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Glaucoma

Glaucoma is the name for a group of eye conditions where your optic nerve is damaged and your vision becomes worse.

If you have glaucoma, your optic nerve (the nerve that connects your eye to your brain) is damaged at the point where it leaves your eye.

Often, this damage can be the result of an increase in pressure in your eye. This may happen when fluid (the aqueous humour) in the front part of your eye (the anterior chamber) doesn't drain away properly. Usually, the amount of fluid produced in your eye is balanced by the amount draining away, so the pressure in your eye remains controlled. If you have glaucoma, the pressure within your eye can be so high that your optic nerve is damaged. Because of this, you may begin to lose your sight.

Although raised pressure in your eye is the most common cause of glaucoma, the condition can also be caused by other things. For example, glaucoma can also be caused by a weakness in your optic nerve. This can lead to damage even when the pressure in your eye appears to be normal. In most people, glaucoma is caused by a combination of high pressure and a weakness in the optic nerve.

Glaucoma can affect both of your eyes, but one eye may be affected more than the other. If you have treatment early, it can prevent further sight loss.

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Details

  • Types Types of glaucoma

    Chronic open angle glaucoma

    Chronic open angle glaucoma (also called primary open angle glaucoma) is the most common type. It develops very slowly and damage to your eyesight happens gradually.

    You can get chronic glaucoma if the fluid in your eye can’t pass through the drainage channels properly. This can slowly raise the pressure within your eye and damage your optic nerve.

    Normal tension glaucoma

    Another form of chronic glaucoma, called normal tension glaucoma, can occur even if the pressure in your eye is within the normal range. This is usually less than 21 millimetre of mercury (mm Hg). It's thought that the optic nerve may have a poor blood supply or a weakness.

    Acute angle-closure glaucoma

    This type of glaucoma happens when the pressure in your eye rises very quickly. Your cornea (the clear window at the front of your eye) comes into contact with your iris (the part that gives your eye its colour). This prevents fluid in your eye from flowing out of your eye as normal. Acute glaucoma can be very painful and you must seek urgent medical attention. It can cause permanent blindness unless treated quickly.

    Secondary glaucoma

    You can get secondary glaucoma if you have other eye conditions, such as an injury to your eye or repeated inflammation. If you have diabetes, you may be at risk of developing a type of secondary glaucoma called rubeotic glaucoma.

    Congenital glaucoma

    This is a very rare condition where a baby is born with glaucoma. This happens when the eye’s drainage system doesn’t develop properly before birth.

  • Symptoms Symptoms of glaucoma

    If you have chronic open angle glaucoma, you might not notice any symptoms until your optic nerve has been affected and your sight gets worse. This is because the first part of your sight to be affected is the outer or peripheral field of vision. Your central vision isn't usually affected until much later. Usually, chronic open angle glaucoma doesn’t cause any pain in your eye.

    Symptoms of acute glaucoma may include:

    • loss of sight
    • pain in your eye
    • a headache
    • blurred vision or a halo around lights
    • feeling sick or vomiting
    • redness in the white of your eye

    If you notice any of these symptoms, seek urgent medical attention straight away.

    The symptoms of congenital glaucoma include watering eyes, sensitivity to light or cloudy and unusually large eyes. These symptoms may be caused by problems other than congenital glaucoma, but if your baby has any of them, see your GP for advice.

  • Diagnosis Diagnosis of glaucoma

    You may not have any symptoms until you start to lose your sight. Therefore, screening tests are important to detect glaucoma. An optometrist – a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses – can do these during a routine eye test.

    As glaucoma is more common if you're over 40, it's important to have an eye test at least every two years from this age onwards. It's important to be tested regularly if you're at risk of developing glaucoma, for example if you have a close family member with the condition.

    There are a number of tests for glaucoma. Your optometrist may:

    • look at your optic nerve by shining a light from a torch into your eye 
    • look at the thickness of your cornea
    • measure the pressure in your eye using a tonometry test – a small amount of pressure is applied to your eye using a tiny tool or a warm puff of air
    • measure your field of vision in a perimetry test – you may be asked to look out for a light that flashes in your side vision.

    If your optometrist thinks you may have glaucoma, he or she will refer you to an ophthalmologist for more tests. An ophthalmologist is a doctor who specialises in eye health, including eye surgery. Your ophthalmologist may advise you to have tests to examine the area in your eye where the fluid drains out.

  • Treatment Treatment of glaucoma

    Treatment for glaucoma aims to lower the pressure inside your eye and reduce your risk of further damage to your sight. Treatment can't reverse any existing damage, so it won't improve your sight if it has already become poor.

    Medicines

    Eye drops which treat chronic open angle glaucoma include the following.

    • Prostaglandin analogues. These help your eye's internal fluid drain out more quickly. 
    • Beta-blockers. These reduce the pressure in your eye and lower the production of fluid in your eye. 
    • Carbonic anhydrase inhibitors. These lower the pressure in your eye by reducing the amount of fluid your eyes produce. 
    • Sympathomimetics. These reduce pressure in your eye and help the fluid build-up to drain away.

    Acute angle closure glaucoma is a medical emergency and you’ll need to have treatment straight away. You may be offered eye drops that are similar to those mentioned above. These may include beta-blockers, sympathomimetics or a carbonic anhydrase inhibitor, such as acetazolamide.

    You may be offered these eye drops separately, or in combination. It's important that you follow your ophthalmologist’s advice and use your medicines as he or she advises you.

    If you think your medicine is causing a side-effect, speak to your ophthalmologist as soon as possible. He or she may be able to offer you another type of treatment. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

    Surgery

    If you have chronic open angle glaucoma, and other treatments haven’t worked for you, your doctor may suggest you have laser treatment or an operation.

    Laser treatment

    Laser treatment helps draining system in your eye work better. Laser treatment may also be used to make a small hole in your iris, to help fluid drain away.

    If you decide to have laser treatment, you’ll be offered a local anaesthetic. This completely blocks pain from the eye area and you will stay awake during the procedure. You will usually be able to go home the same day. Laser treatments are minor procedures and most people are able to recover from them quickly. You will usually need to continue using eye drops after your treatment, to keep the pressure in your eye stable.

    You may also be offered a laser procedure to treat or prevent acute angle closure glaucoma.

    Trabeculectomy surgery

    You may be offered surgery if you have chronic open angle glaucoma and medicines or laser treatment hasn’t lowered the pressure in your eye.

    There are a range of operations; one of the most commonly performed is trabeculectomy. In this operation, a tiny opening is created in the white part of your eye (the sclera) to allow fluid to drain away. If you decide to have a trabeculectomy, you’ll be offered a local or general anaesthetic. If you have a general anaesthetic, you’ll be asleep during the procedure.

    It’s worth bearing in mind that a general anaesthetic can really take it out of you. You might find that you're not so coordinated or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important. Your surgeon will help you decide which type of anaesthetic is best for you.

    Because technology has advanced so much, new types of operations are now becoming available. For example, your surgeon may insert a very small stent in your eye during your operation, to help reduce the pressure in your eye. If you’d like to know more about your treatment options, speak to your doctor.

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  • Causes Causes of glaucoma

    Glaucoma is caused by an increase in pressure within your eye or a weakness in the optic nerve, or both.

    You're more likely to get glaucoma later in life. For example, chronic open angle glaucoma is uncommon in people under 40. It affects one in a 100 people aged over 40 and around five in a 100 people over 65. Other factors that can increase your chances of getting chronic open angle glaucoma include:

    • your ethnicity – you’re more at risk developing the condition if you're from a black origin 
    • a family history of glaucoma – your risk is almost four times higher if your parents or siblings have glaucoma
    • being short-sighted
    • having diabetes

    Women are more likely to develop angle closure glaucoma than men. You’re also more likely to develop the condition if you’re far-sighted or from an Asian ethnicity.

  • Prevention Prevention of glaucoma

    Glaucoma is very common – it’s thought that around 500,000 people have chronic open angle glaucoma in the UK.

    If you're over 40, it's important to have an eye test every two years to check for the early signs of glaucoma. It's also important to be tested regularly if one of your parents, children, brother or sister has glaucoma.

    If you have a close relative that has glaucoma, experts recommend that you should be checked every:

    • three to five years if you’re between 20 and 29 years old 
    • two to four years if you’re between 30 and 64 years old 
    • one to two years from 65 years onwards If you’d like more information, ask your optometrist for advice.
  • FAQs FAQs

    If I have glaucoma, does it help to take supplements?

    Answer

    At the moment, scientists haven’t found any evidence suggesting that taking certain nutritional supplements can help to treat glaucoma.

    Explanation

    Scientists have been looking at whether taking certain nutritional supplements can help people with glaucoma. However, at the moment, they haven’t found any proof that certain nutritional supplements can help treat glaucoma. In general, it’s important to eat a healthy, balanced diet that includes plenty of fruit and vegetables, which are great for your general health.

    What if I forget to put in my eye drops for glaucoma?

    Answer

    If you forget a dose, put in your eye drops as soon as you remember.

    Explanation

    It isn't a problem if you forget to use your eye drops on the odd occasion. However, it's important to get into a routine of using your eye drops at around the same time every day to help you remember.

    Try using a chart with tick boxes to keep a check on whether you have taken your eye drops every day. You could also set a timer to ring at a particular time to remind you when you need to put them in.

    Using your drops regularly, as advised by your doctor, offers the best protection against glaucoma. Although your sight can’t be restored, regularly using your eye drops can help to prevent you from losing any more sight.

    I don’t have any symptoms – how do I know if my glaucoma treatment is working?

    Answer

    Your ophthalmologist (a doctor who specialises in eye health) or optometrist (a registered health professional who examines eyes) will monitor your condition. They will check if your treatment is working.

    Explanation

    If you use eye drops to treat glaucoma, it's important that you follow your ophthalmologist’s advice and use your medicine as he or she advises. This is to make sure your treatment works well. If you don't, the pressure in your eyes may rise again. When you’re diagnosed with glaucoma you may need to visit your ophthalmologist frequently to start with so he or she can check if your treatment is working. If your treatment works, your eye pressure remains stable and you don’t have any major side-effects, you may be asked to have check-ups less often. However, it’s worth bearing in mind that this will depend on your condition. As you don’t have symptoms of glaucoma, it’s important to attend these appointments to check your treatment is working. If it doesn’t work, the pressure in your eye may rise and you could permanently lose more of your sight.

    Can I drive if I have glaucoma?

    Answer

    As long as your sight is good enough to meet the national recommended guidelines for driving, you should still be able to drive.

    Explanation

    If you have severe glaucoma in both eyes, you will need to report it to the Driver and Vehicle Licensing Authority (DVLA). However, if glaucoma affects only one of your eyes you don’t need to tell the DVLA, provided you don’t have any other medical condition in your other eye.

    When you inform the DVLA that you have glaucoma, you will be asked to fill out a medical questionnaire to provide details about your condition. You will be asked to give your consent for the DVLA to request medical information from your ophthalmologist (a doctor who specialises in eye health).

    The DVLA may ask you to have regular tests to assess if it’s safe for you to drive. If your eye sight isn’t good enough to meet the DVLA’s standards, you won’t be able to drive again.

    Ask your optometrist or ophthalmologist for advice about if you can drive and any tests you may need to have.

  • Resources Resources

    Further information

    Sources

    • Glaucoma. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published September 2010
    • Diagnosis and management of chronic open angle glaucoma and ocular hypertension. National Institute of Care and Health Excellence (NICE), 2009. www.nice.org.uk,
    • Glaucoma. American Optometric Association. www.aoa.org, accessed 4 September 2014
    • Primary open angle glaucoma. PatientPlus. www.patient.co.uk/patientplus.asp, published 8 November 2013
    • Glaucoma. Royal National Institute of the Blind. www.rnib.org.uk, accessed 18 June 2014
    • High eye pressure and glaucoma. Glaucoma Research Foundation. www.glaucoma.org, published 5 September 2013
    • Denniston AKO, Murray PI. Oxford handbook of ophthalmology. 2nd ed. Oxford: Oxford University Press; 2009:308−14
    • Glaucoma and ocular hypertension. PatientPlus. www.patient.co.uk/patientplus.asp, published 8 November 2013
    • Angle-closure glaucoma. BMJ Best Practice. www.bestpractice.bmj.com, published 25 November 2013
    • Neovascular glaucoma clinical presentation. Medscape. www.emedicine.medscape.com, published 17 October 2013
    • Childhood glaucoma. Symptoms of open angle glaucoma. Glaucoma Research Foundation. www.glaucoma.org, published 18 February 2014
    • General glaucoma description. The Royal College of Ophthalmologists.www.rcophth.ac.uk, accessed 20 June 2014
    • Primary open-angle glaucoma clinical presentation. Medscape. www.emedicine.medscape.com, published 20 February 2014
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 26 June 2014 (online version)
    • Understanding glaucoma. Royal College of Ophthalmologists. www.rcophth.ac.uk, accessed 23 June 2014
    • Open angle glaucoma. BMJ Best practice. www.bestpractice.bmj.com, published 20 February 2014
    • Five common glaucoma tests. Glaucoma Research Foundation. www.glaucoma.org, published 22 April
    • Trabeculectomy. Medscape. www.emedicine.medscape.com, published 22 January 2014
    • Trabecular stent bypass microsurgery for open angle glaucoma. National Institute of Care and Health Excellence (NICE), 2011. www.nice.org.uk
    • West AL, Oren GA, Moroi SE. Evidence for the use of nutritional supplements and herbal medicines in common eye diseases. American journal of ophthalmology 2006;141(1):157−66. doi:10.1016/j.ajo.2005.07.033
    • Fruits and vegetables. The British Nutrition Foundation. www.nutrition.org.uk, accessed 26 June 2014
    • At a glance guide to the current medical standards of fitness to drive. Drivers Medical Group, Driver and Vehicle Licensing Agencny (DVLA). www.gov.uk, published 2014.
    • Glaucoma and driving. Driver and vehicle licensing agceny (DVLA). www.gov.uk, published 12 June 2014
    • V1 online. Driver and Vehicle Licensing Agency (DVLA). www.gov.uk, accessed 26 June 1014
    • Personal communication, Dr Simon Taylor, Clinical Senior Lecturer in Ophthalmology, Imperial College London, 4 September 2014
  • Related information Related information

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    Produced by Hemali Bedi, Bupa's Health Information Team, September 2014.

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