For as long as I can remember, my regular eye exam has included a glaucoma test. Some of you may be familiar with it. They put numbing drops in your eyes and then place a machine against each eyeball to measure the pressure inside (Intraocular pressure or IOP).
Normal pressure is between 12 and 22 millimeters of mercury (mmHg). If it goes above that, it may be a warning sign that you have or are at risk of glaucoma, a progressive condition that, without treatment, could lead to blindness.
The pressure can increase when a fluid called aqueous humor stops circulating the way it normally does. This fluid is different from tears. It flows between the cornea and the lens and helps the eye function properly.
In a healthy eye, there is a balance between how much fluid is produced and how much drains out. If it doesn’t drain properly or if too much is produced, it can increase the pressure inside the eye, which can damage the optic nerve in the back of the eye.
An eye-opening eye exam
I have never, ever worried about eye pressure or glaucoma. It wasn’t on my radar, at all. So, I thought nothing of it when I had my eyes tested about seven months ago. That is, until my eye doctor said, “Hmmm, the pressure is up a bit in your left eye. It’s 26. Let’s check it again in a few minutes.” It was still high, so he had me return a few days later for a recheck. No change.
The next step was a referral to a glaucoma specialist. At my first appointment, I had several more eye tests which confirmed that not only was the pressure increasing in my left eye, but I also had definite signs of the beginning stages of glaucoma.
A visual field test revealed that I had lost a minuscule amount of peripheral or side vision on the inside of my left eye, close to my nose. Another test confirmed that the optic nerve in my left eye was slightly damaged. Yes, I freaked out. At least on the inside. Ever the reporter, I tried to remain calm and asked lots of questions.
Losing peripheral vision is what happens with glaucoma. I didn’t notice that I’d lost any vision, and still don’t, which is normal in the beginning. But as glaucoma progresses, you lose more and more, leaving you with tunnel vision, and eventually, totally blind.
There is no cure for glaucoma, but the pressure inside the eye can be lowered with one of several medications, laser surgery, conventional surgery, or some combination of those options.
I started off with a daily drop of a beta-blocker called Timolol, which is supposed to lower the pressure by decreasing the amount of fluid in the eye. After a month, I had a re-check and my pressure had increased — to about 36. Yikes!
My doctor put me on another drop called Brimonidine which is also supposed to decrease the pressure but by a different means. For those who like to know, it’s an alpha-adrenergic agonist. I have to put one drop in both eyes (because the pressure had risen slightly in my right eye) three times a day. Two days later, the pressure in my left eye had dropped significantly. I have a follow-up appointment in about a week. Fingers crossed. Even if the pressure goes down to normal, I will have to continue with the drops. Forever, unless something changes.
Treatment depends on the type of glaucoma you have and what you decide after considering your options. As I always try to do, I highly recommend a second opinion. I am working on that now.
I initially thought glaucoma was one disease. It’s actually a group of diseases. The common denominator is that they all damage the optic nerve.
The two main types of glaucoma are open-angle and angle-closure glaucoma.
Open-angle glaucoma accounts for 90 percent of cases. Most of the time, it’s caused by increased pressure due to a clogged drainage system. Why it becomes clogged is usually a mystery.
Sometimes, open-angle glaucoma occurs with normal eye pressure.
Risk factors for normal pressure glaucoma
- Japanese ancestry
- Family history
- Certain heart issues, such as an irregular heartbeat
- Low blood pressure
Untreated, it takes on average about 10-15 years for a person with eye pressure between 21-25 mmHg to become totally blind. If it’s 25-30mmHg, it takes around seven years, and if the pressure is more than 30mmHg, three years. That’s why screening is so important.
Most of the time, there are no symptoms early on. As the disease progresses, the most likely ones are:
- Gradual loss of peripheral (side) vision, usually in both eyes
- Tunnel vision in the advanced stages
The type of glaucoma I have
With open-angle glaucoma, most of the time there’s no specific reason behind a clogged drainage system. In my case, an up-close look revealed some flaky material in the angle between the cornea and the iris of my left eye. Those little flakes were clearly clogging the drain!
The name of this type of open-angle glaucoma is pseudoexfoliative glaucoma, a condition primarily related to age and genetics. From what I’ve learned, it can progress more quickly than the more common type of glaucoma and often causes higher eye pressure.
Treatment is basically the same as with other types of open-angle glaucoma.
Angle-closure glaucoma differs from open-angle in that eye pressure usually rises quickly, and happens because the drainage system becomes blocked or covered over. This type of glaucoma is fairly rare and people usually have symptoms:
- Intense eye pain
- Red eyes
- Rainbows around lights at night
- Very blurred vision
If you have any of these symptoms, you should get medical attention immediately, because this type of glaucoma can progress quite rapidly. The usual treatment is laser or conventional surgery.
If you want to learn more about the different types of glaucoma and how they are treated there is a wealth of information on these two sites:
If you have glaucoma, I would love to hear about your experience and how you are doing. I am in the process of figuring out the best place to get a second opinion. I will keep you updated and share what I learn.
Aging sure has its moments, doesn’t it?!
Or, Dr. Laura Voicu in Danvers, MA, also with Ophthalmic Consultants of Boston (OCB)
If you wish to travel south to Boston or Danvers, MA, I can recommend the above Glaucoma specialists with OCB. If you wish to take the Amtrak Downeaster, you would be within blocks of their office near Boston North Station. I believe that Dr. Ansari sees patients in Boston and Waltham and Dr. Voice sees patients only in Danvers.
Great timing with the article on glaucoma. I have to go see the specialist in the group next month. All of this makes me nervous. In my mind I’m not 74 and I am physically active. I really enjoy life!
Glad it was helpful. I know what you mean about feeling nervous. Feel free to reach out if you need some moral support.