Diagnosis & Treatment of Glaucoma at
Brass Eye Center in Albany New York

Although most people are familiar with the eye disease Glaucoma, few are aware of why Glaucoma is such a significant threat to sight. Most serious eye diseases, eye conditions or eye problems usually produce some symptoms that are visible, and make patients uncomfortable or disturb their vision. Glaucoma begins without any symptoms or obvious loss of vision. In this way it is quite insidious in onset and, if not diagnosed and treated early in its course, will lead to progressive, permanent, and unnoticed vision loss. This is what makes it essential to diagnose and treat Glaucoma as early in its course as possible.

Glaucoma is one of the leading causes of blindness for patients between the ages of 18-65 years of age. Since Glaucoma doesn’t produce any noticeable disturbance in vision until it is advanced, only half of the people who have Glaucoma actually know that they have it. More than 2.25 million Americans over the age of 40 years old have Primary Open Angle Glaucoma, which we will discuss in depth in this section.

Other national studies estimate that between 3-6 million people in the United States have higher than normal Intraocular Pressure (IOP), without obvious clinical signs of damage to the optic nerve. High Intraocular Pressure is one of the diagnostic signs that may indicate the presence of Glaucoma. Thus it is likely that there are another million people who may have Glaucoma, but have not yet been diagnosed because they do not have access to eye care or even Glaucoma screenings. Just in the United States, there are approximately 100,000 patients who are believed to be legally blind from glaucoma.

Glaucoma is really not a single disease but is a collective term that is used to characterize a broad range of eye problems that damage the optic nerve and potentially cause loss of vision. Many patients are under the impression that Glaucoma is simply due to a high pressure within the eye. The pressure inside the eye is called Intraocular Pressure (IOP) and generally falls within some range that is considered “normal”. While a high Intraocular pressure certainly can be one cause of Glaucoma, and in fact is the most common cause of Glaucoma, a high IOP may not be the only cause of Glaucoma. There are many possible causes of Glaucoma. Regardless of the cause, the various types of Glaucoma share a common factor-if not diagnosed early, treated properly and controlled, it will result in permanent vision loss and potentially blindness. 

As we described earlier, the most disturbing attributes of Glaucoma are that its course begins with its slow onset and there is a lack of visual symptoms.  This makes it likely to go unnoticed by patients unless they are consistent about having routine eye examinations with Glaucoma testing. It is entirely possible to have a higher than normal Intraocular Pressure (IOP) and vision loss and simply not know it.

This is why Dr. Brass recommends that all patients over 50 years of age who have no previous family history of Glaucoma or other general health conditions such as diabetes or high blood pressure, be evaluated for Glaucoma every two years. If there is any family history of Glaucoma at all, or any other general health problems, Dr. Brass recommends patient be evaluated for Glaucoma every year beginning at 40.

In addition, we now also know that there is considerable risk for siblings of those who have Glaucoma. In the Nottingham Glaucoma Study, it was found that the siblings of Glaucoma patients are 5 times the risk for developing Glaucoma by the age of 70 and therefore should be examined every year.

Causes & Types of Glaucoma

To help you understand more about the causes and types of Glaucoma, it is necessary to learn about the eye functions.

In the “normal” eye, there is a continual production and drainage of fluid called Aqueous Humor. This production and drainage is balanced so as to maintain a “normal’ Intraocular Pressure (IOP).

Aqueous Humor is produced by the Ciliary Body, a structure positioned just behind the Iris, or colored part that is visible. Aqueous Humor is normally drained through a structure called the Trabecular Meshwork, which is a tissue meshwork located at the base of the Iris.

Any time there is a disturbance in which either too much Aqueous Humor is being produced or too little fluid is being drained, there is a rise in pressure inside the eye. It is best to have equilibrium of Aqueous Humor fluid so that a “normal” pressure in the eye is maintained.

• Primary Open Angle Glaucoma
  The most common type of Glaucoma is Primary Open Angle Glaucoma (POAG). Patients with Primary Open Angle Glaucoma usually have an increase in Intraocular Pressure (IOP) upon routine measurement, called Tonometry. This increased Intraocular Pressure (IOP) results from either too much Aqueous Humor being produced or too little being drained as discussed earlier. This fluid buildup within the closed space of the inside of the eye causes the pressure to rise. This elevation in pressure (IOP) causes the circulation in the optic nerve to become challenged, depriving it of oxygen and nutrients, resulting in permanent changes and even damage to the optic nerve resulting in vision loss. The optic nerve is the connection between the retina and the brain and is responsible for communicating visual images. Once the optic nerve is damaged, it is not able to carry visual images, resulting in vision loss. This is why it is so important to monitor, detect and control Intraocular Pressure (IOP). If left untreated, an elevated Intraocular Pressure (IOP) may, over time, cause slow progressive, permanent damage to the optic nerve that can result in blindness.
  
  
• Angle Closure Glaucoma
  Angle Closure Glaucoma can be divided in two main types: Primary Angle Closure Glaucoma and Acute Angle Closure Glaucoma. Although Angle Closure Glaucoma is occurs much less frequently than Open Angle Glaucoma, it is important to understand it because it has the ability to produce considerable vision loss in a short period of time.
  
  Primary Angle Closure Glaucoma accounts for approximately 10% of all cases of Glaucoma and about 2/3 of these once again produce no symptoms for patients
  
  Acute Angle Closure Glaucoma is one of the only types of Glaucoma that produce distinct symptoms that include pain, light sensitivity, redness, blurred vision, colored haloes around lights and nausea or vomiting.
  
  Angle Closure Glaucoma is characterized by a blockage or complete closure of the drainage structure of the eye-the Trabecular Meshwork. The Trabecular Meshwork is actually a fine filter. If it is blocked or obstructed by any alteration in the size or shape of the surrounding structures, or by change in the size or shape of the tissue itself, it will cause the Intraocular Pressure to elevate. In instances where the meshwork becomes blocked abruptly, it will cause a sudden rise in the Intraocular Pressure (IOP), resulting in Acute Angle Closure Glaucoma. Angle Closure Glaucoma is characterized by this sudden rise in pressure which will can cause pain, redness, blurred vision and if left untreated permanent loss of vision.
  
  While there can be a several causes of Angle Closure Glaucoma, it is most often caused by anatomical changes within the internal structures of the eye. Angel Closure Glaucoma is considerably more common in farsighted eyes, which tend to be smaller and in patients between the ages of 45-60 years of age where the Crystalline Lens is beginning to swell. During your general eye exam if Dr. Brass observes or measures a narrowed angle, he will perform an additional examination procedure called Gonioscopy. This allows Dr. Brass to fully visualize the meshwork and the angle in order to carefully assess your predisposition to Angle Closure Glaucoma. Gonioscopy is performed by placing a special contact lens on your eye and then using the slit lamp biomicroscope to fully examine the meshwork and the angle.
  
  In the event that you are at risk for Angle Closure Glaucoma or in the event that you have Acute Angle Closure Glaucoma, Dr. Brass may initially prescribe some medication to begin to lower the pressure and then will most likely recommend using a laser to produce a small opening or hole in the Iris so that Aqueous Humor can quickly and efficiently drain from the eye. This procedure, called a Laser Iridotomy, is quite successful in treating Angle Closure Glaucoma and preventing recurrences.

Risk Factors for Glaucoma

There are a number of factors that by themselves can predispose you to developing Glaucoma, and others that when combined can predispose you to risk.

• Increased Intraocular Pressure
  If you have a high Intraocular Pressure (IOP) you are considered to be at risk for developing Glaucoma.
• Age
  The incidence of Glaucoma increases with age and becomes much more frequent after the age of 40. Dr. Brass recommends routine eye examinations with Glaucoma testing every 2 years for anyone above 40 years of age if they have no other family or medical history that is significant, and more often if there is any family history of Glaucoma or other systemic or eye disease that compromises circulation.
• Race
  African-Americans have certain genetic factors that cause a higher likelihood of developing Glaucoma. In fact they have a 5-fold increase in risk for Glaucoma.
• Myopia
  Some patients who are nearsighted may have anatomical features that may increase the risk of Glaucoma.
• Hypertension
  If you are taking medication for high blood pressure may be at greater risk for Glaucoma due to the lowering of the blood pressure within the optic nerve.
• Diabetes
  If you are being treated for diabetes you are considered to be at greater risk for Glaucoma due to the general circulation problems associated with diabetes.
• Family History
  If anyone in your family has Glaucoma, this is a very significant risk factor. If any other family members have been diagnosed with Glaucoma, your risk of developing Glaucoma increases considerably. This is particularly true for siblings of Glaucoma patients have a 5-fold increase in risk for developing Glaucoma.

Treatment of Glaucoma

Fortunately, today Dr. Brass has many treatment options for controlling Glaucoma. In fact Glaucoma is in almost all cases, treatable, but must be diagnosed as early as possible. Thanks to advances in medical treatment for Glaucoma, laser treatment for Glaucoma and surgical Treatment for Glaucoma, Dr. Brass will recommend an individual treatment plan that is best for you.

The following information is limited to treatment of Primary Open Angle Glaucoma, as it is the most common type of Glaucoma. Primary Open Angle Glaucoma is treated by the three different approaches above depending on the severity of the disease and the ability of each treatment option to slow or halt the disease progression.

Medical Treatment of Glaucoma

Primary Open Angle Glaucoma is most often treated with eye drops. There are many types of eye drops that Dr. Brass can prescribe to lower your Intraocular Pressure (IOP). By using a single type of medication or sometimes 2 eye drops in combination, more than 80% of the patients with Open Angle Glaucoma can be successfully treated. These eye drops work by either decreasing the amount of fluid being produced inside your eye or by increasing the rate of drainage of fluid from your eye. For most patients, using the eye drops as prescribed-1-2 times per day it is possible to control the Intraocular Pressure (IOP) and slow or even halt the loss of vision.

Unfortunately, some patients may experience side effects of these eye drops and it makes the use of eye drops a poor treatment option. Also, some patients are unable to achieve adequate control with eye drops alone and require Laser treatment in addition to the eye drops in order to maintain control.

Laser Treatment of Glaucoma

The use of Laser Treatment for Glaucoma has become an important treatment option for many patients. In the past, Laser Treatment for Glaucoma was considered a “last resort” before Glaucoma Surgery. Today, thanks to advances in lasers, using a laser treatment in conjunction with the eye drop treatment or sometimes even using the laser treatment as the primary treatment are excellent options to help maintain control and slow or stop the progression of the disease.

In fact, Laser Treatment for Glaucoma is widely used to help prevent vision loss and is becoming a Glaucoma treatment of choice for many patients who have problems with eye drops or are unable to use eye drops properly. Argon Laser Trabeculoplasty (ALT) is a glaucoma laser treatment that helps to reduce the Intraocular Pressure (IOP) by creating more effective drainage of fluid through the Trabecular Meshwork. Unfortunately, for some patients, the effect of ALT decreases over time, rendering it ineffective. This is limiting, as ALT cannot usually be repeated.

Another type of Laser Treatment for Glaucoma is called Selective Laser Trabeculoplasty (SLT). This type of laser treatment is quickly becoming the preferred treatment for Glaucoma for a number of important reasons. First, SLT appears to be considerably gentler on the eye. Second, should the effect decrease over time, SLT can be repeated several times in order to control the pressure and slow or halt the progression of the disease. SLT is becoming an important treatment option not only for Glaucoma patients who are unable to use eye drops and obtain control, but as a primary treatment to help Glaucoma patients avoid needing to use eye drops altogether.

Dr. Brass routinely performs all types of Laser Treatment for Glaucoma and will recommend laser treatment if it the best treatment option for you.

Surgical Treatment of Glaucoma

For a small number of patients, even with the maximum medical therapy they can achieve with Glaucoma eye drops and Laser Treatment for Glaucoma, it is still not possible to achieve good stable control and stop the progression of the disease. For these patients there are surgical procedures that Dr. Brass can perform to achieve control of the Intraocular Pressure (IOP) and slow or stop the progression of the disease. These include removing a tiny piece of the Trabecular Meshwork or even implanting a microscopic Glaucoma to help reduce and stabilize the Intraocular Pressure (IOP) and prevent vision loss.

Glaucoma is a very complex eye disease, and not simply an elevated Intraocular Pressure (IOP). Nonetheless, when detected early it can be successfully treated. Brass Eye Center and it’s staff, under the medical direction of Dr. Robert E. Brass, provides the full scope of advanced technology diagnostic testing and treatment, as well as taking the time necessary to provide each patient the personal education needed to fully understand their condition and get the best possible outcomes for their patients. If you or a family member or friend have not had a recent screening and examination for Glaucoma, please take a moment to request an appointment by calling 518.782.7827 or e-mailing Brass Eye Center.

Brass Eye Center is conveniently located for patients seeking general eye care and eye examinations from Albany, Troy, Schenectady, Saratoga Springs, Clifton Park, Cohoes, East Glenville, Loudonville, Mechanicsville, Niskyuna, Rexford, Westmere, Colonie, Half Moon and Delmar New York. Please phone 518.782.7827 to schedule an appointment for a Consultation for Glaucoma.