What are the signs of Glaucoma? Learn the underlying causes

You may have come across the term “glaucoma” at least once at some point in your life. A parent may have mentioned in passing that an older relative was recently diagnosed with glaucoma. You may have come across the word in the media lately. Or you yourself may have been told that you have a “risk of glaucoma” that requires monitoring. But what is glaucoma exactly? And how is it treated? Most importantly, what are the symptoms or signs of glaucoma that could alert you to visit an eye care provider?
 
The prevalence of glaucoma in Australia sits around 3%; approximately half of those with the disease are actually unaware they have it.

What is Glaucoma?

Glaucoma is a type of eye disease known as an optic neuropathy. Referring to damage and disease of the optic nerve at the back of the eye. The optic nerve is a bundle of nerve fibres that carry signals from the sensory retina of the eye to the brain for visual processing. Damage to this nerve from glaucoma results in irreversible vision loss. There are a multitude of underlying causes of this disease. Some still not well understood.
 
At a basic level, we know that damage to the optic nerve occurs because the pressure inside the eye. Intraocular pressure (IOP), at a level too high for the health of the nerve. There are also likely other factors that reduce the nerve’s tolerance of and resilience to these pressures. Such as age, oxidative stress, or specific anatomical characteristics.
 
Many factors are associated with glaucoma. The most commonly quoted risk factors include:
 
  • Refractive error, both long- and short-sightedness
 
  • Family history of glaucoma
 
  • Increasing age
 
  • Use of steroidal medication
 
  • High IOP
 
  • Asian ethnicity
 
  • Sleep apnoea

What are the Signs of Glaucoma?

In the vast majority of cases there will be no noticeable symptoms to alert an individual that they may have glaucoma. The vision loss from glaucoma is painless. The loss begins in the periphery where we are less aware of such slow changes. Once the vision has deteriorated to a point where it becomes noticeable, the disease is often already in its advanced stages.
 
In a sub-type of glaucoma known as acute angle closure glaucoma, the IOP may spike to very high levels. This has the potential to induce several symptoms. Including blurred vision, haloes around lights, a very red, painful eye, and even nausea and vomiting. However, these presentations are relatively rare. In most cases, glaucoma goes undetected until you attend for a routine eye exam.
 
Detecting the signs of glaucoma and coming to a definitive diagnosis are unfortunately not always straightforward. This is due to a variety of reasons. Including physiological differences between healthy individuals and even between individuals with the condition. As well as the fact that glaucoma is a very complex disease.
 
When examining an eye for glaucoma, tests include:
 
  • Tonometry – this is a method of measuring IOP. Several techniques are available for this. Including non-contact tonometry involving an air puff. iCare tonometry using a light probe to tap the surface of the eye. Or applanation tonometry, which requires anaesthetic eye drops and a larger probe gently placed on the eye.
 
  • Optical coherence tomography (OCT) . This non-invasive scan provides information about the thickness of the retinal nerve fibre layer and can detect areas of damage and thinning. Certain models of OCT machines can also record and analyse progression of nerve thinning over a series of scans.
 
  • Visual field testing (VFT) – also known as automated perimetry, VFT maps the sensitivity of your vision across the visual field. Areas of damaged retinal nerve fibre will correspond to areas of decreased sensitivity or vision loss in a certain area of the visual field. Studies have shown that up to 50% of the nerve fibre layer can be lost before manifesting on VFT. Meaning this test is not often used as the first-line for detecting glaucoma but can be helpful to aid in diagnosis and monitor progression.
 
  • Ophthalmoscopy – by directly looking inside the eye, a trained practitioner can assess the neuroretinal rim of the optic nerve. Noticing any changes to its thickness, shape, and colour that may indicate glaucomatous damage.

Glaucoma Treatment

All treatments involve lowering the IOP in efforts to protect the optic nerve from further damage. But no treatment is able to reverse existing damage or cure glaucoma altogether. Traditional therapy has involved topical eye drops. Such as beta-blocker or prostaglandin drugs. These either decrease fluid production in the eye, increase fluid outflow, or a combination of both, to control the IOP.
 
Laser procedures are also available to stimulate fluid outflow but the effects of these often wear off over some years. We now also have the advent of minimally invasive glaucoma surgery (MIGS). Involving the insertion of microscopic stents or tubes into the eye to aid in fluid outflow.
 
Though many patients are already successfully treated with the existing therapies, glaucoma treatment continues to advance and evolve with greater understanding of what drives this disease.
 
Protect and maintain your eye health, contact us at 1300 297 583 to schedule a consultation.

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About the expert

Dr Anton van Heerden, MBCHB; FRANZCO
Ophthalmologist & Laser Eye Surgeon

Based in Melbourne, but with a reputation that transcends borders, Dr Van Heerden sets the highest bar for laser vision correction surgery in Australia. While his skills and experience are second to none, it is his fun, caring and down to earth nature that truly set’s him apart from the rest. You can sit back and enjoy the journey knowing every detail has been carefully considered.

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