Glaucoma

What Is Glaucoma?

Glaucoma is a condition that damages your eye's optic nerve. It gets worse over time. It's often linked to a buildup of pressure inside your eye. Glaucoma tends to run in families. You usually don’t get it until later in life.

The increased pressure in your eye, called intraocular pressure, can damage your optic nerve, which sends images to your brain. If the damage worsens, glaucoma can cause permanent vision loss or even total blindness within a few years.

Most people with glaucoma have no early symptoms or pain. Visit your eye doctor regularly so they can diagnose and treat glaucoma before you have long-term vision loss.

If you lose vision, it can’t be brought back. But lowering eye pressure can help you keep the sight you have. Most people with glaucoma who follow their treatment plan and have regular eye exams are able to keep their vision.

Glaucoma Causes

The fluid inside your eye, called aqueous humor, usually flows out of your eye through a mesh-like channel. If this channel gets blocked, the liquid builds up. Sometimes, experts don’t know what causes this blockage. But it can be inherited, meaning it’s passed from parents to children.

Less-common causes of glaucoma include a blunt or chemical injury to your eye, severe eye infection, blocked blood vessels inside your eye, and inflammatory conditions. It’s rare, but eye surgery to correct another condition can sometimes bring it on. It usually affects both eyes, but it may be worse in one than the other.

Glaucoma Risk Factors

It mostly affects adults over 40, but young adults, children, and even infants can have it. African American people tend to get it more often, when they're younger, and with more vision loss.

You’re more likely to get it if you:

  • Are of African American, Irish, Russian, Japanese, Hispanic, Inuit, or Scandinavian descent
  • Are over 40
  • Have a family history of glaucoma
  • Are nearsighted or farsighted
  • Have poor vision
  • Have diabetes
  • Take certain steroid medications such as prednisone
  • Take certain drugs for bladder control or seizures, or some over-the-counter cold remedies
  • Have had an injury to your eye or eyes
  • Have corneas that are thinner than usual
  • Have high blood pressure, heart disease, diabetes, or sickle cell anemia
  • Have high eye pressure

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Types of Glaucoma

There are two main kinds:

Open-angle glaucoma. This is the most common type. Your doctor may also call it wide-angle glaucoma. The drain structure in your eye (called the trabecular meshwork) looks fine, but fluid doesn’t flow out like it should.

Angle-closure glaucoma. This is more common in Asia. You may also hear it called acute or chronic angle-closure or narrow-angle glaucoma. Your eye doesn’t drain like it should because the drain space between your iris and cornea becomes too narrow. This can cause a sudden buildup of pressure in your eye. It’s also linked to farsightedness and cataracts, a clouding of the lens inside your eye.

Less common types of glaucoma include:

Secondary glaucoma. This is when another condition, like cataracts or diabetes, causes added pressure in your eye.

Normal-tension glaucoma. This is when you have blind spots in your vision or your optic nerve is damaged even though your eye pressure is within the average range. Some experts say it’s a form of open-angle glaucoma.

Pigmentary glaucoma. With this form, tiny bits of pigment from your iris, the colored part of your eye, get into the fluid inside your eye and clog the drainage canals.

Glaucoma Symptoms

Most people with open-angle glaucoma don’t have symptoms. If symptoms do develop, it’s usually late in the disease. That’s why glaucoma is often called the "sneak thief of vision." The main sign is usually a loss of side, or peripheral, vision.

Symptoms of angle-closure glaucoma usually come on faster and are more obvious. Damage can happen quickly. If you have any of these symptoms, get medical care right away:

  • Seeing halos around lights
  • Vision loss
  • Redness in your eye
  • Eye that looks hazy (particularly in infants)
  • Upset stomach or vomiting
  • Eye pain

Glaucoma Diagnosis

Glaucoma tests are painless and don’t take long. Your eye doctor will test your vision. They’ll use drops to widen (dilate) your pupils and examine your eyes.

They’ll check your optic nerve for signs of glaucoma. They may take photographs so they can spot changes at your next visit. They’ll do a test called tonometry to check your eye pressure. They may also do a visual field test to see if you've lost peripheral vision.

If your doctor suspects glaucoma, they may order special imaging tests of your optic nerve.

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Glaucoma Treatment

Your doctor may use prescription eye drops, oral medications, laser surgery, or microsurgery to lower pressure in your eye.

Eye drops. These either lower the creation of fluid in your eye or increase its flow out, lowering eye pressure. Side effects can include allergies, redness, stinging, blurred vision, and irritated eyes. Some glaucoma drugs may affect your heart and lungs. Because of potential drug interactions, be sure to tell your doctor about any other medical problems you have or other medications you take. Also let them know if it’s hard for you to follow a regimen involving two or three different eye drops or if they have side effects. They may be able to change your treatment.

Oral medication. Your doctor might also prescribe medication for you to take by mouth, such as a beta-blocker or a carbonic anhydrase inhibitor. These drugs can improve drainage or slow the creation of fluid in your eye.

Laser surgery. This procedure can slightly raise the flow of fluid from your eye if you have open-angle glaucoma. It can stop fluid blockage if you have angle-closure glaucoma. Procedures include:

  • Trabeculoplasty. This opens the drainage area.
  • Iridotomy. This makes a tiny hole in your iris to let fluid flow more freely.
  • Cyclophotocoagulation. This treats areas of the middle layer of your eye to lower fluid production.

Microsurgery. In a procedure called a trabeculectomy, your doctor creates a new channel to drain the fluid and ease eye pressure. This form of surgery may need to be done more than once. Your doctor might implant a tube to help drain fluid. This surgery can lead to temporary or permanent vision loss, as well as bleeding or infection.

Open-angle glaucoma is most often treated with combinations of eye drops, laser trabeculoplasty, and microsurgery. Doctors tend to start with medications, but early laser surgery or microsurgery could work better for some people.

Acute angle-closure glaucoma is usually treated with a laser procedure.

Infant or congenital glaucoma -- meaning you’re born with it -- is usually treated with surgery because the cause is a problem with your drainage system.

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Marijuana and glaucoma

Studies in the 1970s reported that smoking marijuana could lower eye pressure. But it would take far too much to significantly lower eye processes, and it also lowers blood pressure. That could wipe out any gains from marijuana by limiting the blood flow that your optic nerve needs.

Reviews by the National Eye Institute and the Institute of Medicine show that there is no scientific evidence that marijuana is more effective than modern medications.

Tips for Living With Glaucoma

Glaucoma is a lifelong condition and needs continual follow-up with your eye doctor. There are other things you can do to help keep your eyes healthy.

Get moving. Regular exercise may help lower eye pressure and keep blood flowing to the nerves in your eye. Some activities can raise pressure, so talk to your doctor about the best exercise program for you.

Eat healthy. Enjoy a healthy, well-rounded diet. It won't keep your glaucoma from getting worse, but it's key to keeping your body and eyes healthy. Some studies suggest that food high in antioxidants can help when you have glaucoma. Eat more nutrient-rich foods like:

  • Dark, leafy greens
  • Fish that's packed with omega-3 fatty acids

Take your medicine. Be sure to take your drops or pills exactly as directed. Set a reminder on your phone or watch so you don't forget. Missing your meds could make your glaucoma worse.

Careful with contacts. You should be able to continue wearing contact lenses if you use medicated eye drops. But you may need to use some drugs when you don’t have lenses in. Also, some older medications can change your vision prescription. And if you need surgery, it may affect your ability to wear contacts.

Don't smoke. It's important to keep your body healthy, and nicotine takes a toll. Smoking also raises blood pressure and eye inflammation. That can make your risk of diabetes and cataracts go up. Both are risk factors for glaucoma. If you smoke, ask your doctor for advice on how to quit.

Watch your caffeine . Watch how much soda, coffee, and tea you drink. Too much caffeine can raise your eye pressure. One study found that just a cup of coffee could make the pressure in your eye go up a significant amount for up to 90 minutes.

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Elevate your head. Use a wedge pillow when you sleep. It'll keep your head raised just a little. That should help lower your eye pressure.

Drink fluids slowly. Don't cut back on how much you drink, but spread out your beverages through the day. If you drink a lot at once, it can strain your eyes. Don't have more than a quart at one time. Instead, sip small amounts.

Protect your eyes. Put on protective glasses when you work in the yard or play contact sports. Wear goggles when you swim. When choosing makeup, use non-allergenic brands, and replace items often. Be sure to wear sunglasses outside, especially in summer or around high-glare surfaces like sand, snow, and water. When you have glaucoma, your eyes can be very sensitive to glare.

Don't rub. Glaucoma and the medicine you take might make your eyes feel itchy. But fight the urge. You can scratch them and make things worse. Ask your doctor if you can use drops to treat dryness.

Drive safely. Most people with glaucoma can still drive as long as they pass their state’s vision test. Simply put, your ability to drive will depend on how much vision has been lost. Some people with advanced glaucoma can get their license renewed with restrictions. Ask your doctor about whether driving will be a concern for you.

Be careful with yoga . You may need to reconsider some yoga positions. Some head-down moves that put your heart above your eye can raise your eye pressure. Research hasn’t shown that it makes glaucoma worse, but it’s not a good idea to do yoga positions that increase eye pressure. You may want to avoid poses such as:

  • Downward-facing dog
  • Standing forward bend
  • Plow
  • Legs up the wall

How can I help a parent with glaucoma?

A glaucoma diagnosis can be scary. Many older people are dealing with several problems that come with age. They often worry that they will become a burden to the family if they lose their vision. So first, reassure your parent that many people keep their vision with proper medication and care.

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Next, help your loved one establish a routine so they get their eye drops correctly on schedule. They may have to put them in several times a day. This can be especially difficult for people with arthritis, and it’s not an easy task for anyone to remember. You could offer to help, maybe by stopping by the house or by calling with a reminder. Otherwise, talk with your parent's doctor to make sure a plan is in place. Following a treatment plan is extremely important in glaucoma to prevent permanent vision loss.

If your parent needs surgery, do what you can to help them prepare, and arrange transportation to follow-up visits to the doctor.

Many services and products can help someone with impaired vision continue to write checks, organize their kitchen, tell time, and even play cards. Contact the Glaucoma Foundation to learn more.

Remember, the best help you can offer is your emotional support.

Glaucoma Prevention

You can’t prevent glaucoma. But if you find it early, you can lower your risk of eye damage. These steps may help protect your vision:

  • Have regular eye exams. The sooner your doctor spots the signs of glaucoma, the sooner you can start treatment. All adults need to be checked for glaucoma every 3 to 5 years. If you’re over age 40 and have a family history of the disease, get a complete eye exam from an eye doctor every 1 to 2 years. If you have health problems like diabetes or are at risk of other eye diseases, you may need to go more often.
  • Learn your family history. Ask your relatives whether any of them have been diagnosed with glaucoma.
  • Follow your doctor’s instructions. If they find that you have high eye pressure, they might give you drops to prevent glaucoma.
  • Exercise. Do moderate activity like walking or jogging at least three times a week.
  • Protect your eyes. Use protective eyewear when playing sports or working on home improvement projects.
WebMD Medical Reference Reviewed by Alan Kozarsky, MD on November 01, 2019

Sources

SOURCES:

National Institutes of Health.

Glaucoma Research Foundation: “Other Types of Glaucoma,” “Questions & Answers: Normal-Tension Glaucoma,” “Symptoms of Angle-Closure Glaucoma,” “Medication Guide,” “What Can I Do To Prevent Glaucoma?” "What You Can Do to Manage Your Glaucoma, "Dry Eyes and Glaucoma: Double Trouble," "Summertime Tips,”  “Learn About Glaucoma,” “How Often Should I Have My Eyes Tested?” “Five Common Glaucoma Tests,” “Glaucoma Medications and Their Side Effects,” “Should You Be Smoking Marijuana to Treat Your Glaucoma?”

American Academy of Ophthalmology: “What Are the Symptoms of Glaucoma?” “Who Is at Risk for Glaucoma?” “What Is Ocular Hypertension?” “Glaucoma Treatment,” “Does Marijuana Help Treat Glaucoma?” “Early Detection Key to Slowing Progression of Glaucoma.”

Mayo Clinic: “Glaucoma.”

CDC: “Don’t Let Glaucoma Steal Your Sight!”

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Ophthalmology: "Intraocular pressure changes and ocular biometry during Sirsasana (headstand posture) in yoga practitioners."

AllAboutVision: "Research Says You Should Rethink Your Yoga Routine if You Have Glaucoma."

U.S. Preventive Services Task Force: "Screening for Primary Open-Angle Glaucoma in the Primary Care Setting."

Kellogg Eye Center: “Glaucoma.”

American Glaucoma Society: “Position Statement on Marijuana and the Treatment of Glaucoma.”

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