|
 |
|
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 glaucoma, the drain is clogged and pressure builds up,"
he explains.
There are several
variations of glaucoma, but primary open-angle is the most common.
Generally affecting the elderly, it occurs when fluid in the eye doesn't
properly drain out. Left undetected, glaucoma can cause irreversible loss
of vision and severe damage to the nerve fibers of the optic nerve.
| 
|
|
|
| A
healthy optic nerve, located in the center of the image is pink
in color. Notice the blood vessels that nourish the eye are emerging
from the center of the nerve. |
|
Here,
an optic nerve with glaucoma. Notice the center of the image is
pale in color, representing the loss of nerve tissue. |
Congenital glaucoma is very rare and affects babies, with 80 percent
of the cases diagnosed by the age of one. The children born with this
disease have narrow angles or some other defect in the drainage system
of the eye. Congenital glaucoma occurs more often in boys than girls.
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 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.
What's
the difference between and optometrist and an ophthalmologist?
Click here to find out.
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
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 Dr. 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.
If medications are
unsuccessful, laser trabeculoplasty surgery may be
necessary. Here, 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 a trabeculectomy, or incisional surgery,
to actually create new drainage pathways for the fluid to escape. This
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.
"A particularly exciting
trial we are involved in 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. Everything else we’ve been
doing has been related to pressure lowering. This drug, we think, blocks
the chemical pathway that may damage the nerve, allowing us to have a
dual approach to therapy. To me, this is one of the most significant forms
of research because it offers us hope for patients who are getting worse,
despite successful pressure-lowering techniques,” Fechtner says.
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.
University
Hospital is still accepting patients with moderate to advanced glaucoma
for the Memantine Clinical Trial. To be considered, please contact Eileen
Buroff, COT, Glaucoma Research Coordinator, Tel: (973) 972-0205.
|
