How to Treat Glaucoma

Glaucoma is a collection of eye diseases that if left undetected and untreated, can lead to optic nerve damage and permanent vision loss. It is one of the leading causes of irreversible blindness worldwide. Although we don’t have a cure, we have excellent medical and surgical treatments that can stabilise and save vision. Most people with the glaucoma are able to manage their condition successfully with the use of eye drops and at times, laser treatment. At the time of diagnosis the information from tests, assessments and lifestyle, along with condition type provides the information which will determine initial treatment.

  • Approximately 300,000 Australians have glaucoma
  • 50% of people with the condition in Australia are undiagnosed

What is glaucoma?

Glaucoma is a disease where the pressure inside the eye is too high for the optic nerve, leading to nerve damage and vision loss. The optic nerve is located at the back of the eye and connects the light-sensitive retina to the brain. It’s job is to transfer visual information from the eye to the brain.

According to ProVision optometrist and University of Melbourne Senior Fellow Dr. Graham Lakkis, glaucoma has no significant symptoms so can sneak up on you, going undetected until it’s too late. That is why the condition is known as the “silent thief of sight.” Regular eye exams with your optometrist are key to early detection and prevention of vision loss.

We asked Dr. Graham what we need to know, and what we need to do to treat Glaucoma.

What causes glaucoma?

Glaucoma usually occurs when the pressure inside the eye rises to a level that causes damage to the optic nerve. Lifestyle and behavioural choices don’t contribute greatly to the development of the condition, therefore genetics and the ageing process are the main causes. As the eye ages, it is more difficult for the natural fluids inside the eyeball to drain out, leading to an increase eye pressure. Glaucoma is also more common if you a relative with the disease, so genetics plays a large part.

Who is affected by glaucoma?

Approximately 300,000 people currently have glaucoma in Australia. Due to our rising population and longer life expectancy, this figure will rise in the future. At age 40, 1 in 200 people have the condition, and this increases to almost 1 in 10 at age 80.

Family history and age are the main risk factors, are there any others?

Glaucoma has been associated with a number of risk other risk factors. For example, races such as African and Asian descent are more likely to get certain forms of the condition. Other risk factors include direct trauma to the eyeball and being very short sighted (myopia). Diseases in other parts of the body and medications such as steroids also increase your risk. Even such things as getting regular migraine headaches and having sleep apnoea are risk factors.

What are the signs and symptoms of glaucoma?

Most people are unaware they have glaucoma. This is because a gradual rise in eye pressure can’t be felt, and rapid rises in eye pressure are usually rare.

The symptoms will depend on the type of glaucoma. The most common kind is called ‘open angle glaucoma’ which causes two-thirds of cases. It has no early warning signs that vision loss is occurring due to the gradual rise in eye pressure and gradual loss of peripheral vision.

Another type is called ‘angle closure glaucoma’, where the fluid drainage angle of the eye becomes narrow and then closes up. If the angle closes rapidly, there is a sudden pressure rise which causes the vision to become blurred with coloured rainbows around lights, and headaches and nausea.

There is also another type called ‘normal tension glaucoma’. Even though the patient has eye pressure in the normal range, optic nerve damage still occurs in the same fashion as those with higher eye pressures. This is believed to be caused by poor blood circulation to the optic nerve.

With worsening glaucoma, the patient will start to have eyesight problems especially in their peripheral vision and they may experience difficulty walking down stairs and have trouble reading. Glaucoma is usually a slowly progressing disease. It doesn’t cause vision loss immediately but over years and decades, however the vision loss caused is permanent and can’t be recovered with current medical treatments. Very few people actually go blind from glaucoma if it is detected early and managed properly. The people that lose vision are usually the ones that are not getting their eyes examined regularly and glaucoma is diagnosed late when the vision has already been permanently lost.

How is the condition diagnosed?

All optometrists check eye health at every comprehensive examination, looking for the three most common eye diseases cataracts, glaucoma and macular degeneration as well as other less common problems.

There is no single test for detecting glaucoma, so the optometrist looks at the results of a number of tests such as medical and family history, eye pressure, optic nerve assessment and drainage angle appearance to find patients that are suspicious for having the condition. These ‘glaucoma suspects’ are then examined with specialised instruments such as OCT scans, corneal ultrasound and visual field testing to make the diagnosis. Sometimes these tests have to be repeated over a number of months or even years to determine if deterioration is occurring.

How is glaucoma treated?

Once a diagnosis is made, treatment needs to be commenced. While most optometrists can detect and diagnose glaucoma, a number of optometrists have the equipment and expertise to treat it as well. At our clinic we treat all of our own glaucoma patients, and receive referrals from other optometrists to manage their patients as well.

Treatments includes medicated eye drops, laser, and surgery, however the vast majority of glaucoma is treated with eyedrops.

Glaucoma eye drops contain a pressure lowering medication, like blood pressure tablets but in liquid form, that are instilled once or twice a day. Eye drop treatment reduces the pressure by about one-third to protect the eye from further damage. There are about 10 different varieties of eye drops and some patients need to use multiple medications to control their glaucoma effectively. In cases where the patient becomes allergic, the eye drops don’t work or the patient is forgetful and doesn’t use them as directed, the optometrist needs to consider other treatments. These include cataract surgery with drainage stents, selective laser trabeculoplasty (SLT) or drainage surgery called trabeculectomy. To access these treatments your optometrist will refer you to a surgeon.

Although surgery is not frequently required, it can be a better option than drops to keep eye pressures under control. SLT laser surgery lowers pressure a similar amount to eyedrops but the effect from laser only lasts for about 2 years then has to be reapplied. Drainage stents and drainage surgery are longer lasting treatments that are useful at keeping eye pressures low for the long term.

Do you advise young people to have vision checks too?

Although glaucoma is not common earlier in life, it can still occur, even in babies. Young people need eyecare, especially for optimising their vision and reducing eye strain while they read, work and study. Vision problems such as myopia are also increasing in young people due to excessive screen use.

Many people don’t go to the optometrist unless they have blurred vision, and if they don’t wear glasses they miss that opportunity to get their eye health checked. We encourage people to go to the optometrist regularly so that if there are any early signs of problems, they can be detected and treated before they become major issues.

For long term healthy eyesight, it is vital to have a comprehensive eye exam every 2-3 years. If over 65 years of age, annual exams are recommended. If there are other risk factors, more regular checks may be required and your optometrist will advise you on how often you should attend.

Is there any good news about glaucoma?

There have been great advances in glaucoma in recent years due to extensive scientific research. With new diagnostic equipment, practitioners are detecting the condition and starting treatment at earlier stages than in the past. Medications, stents and lasers have all improved to become safer and better tolerated. There are new drops and injections due to arrive in the near future.

The best news is that glaucoma rarely causes blindness anymore. With regular eye exams, early detection and modern treatments, the condition can be well-managed to ensure lifelong good vision for our patients.

Dr Graham Lakkis is owner of Lakkis Optometry. Dr Lakkis completed a postgraduate degree in Ocular Therapeutics at the University of Melbourne in 2001 to enhance the management of complex eye disease. He was awarded fellowship of the Australian College of Optometry in 2012 for his contributions to the profession of Optometry. Currently Dr Lakkis is Senior Fellow in the Department of Optometry at the University of Melbourne, and lead optometrist of the University Glaucoma Clinic, with responsibility for lecturing and clinical teaching in glaucoma and other eye diseases. Dr Lakkis has also lectured at conferences in Australia and overseas on topics such as macular degeneration, complex contact lens fitting, glaucoma, and scanning laser tomography.

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