Glaucoma is a disease of the optic nerve associated with elevated pressure inside the eye. Increased eye pressure is just one risk factor for developing glaucoma in addition to family history, ethnicity, age, nearsightedness, and other factors. Many glaucoma patients (about 30%) have no history of increased eye pressure.

 There are no symptoms associated with the most common form of glaucoma in the United States, open angle glaucoma, until late in the course of the disease. When patients are diagnosed with open angle glaucoma and vision loss has already occurred, this vision loss is irreversible. To prevent vision loss, early detection of glaucoma is important.

 If you have a family history of glaucoma or have a history of being a “glaucoma suspect” based on elevated eye pressure or the appearance of the optic nerve it is important to be examined regularly by an ophthalmologist.  Your ophthalmologist can perform an automated visual field examination which maps out peripheral vision. Optic nerve imaging can also be performed to look for thinning in the nerve fiber layer which makes up the substance of the optic nerve.

 When glaucoma is detected early in the course of disease, the prognosis is good. The goal of glaucoma treatment is lowering intraocular pressure to a level that is deemed safe for an individual patient. The three methods of lowering intraocular pressure are 1) topical medications, 2) laser trabeculoplasty and 3) glaucoma surgery. Typically topical medications and laser trabeculoplasty are tried before surgery but patients with disease that is already advanced may have a better outcome with initial surgery.

 Narrow angle glaucoma is less common in the United States but more common in Asia and in Asian Americans. It almost always occurs in farsighted patients, those with a plus in front of their glasses prescription. In this disease, the front part of the eye is crowded and the drainage angle where fluid drains out of the eye is blocked. It can occur suddenly or gradually and cause chronic scarring of the drainage angle. If it occurs suddenly, you will experience redness, eye pain (often an ache over the brow), and loss of vision. To lower the eye pressure in these cases it is often necessary to make a hole in the iris using a laser. Cataract surgery may also be necessary in these cases. Some patients found during examination to be at risk of narrow angle glaucoma (also known as angle closure glaucoma) may benefit from a preventive laser treatment of the iris.