person consumes, the greater the increase in his or her intraocular pressure. Beverages such as coffee, cola, energy drinks, and black tea should be consumed in moderation or avoided altogether.

Have Your Eyes Examined Regularly

If you believe you are at risk for glaucoma, you should contact an ophthalmologist as soon as possible to schedule a comprehensive dilated eye exam. Early treatment of glaucoma improves the chances of preserving your vision. Glaucoma treatment can significantly slow or even halt the progression of the disease, but it cannot restore lost vision.

People currently being treated for glaucoma should take their medications regularly, see an ophthalmologist at least annually, and schedule an eye exam right away if any new symptoms develop.

Contact Cape Fear Eye Associates for Glaucoma Treatment in North Carolina

If you have glaucoma or believe you are at risk for glaucoma, our North Carolina eye and vision care centers can provide you with the necessary screening and treatment to protect your eyes from vision loss. To schedule a comprehensive dilated eye exam with one of our ophthalmologists, contact Cape Fear Eye Associates today.