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Glaucoma is often called the “silent thief of sight”, because most types typically cause no pain and produce no symptoms until noticeable vision loss occurs. For this reason, glaucoma often progresses undetected until the optic nerve has already been irreversibly damaged, with varying degrees of permanent vision loss. 

But with acute angle-closure glaucoma, symptoms that occur suddenly can include blurry vision, halos around lights, intense eye pain, nausea, and vomiting. If you have these symptoms, make sure you see an eye care practitioner or visit the emergency room immediately so steps can be taken to prevent permanent vision loss. 

Glaucoma can be very destructive to your vision, in fact, it’s the second-leading cause of blindness in the United States. 

Diagnosis, Screening, and Testing for Glaucoma

During routine eye exams, a tonometer is used to measure your intraocular pressure or IOP. Your eye typically is numbed with eye drops, and a small probe gently rests against your eye’s surface. Other tonometers send a puff of air onto your eye’s surface.

Your eye pressure (intraocular pressure) will be measured with a tonometer. Some tonometers blow a puff of air onto your eye’s surface. Others rest gently against the surface of your eye, which will be numbed with eye drops.

An abnormally high IOP reading indicates a problem with the amount of fluid (aqueous humor) in the eye. Either the eye is producing too much fluid, or it’s not draining properly.

Normally, IOP should be below 21 mmHg (millimeter of mercury) – a unit of measurement based on how much force is exerted within a certain defined area.  

If your IOP is higher than 30 mmHg, your risk of vision loss from glaucoma is 40 times greater than someone with intraocular pressure of 15 mmHg or lower. Other methods of monitoring glaucoma involve the use of sophisticated imaging technology – such as scanning laser polarimetry (SLP), optical coherence tomography (OCT), and confocal scanning laser ophthalmology – to create baseline images and measurements of the eye’s optic nerve and internal structures. 

Visual field testing is a way for your eye doctor to determine if you are experiencing vision loss from glaucoma. Visual field testing involves staring straight ahead into a machine and clicking a button when you notice a blinking light in your peripheral vision. The visual field test may be repeated at regular intervals to make sure you are not developing blind spots from damage to the optic nerve or to determine the extent or progression of the vision loss from glaucoma.  

Gonioscopy also may be performed to make sure the aqueous humor (or “aqueous”) can drain freely from the eye. In gonioscopy, special lenses are used with a biomicroscope to enable your eye doctor to see the structure inside your eye (called the drainage angle) that controls the outflow of aqueous and thereby affects intraocular pressure.

Types of Glaucoma

The two major types of glaucoma are chronic and primary-angle glaucoma (POAG) and acute angle-closure glaucoma. The “angle” in both cases refers to the drainage angle inside the eye that controls aqueous outflow. Other variations include normal-tension glaucoma, pigmentary glaucoma, secondary glaucoma, and congenital glaucoma.

Glaucoma Treatments

Treatment can involve glaucoma surgery, lasers, or medication, depending on the severity. Eye drops with medication aimed at lowering IOP usually are tried first to control glaucoma.  

Because glaucoma often is painless, people may become careless about the strict use of eye drops that can control eye pressure and help prevent permanent eye damage. 

In fact, non-compliance with a program of prescribed glaucoma medication is a major reason for blindness caused by glaucoma.
If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting your eye doctor about a possible alternative therapy. 

You can learn more about glaucoma and the treatments available with these videos!

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