As professor of ophthalmology and director of the glaucoma research and clinical fellowships at Mount Sinai, Janet Serle is an ophthalmologist who has been practicing since 1985. Her patients have glaucoma.
Who’s at risk:
“Glaucoma is a disease that causes loss of vision and eventually blindness if not adequately treated,” says Serle. “This is a disease that we can manage with medication, laser treatments and surgery — but far too many patients are only diagnosed when they’ve lost much of their vision.”
January is glaucoma awareness month, a nationwide initiative to bring treatment to the estimated 1 million Americans who have glaucoma without knowing it.
Over 2 million Americans have glaucoma, and 120,000 of them are blind from it.
Glaucoma is the result of damage that occurs in the optic nerve, the pathway that carries images from the eye to the brain.
“We don’t know exactly what causes glaucoma, but we think it’s a combination of genetics and environmental factors,” says Serle. “In the United States, glaucoma accounts for 12% of all cases of blindness, and is the second-leading cause of blindness around the world.”
Doctors have identified certain population groups as being at increased risk.
VISION & EYE HEALTH
“While Caucasians have about 1%-2% risk of getting glaucoma, blacks and Hispanics have a 5% risk,” says Serle. “And this risk goes up with age. Studies have found that by age 80, 10% of blacks and 20% of Hispanics have glaucoma.”
You’re also considered at high risk if you have a family history of the disease, thin corneas, eye pressure above the normal range, optic-nerve cupping, eye injuries, diabetes or nearsightedness.
Signs and symptoms:
One difficulty in treating glaucoma is that it often sneaks up on people.
“We call the most common type of glaucoma — open-angle glaucoma — the silent thief of vision,” says Serle. “It has no symptoms until the late stages and is only discovered through careful examination by an ophthalmologist.”
Angle closure glaucoma, which is most common in Asian patients, causes symptoms like pain in the eyes, blurry vision, a halo around lights, and even abdominal and chest pain.
Routine eye exams are the key to fighting glaucoma.
“For a typical patient under age 40, we recommend a thorough eye exam every two to four years,” says Serle. “That drops to one exam every three years for the next 10 years, and then exams every one to two years until age 65. After that, we recommend one to two exams a year.
“People with risk factors like family history should consult their doctor about an exam schedule, and expect to start getting exams every one to two years after age 35.”
Visiting the optical shop to get a new prescription for glasses doesn’t count — they don’t do a complete exam for glaucoma.
Getting glaucoma diagnosed is a vital first step, because doctors can prevent it from progressing to blindness. It’s a chronic disease that can be managed, not cured.
“We treat glaucoma by lowering the pressure in the eye, which we can do three ways,” says Serle. “We start with medications, then laser treatments, then surgery.
“For the vast majority of patients, adequate treatment and regular followup exams are enough to prevent vision loss,” says Serle.
Medications can manage glaucoma in one of two ways.
“Fluid is secreted into the eye and also leaves the eye,” says Serle. “So medications can decrease the fluid being secreted into the eye or increase the amount being secreted out.” Most medications are administered as eye drops one to four times a day.
Laser treatments are painless procedures done at the doctor’s office.
“The lasers direct energy into the eye, opening up the channels that fluid uses to exit the eye,” says Serle, “However, we can do a laser at most three times in each eye, and they have a limited duration of effect.”
Surgery makes alternative pathways for fluid to leave the eye.
“Either we make a hole in the eye or insert a tube into the eye,” says Serle. “These surgeries are done under local anesthesia, and most patients go home the same day.”
There’s an 80%-90% success rate for the first year, and 60%-70% success rate five years down the road, says Serle.
It’s a promising time for glaucoma research.
“On the horizon, we have exciting new medications and lots of new surgical procedures,” says Serle. “Earlier detection is also a big push, so we’re testing devices that would detect glaucoma before permanent damage is done.”
What you can do:
Get regular eye exams.
Depending on your age and risk factors, you should be screened as often as twice a year or as little as once every four years. “Make sure that you don’t miss these exams,” says Serle.
Know your family history.
Know your relatives’ ocular and medical history. If you’re at increased risk, you should get eye exams more frequently.
For reliable info, start with the American Academy of Ophthalmology, at aao.org, or the Glaucoma Research Foundation, glaucoma.org.
Get a comprehensive glaucoma exam.
If you have risk factors, make sure that you get the full workup, which includes checking intra-ocular pressure, an optic nerve exam, computerized visual field testing, measurement of corneal thickness and an exam of the angle of the eye.
Questions for your doctor:
Ask, “What’s my eye pressure?” If the answer is 21 or higher, then ask, “Should I have extra testing?” When you go for an eye exam, ask “What kind of device did you use to measure my eye pressure?” The preferred unit is the Goldmann machine, which uses a blue light, notes Serle.
By the numbers:
Glaucoma affects over 2.2 million Americans and 60 million people worldwide.
120,000 Americans are blind from glaucoma.
Glaucoma accounts for 12% of all cases of blindness in the U.S.
Half of people with glaucoma don’t know they have it.