Can you guess who is at risk for developing glaucoma?

• a person with 20/20 vision
• a grandmother
• a diabetic
• an infant

The answer is all of them; because glaucoma can affect anyone at any age. In fact, four million people in the United States have glaucoma and half of them are unaware of it.

Glaucoma, the second leading cause of preventable blindness in the United States, is often called the "sneak thief of sight" because it creeps up gradually and can eventually steal your vision. By the time you notice the warning signs, the damage has already been done. Yet, despite these devastating consequences, many people remain in the dark about this serious disease.

But, there is hope. New medications, treatments, technology and research are now helping the millions of people afflicted with glaucoma. Getting the facts about glaucoma is the first and most important step.

Glaucoma: What it is. What it is not.

A normal, healthy eye is nourished and protected by fluid, which, just like your blood, has pressure. When the eye pressure rises to a dangerous level, it damages the optic nerve and can cause blindness. "Think of the eye like a drain in a sink," says Dr. Robert D. Fechtner, Director of the Glaucoma Division at the New Jersey Medical School’s Department of Ophthalmology. "Fluid flows in the sink and fluid must flow out of the drain. In the most common glaucoma, the drain is clogged and pressure builds up," he explains.

Pigmentary glaucoma, another rare form of the disease, is when pigment from the iris clogs the draining angles and prevents fluid from leaving the eye. Over time, the inflammatory response to the blocked angle causes damage to the drainage system. Pigmentary glaucoma affects mostly white males in their mid-30s to mid-40s.

Secondary glaucoma develops after trauma to the eye. Injury, infection, inflammation, diabetes, tumors or an enlarged cataract can precipitate secondary glaucoma.

Who's At Risk?

Unfortunately, everyone from infants to seniors can develop glaucoma. And although there is no known reason for its development, some groups are at even greater risk. For instance, if:

• someone in your family has a history of glaucoma
• you have abnormally high eye pressure
• you are of African-American descent
• you have diabetes
• you have myopia (nearsightedness)
• you are a regular, long-term steroid/cortisone user
• you have a previous eye injury
   
   

Saving Your Sight With A Simple Test

"For most people with glaucoma, there are absolutely no warning signs," says Dr. Fechtner. "The only way to detect glaucoma and preserve your sight is to be tested by an eye specialist or ophthalmologist. During ‘applanation’, the preferred method of testing eye pressure, the eye is anesthetized with eye drops and the patient is asked to look at a blue light. Then, using a special instrument, the doctor briefly and painlessly touches the surface of the eye to measure the pressure. The doctor will also look inside the eye to examine the nerve that connects the eye to the brain. The test itself is simple and painless. If there are any abnormalities, additional testing may be needed," adds Dr. Fechtner.

How often should you be tested? The American Academy of Ophthalmology recommends that everyone over 40 get at least one comprehensive eye examination every 2-4 years, which includes testing for glaucoma and other eye problems. "People who are at a particularly high risk for glaucoma should be checked more regularly," says Dr. Fechtner.

Treatment Options

Medical Therapy: If your doctor diagnoses you with glaucoma, the first line of treatment is generally eye drops to lower fluid production and reduce pressure. “Two classes of drugs that are very popular right now are beta blockers, which reduce the amount of fluid in the eye, like turning off the faucet, and prostaglandin analogs, which increase the outflow of fluid from the eye, like cleaning the drain. The prostaglandin analogs are relatively new drugs, but they’ve been very promising and seem to lower pressure as well as or better than anything we’ve used before,” says Fechtner.

Of course, no one medication is right for every patient. The eye MD or ophthalmologist will first review a patient’s entire health history, and medical conditions in order to prescribe the right medication for that patient.

“When it is not possible to lower the intraocular pressure with eye drops or oral drugs, eye surgery may be necessary,” according to eye surgeon Dr. Paul Lama of the Glaucoma Division at the New Jersey Medical School’s Department of Ophthalmology.

Surgery: There are two types of surgeries: laser surgery and incisional surgery. In laser surgery, a small beam of laser light is used to treat the meshwork of the eye, improving its draining function and reducing pressure. The surgery, which is performed on an outpatient basis, is quick, comfortable and doesn’t restrict the patient’s activities in any way.

When eye drops and lasers are unsuccessful, the eye surgeon can perform incisional surgery, which is also called filtering surgery or trabeculectomy, to actually create new drainage pathways for fluid to escape. During incisional surgery, tiny instruments are used to make a very small hole in the sclera (white of the eye). The aqueous humor (fluid) can now drain out through the hole and be reabsorbed into the bloodstream. This reduces the pressure in the eye. In those cases when a trabeculectomy cannot be performed, “the surgeon can place an artificial drainage device in the eye through a tiny incision. The device acts as a regulator for the buildup of fluid within the eye. When the pressure becomes too high, the device allows the fluid to flow out and be reabsorbed,” adds Dr. Lama.

Surgical intervention is often necessary over a patient’s lifetime when medical therapy is ineffective. In comparison to other surgeries, glaucoma surgery is unusual because it depends upon incomplete, not complete healing to allow the artificially created or implanted drainage channel to remain open. The normal healing process attempts to close the pathway by causing the drainage channel to scar, however, Dr. Lama says, “advances in surgical techniques and use of anti-scarring medication can now alter the healing process,” which keeps the channel open and functional. Many patients have been saved from the ravages of blindness from glaucoma following surgery.

The procedure is generally performed as outpatient surgery and the recuperation is mostly complete within the first month. But because of its risks, surgery is usually the last option. Whatever treatment options are selected, the goal is always the same: prevent the optic nerve from deteriorating and balance the production of fluid in the eye and the outflow of fluid from the eye.

New Jersey Medical School - Offering Hope

The future for glaucoma patients is bright, according to the experts from New Jersey Medical School, which houses the only university-based glaucoma center in New Jersey - including a clinical research and diagnostic laboratory. Some of the center’s latest glaucoma advancements include computer-assisted laser imaging systems, software development designed to detect worsening glaucoma, and highly advanced trials and studies.

"One of our particularly exciting clinical research projects is the Memantine Clinical Trial," reports Dr. Fechtner. Memantine, a medication used in Europe for many years, is typically used to treat conditions such as Alzheimer’s and Parkinson’s disease. “We now believe that Memantine has properties that may preserve the nerve connecting the eye to the brain, separate from any pressure-lowering effect, a strategy called neuro protection,” Fechtner says. In addition to the Memantine trial, the glaucoma research division is involved in several other research endeavors that focus on early glaucoma detection, medical and surgical treatments. Digital and laser imaging technologies of the optic nerve and nerve fiber layer, and new surgical interventions are among those areas of actively evolving research. Several of our research endeavors are conducted in collaboration with the New Jersey Institute of Technology, and other institutions.

Continuously evolving and newly emerging imaging technologies allow early detection of glaucoma. Scanning laser images of the optic nerve (left) and nerve fiber layer (middle), and digitally processed images of the optic nerve (right) are technologies currently used in glaucoma research and assist in guiding treatment.

Final Thoughts

Glaucoma is an unforgiving disease. It can’t be cured, but if caught early, it can be controlled. People who wait until they are nearly blind before getting an eye exam are in serious trouble. Dr. Fechtner stresses, "If there is one message I’d like to get across to everyone, it’s GET TESTED! A diagnosis of glaucoma does not mean that you are going blind. Actually, it’s an opportunity to save your vision. With proper care, regular eye exams, eye drops and appropriate treatment, there’s tremendous hope for maintaining your vision for a lifetime"

For more information about treatment for glaucoma, call the Glaucoma Division of the New Jersey Medical School at (973) 972-2065.