Glaucoma Explained: Types, Treatment and How to Protect Your Eyesight

Glaucoma is the leading cause of vision loss and blindness in the United States for people over 60 years old. It affects over 60 million people worldwide and about 3 million people the United States.

Glaucoma has no early warning signs or symptoms, and more than half of people with this disease don’t know they have it. That's why it is known as the “silent thief.” There is no cure, but early treatment can often slow the damage and protect your vision.

What is glaucoma?

Glaucoma is a group of eye diseases that can cause vision loss by damaging a nerve in the back of your eye called the optic nerve. It usually happens when fluid builds up in the front part of your eye. That extra fluid increases the pressure in your eye, damaging the optic nerve. As the disease progresses, it can affect your vision. Blind spots may develop in your peripheral (side) vision and, later, in your center vision as well. Glaucoma can affect one or both of your eyes.

Types of glaucoma

The most common type of glaucoma is called open-angle glaucoma. This type of glaucoma occurs gradually over time. It's painless and causes no vision changes at first. Another type of glaucoma is called closed-angle glaucoma. This type occurs suddenly and can be more serious.  It's important to note that not all types of glaucoma involve an elevated eye pressure: About 30-50% of people with glaucoma have normal eye pressure.

Symptoms of glaucoma

While glaucoma tends to be a completely silent in its symptoms, some patients with closed-angle glaucoma experience blurred vision, halos around bright lights, nausea and headaches. If your doctor is able to detect your glaucoma early, these symptoms can usually be controlled.

Am I at risk for glaucoma?

The direct cause of glaucoma is unknown, but there are several risk factors, including age. You may be at a higher risk if you:

• Are over the age of 60
• Have a family history of glaucoma
• Are of African, Hispanic or Asian heritage
• Are farsighted or nearsighted
• Have had an eye injury
• Use long-term steroid medications
• Have diabetes, migraines, high blood pressure, poor blood circulation or other health problems

You may also be at higher risk for glaucoma if you have had eye injuries or have other eye-related issues like thinning of your optic nerve or corneas that are thin in the center. Your ophthalmologist will be able to identify these changes. 

Glaucoma diagnosis

The only way to find out if you have glaucoma is to get a dilated eye exam. During your eye exam, your doctor will test your sight, evaluate your eye pressure, check for fluid drainage and measure the drainage angle of your eye, examine your optic nerve and even take photographs if needed.

What’s the treatment for glaucoma?

Doctors use different types of treatment for glaucoma including medication, laser treatment and surgery. If you are diagnosed with glaucoma, it is important to start treatment right away. Treatment won’t undo damage to your vision, but it can slow down the process and help prevent it from getting worse.

Prescription eye drops are the most common treatment. The drops are used every day and lower the pressure in your eye. Decreasing the eye pressure can prevent further damage to your optic nerve. Depending on the type of eye drop, you may need to use them once or multiple times a day. It’s important to talk to your doctor about any potential side effects of prescription eye drops.

Laser treatment is another option. Doctors can use a laser to help the fluid drain out of your eye, effectively lowering eye pressure. In many cases, it’s a simple procedure that your doctor can do in office. During the procedure your doctor will use eye drops to numb your eye and aim a small beam of light into your eye using a special lens. You may see small flashes of red light during the treatment. Most people feel little to no pain during the procedure.

If medication and laser treatment don’t work, your doctor may suggest surgery. There are different types of surgery that can help the fluid drain out of your eye:

• Glaucoma drainage devices: Your ophthalmologist may implant a tiny drainage tube in your eye. The glaucoma drainage implant sends fluid to a collection area, called a reservoir. Your eye surgeon creates this reservoir, and the fluid is then absorbed into nearby blood vessels.
• Trabeculectomy: This type of surgery is usually used to treat open-angle glaucoma. The surgeon will create a tiny opening in the top of your eye, under your eyelid where no one will see it. This opening allows extra fluid in your eye to drain, lowering pressure. Usually, people are awake during this surgery but receive numbing medicine to prevent any discomfort. Patients typically go home the same day after trabeculectomy surgery, but will need someone to drive them home.
• Minimally invasive glaucoma surgery: If you have mild glaucoma, your doctor may recommend a new approach called minimally invasive glaucoma surgery (MIGS). This procedure also lowers eye pressure, but it’s safer and helps you recover faster. There are different types of MIGS, so ask your eye doctor about whether MIGS may be an option for you.

If you have glaucoma, you may also benefit from wearing glasses. While glasses can't treat the problem, they can help with other symptoms caused by glaucoma: Like eye strain, glare or trouble with peripheral (side) vision. 

Treating glaucoma is a team effort between you and your doctor. Once you begin taking medications for glaucoma, your ophthalmologist will likely want to see you regularly. You can expect to visit your ophthalmologist every few months. But timing can vary depending on your treatment needs.