What is glaucoma? Glaucoma is the name given to a group of eye diseases that lead to damage of the optic nerve (the bundle of nerve fibers that carries information from the eye to the brain), which can then lead to vision loss and possibly blindness. Optic nerve damage usually occurs in the presence of high eye pressure (also called intraocular pressure, IOP); however, it can occur with normal or even less than normal eye pressure. The only treatment for glaucoma is to lower the IOP. If you think about the inside of the eye like a drain and a faucet, and using this analogy, high IOP is related to an imbalance between the amount of fluid made inside the eye and the amount of fluid the eye can drain. This fluid is called the aqueous and when we consider various treatment options to lower IOP, we can either decrease the amount of aqueous the eye makes or increase the drainage of aqueous from inside the eye.
Are there different forms of glaucoma? There are two main forms of glaucoma: (1) open-angle glaucoma- the most common form, affecting approximately 70-90% of individuals; and (2) angle-closure glaucoma. There are also several other subsets of glaucoma, including: normal-tension, congenital, juvenile, and secondary glaucoma.
Who is at risk for developing glaucoma? The exact cause of Glaucoma still eludes scientists. Because most forms of glaucoma develop slowly and silently, everyone, especially those at high risk, should be sure to have their eyes examined on a regular basis, preferably every one to two years or as directed by a doctor.
· People over the age of 40. While glaucoma can develop in younger patients, it occurs more frequently as we get older. · People who have a family history of glaucoma. Glaucoma appears to run in families. The tendency for developing glaucoma may be inherited. However, just because someone in your family has glaucoma does not mean that you will necessarily develop the disease. And likewise, just because you have no family history also doesn’t mean that you aren’t at risk for developing the disease. · People with abnormally high intraocular pressure (IOP). High IOP is the most important risk factor for glaucoma damage. · People of African, Latino, and Asian descent. People with African and Latino ancestry have a greater tendency for developing primary open-angle glaucoma than do people of other races. People of Asian descent are more prone to develop angle- closure glaucoma and normal-tension glaucoma. · People who have: o Diabetes o Myopia (nearsightedness) o Regular, long-term steroid/cortisone use o A previous eye injury o A family history of glaucoma o Extremely high or low blood pressure
How do I know if I have glaucoma? Your doctor will review your medical history and conduct a comprehensive eye examination. He or she may perform several tests, including: Measuring intraocular pressure (tonometry) Testing for optic nerve damage with a dilated eye examination and imaging tests Checking for areas of vision loss (visual field test) Measuring corneal thickness (pachymetry) Inspecting the drainage angle (gonioscopy) I was told I have “pre-glaucoma”– what does that mean? This is another way of saying that you are a glaucoma suspect. A glaucoma suspect is someone who might have glaucoma but it's too early to tell. This term includes patients with ocular hypertension (persons with elevated intraocular pressure but no detectable disc or visual field damage), and patients with large cup/disc ratios and normal visual fields who may or may not have early normal-tension glaucoma. If you have been diagnosed as a glaucoma suspect, it is important that you see your eye care specialist regularly to monitor your condition so that you do not experience any unexpected loss of vision. What is normal eye pressure? Unfortunately, the answer is not any single number. While the average eye pressure is approximately 15, the range of normal eye pressure is much larger. About 90 percent of people will fall between a pressure of 10 and 21. Even so, this does not mean that if you have a pressure of 22 or higher it is abnormal. Every individual and every eye is different. There are many patients with pressures in the mid-20s who do not have glaucoma, and they can be followed with routine eye examinations by their eye care specialist. There are also patients who have been diagnosed with glaucoma and yet, even though their pressure may be within the “normal range,” they still experience worsening of their glaucoma. It is important that you see an eye care specialist to receive a thorough examination and determine if your eye pressure is problematic.
Is there a cure for glaucoma? Unfortunately, glaucoma cannot be cured or prevented. But you can take preventive measures to stop further damage to your eye sight. The sooner you get it diagnosed, the better. While vision loss due to glaucoma cannot be recovered, further vision loss can hopefully be prevented with appropriate treatment. Early detection, ongoing treatment and monitoring are key factors to limiting damage from the disease, which lasts a lifetime.
What are the most common treatments for glaucoma? Although glaucoma cannot be cured, it can be controlled. Prescription eyedrops, oral medications, laser treatment, surgery or a combination of any of these are used to prevent or slow further damage from occurring. With any type of glaucoma, regular eye examinations are very important to detect progression and alter treatments to prevent vision loss.
Eyedrops: Glaucoma treatment often starts with prescription eyedrops. These can help decrease eye pressure by improving how fluid drains from your eye or by decreasing the amount of fluid your eye makes. Depending on how low your eye pressure needs to be, more than one eyedrop may need to be prescribed until your doctor finds the combination that works best for you. It is important to take your medications regularly and exactly as prescribed. Patients who are not compliant with taking eyedrops will not be successful controlling glaucoma and eye pressure with eyedrops.
Oral medications: If eyedrops alone don't bring your eye pressure down to the desired level, your doctor may also prescribe an oral medication, usually a carbonic anhydrase inhibitor. These pills, which have more systemic side effects than eyedrops, also serve to lessen the production of fluid inside the eye. These medications are usually taken from two to four times daily.
Laser Treatment: If eyedrops and medications are not working effectively, most patients are a candidate for laser treatments. Laser surgery has become increasingly popular as an intermediate step between drugs and other more invasive glaucoma surgeries. The following techniques are intended to improve the drainage of fluid within the eye, thereby lowering the risk of glaucoma progression. SLT: The most common type performed for open-angle glaucoma is called “Selective Laser Trabeculoplasty.” The laser beam (a high energy light beam) is focused upon the eye's drain. Contrary to what many people think, the laser does not burn a hole through the eye. Instead, the eye's drainage system is changed in very subtle ways so that aqueous fluid is able to pass more easily out of the drain, thus lowering eye pressure. This procedure takes between 10 and 15 minutes, is painless, and can be performed in the doctor's office. Your doctor will likely check your eye pressure 1-2 hours following laser surgery, but then you may go home and resume your normal activities following surgery. After this procedure, many patients respond well enough to be able to avoid or delay surgery. While it may take a few weeks to see the full pressure-lowering effect of this procedure, during which time you may have to continue taking your medications, many patients are eventually able to discontinue some of their medications. This, however, is not true in all cases. Your doctor is the best judge of determining whether or not you will still need medication. Complications from laser are minimal, which is why this procedure has become increasingly popular and many doctors are recommending the use of laser much sooner for patients.
LPI: You may need a procedure called a “Laser Peripheral Iridotomy” in which the doctor creates a small opening in your iris using a laser. This allows fluid (aqueous humor) to flow from behind the iris directly to the anterior chamber of the eye, relieving eye pressure. This is most common for patients with “Anatomically Narrow Angles” or “Acute angle-closure glaucoma.” This procedure takes between 10 and 15 minutes, is painless, and is performed in an outpatient surgery center. Your doctor will likely check your eye pressure 1-2 hours following laser surgery, but then you may go home and resume your normal activities immediately following surgery.
Minimally invasive glaucoma surgery (MIGS). Your doctor may suggest a MIGS procedure to lower your eye pressure. MIGS can be thought of in a few broad categories, either enhancing fluid outflow using the eye’s inherent drainage system (GATT, Kahook Dual Blade Goniotomy, Trabectome, iStent, OMNI), shunting fluid to the outside of the eye (XEN Gel Stent) or decreasing production of fluid within the eye (ECP). These procedures generally require less immediate postoperative care and have less risk than some of the traditional more invasive glaucoma surgeries. The traditional glaucoma surgeries (trabeculectomy and glaucoma drainage devices), while very effective, are associated with risks such as double vision, devastating eye infections, exposure of a drainage implant, swelling of the cornea, and excessively low IOP. Although these risks are relatively infrequent, they make most surgeons delay glaucoma surgery until all other less invasive treatment options are maximized (medications and laser treatment) and the patient has definitive glaucoma worsening.
The procedures have been developed in recent years to reduce some of the complications of most standard glaucoma surgeries, and work by using microscopic-sized equipment and tiny incisions. Fortunately, the revolution has allowed us to change our approach to surgical glaucoma for many patients. The main theme and priority of is patient safety. While no surgery is without risk, provide improved safety while usually providing mild-to-moderate lowering. In addition, MIGS procedures are often combined with cataract surgery requiring no different post op care for the patient.
Does insurance cover glaucoma evaluations or treatments? Because glaucoma is an eye disease, evaluation and treatment for the condition is usually covered by medical health insurance plans, but not vision health insurance plans. Under the Affordable Care Act (ACA, also known as Obamacare), all qualified health plans must cover eye diseases such as glaucoma.
What is a cataract? Inside our eyes, we have a natural lens. This lens bends (refracts) light rays that come into the eye to help us see. The lens should be clear; however, if you have a cataract the lens has become cloudy. It is like looking through a foggy or dusty car windshield. Things look blurry, hazy, or less colorful with a cataract.
In a healthy human eye, light rays travel into the eye through the pupil, they pass through the clear lens and focus onto the retina.
In an eye with a cataract, the light rays scatter throughout the eye instead of focusing precisely on the retina, causing distorted vision.
What are the symptoms of a cataract? Cataracts are the most common reason people start to lose vision. Most age-related cataracts develop gradually. As a result, some patients do not notice changes in their vision right away. However, over time most patients will begin to notice some, or all, of these symptoms:
Blurry or hazy vision
Seeing double or ghost images- when you see two images instead of one
Being extra sensitive to bright light, especially when outdoors
Having trouble seeing well at night, or needing more light when you read
Colors aren’t as bright- may appear dull, faded, or yellow instead
What causes a cataract? Though there are other risk factors for cataracts, aging is the most common cause. This is due to normal eye changes that begin around age 40, when proteins in the lens start to break down causing the lens itself to discolor. Not until around age 60 will people usually start to notice some increasing symptoms of their cataract. Most age-related cataracts develop gradually. However, other types of cataracts can develop more quickly, such as those in younger people or those in people with diabetes. Doctors unfortunately cannot always predict how quickly a person’s cataract will develop. Besides age, other cataract risk factors include:
having parents, brothers, sisters, or other family members who have cataracts
having certain medical problems such as diabetes, high blood pressure, or obesity
taking certain medications such as steroids
having had an eye injury, eye surgery, or radiation treatments on your upper body
having spent a lot of time in the sun, especially without sunglasses that protect your eyes from damaging ultraviolet (UV) rays
Who needs cataract surgery? If your cataract symptoms are not very bothersome, you do not have to have surgery right away. A new eyeglass prescription may help you see better for now. However, as your cataract matures even a new prescription will not help. You should consider cataract surgery when your cataracts are making it difficult for you to do things you want or need to do (like reading, watching TV, driving, golfing, etc.). Your doctor will help you decide when the right time is for your cataract surgery. If you are not ready for cataract surgery, this is what we recommend in the meantime:
Have an eye exam every year if you're older than 65, or every two years if younger.
Get the right eyeglasses or contact lenses to help correct your vision as much as possible
Protect your eyes from UV light with sunglasses and a hat when outdoors.
If you smoke, quit. Smoking is a key risk factor for cataracts.
Use brighter lights for reading and other activities. A magnifying glass may be useful, too.
Limit driving at night once night vision, halos, or glare become bothersome.
Take care of any other health problems, especially diabetes.
Do not use eye drops or other treatments that claim to dissolve or remove cataracts. There is no proven way to resolve cataracts with eye drops. Surgery is the only way to remove cataracts.
What to expect with cataract surgery? When your vision is making it difficult to complete your regular activities, schedule a cataract consultation with one of our surgeons. At this appointment our staff will go over all your surgical options and help you make an informed decision about cataract surgery, including: preparation for and recovery after surgery, benefits and possible risks of cataract surgery, surgical techniques and options, cataract surgery costs, insurance coverage, scheduling, and any other questions you may have.
Cataract surgery is a quick outpatient procedure (about 20-30 minutes) done in an outpatient surgery center or hospital under twilight anesthesia. During cataract surgery, your surgeon will remove your eye’s cloudy cataract lens and replace it with a clear artificial lens. This new artificial lens is called an intraocular lens (or “IOL”). When you decide to have cataract surgery, your doctor will talk with you about different surgical techniques, IOLs and how they work.
Recovery after cataract surgery is generally very easy. Most patients can expect to have about 1-3 days of downtime following their procedure. You will be using eyedrops for a few weeks to help protect against any inflammation or infection. Your surgeon will talk with you about how active you can be following your surgery. Often patients need to refrain from exercise, heavy lifting, underwater activities (pool, ocean, sauna, etc.), and dusty dirty environments for a few weeks. Driving can typically be resumed in a day or two after surgery.
Does insurance cover cataract surgery? Cataract surgery is generally covered by Medicare and most private medical insurances when your vision tests at a certain decreased level of acuity or clarity. However, even if surgery is covered by insurance you may still have some additional costs. Special types of IOLs and refractive correction (for patients who want to be less dependent on eyeglasses after surgery) are typically not covered and may cost you more. Also, choosing to have cataract surgery before your vision has deteriorated enough may not be covered. In certain cases, it might be possible to get coverage before you meet the age or vision requirements. Talk with your surgeon if you are considering having early cataract surgery. What do you do if you don't have Medicare or insurance coverage? You may still be able to reduce and manage the cost of cataract surgery. See if your employer offers flexible spending or health saves programs or sign up for outside financing such as CareCredit. We are here help if you have any questions!