Glaucoma: causes, symptoms and treatments

What are the symptoms of glaucoma?

• Gradual or sudden vision loss (blurred, narrow or tunnel vision, and blind spots)
• Eye pain (severe eye pain in the case of acute angle-glaucoma)
• Headaches / Migraines
• Red eyes
• Halos around lights
• Nausea and vomiting (in severe cases)

Unfortunately, half of the people with this disease are unaware they have eye health issues, as there are typically no early warning signs. Glaucoma is called the “Silent Thief of Sight” as vision is preserved until late in the disease when irreversible and permanent damage has already occurred. 

As with many diseases, early detection and treatment, as well as regular treatment follow-up, are critically important to lower eye pressure to help minimize long-term harm.

What causes glaucoma? 

The exact cause of glaucoma is not fully understood, but some factors have been found to contribute to the development of the disease, including:

Age 

Your risk of getting glaucoma increases as you age, especially beyond 60.

Ethnicity 

Asians are more likely to suffer from angle-closure glaucoma than other ethnic groups. African Americans over 40 and Hispanics over 60 are also at increased risk for open-angle glaucoma.

Family history of glaucoma 

Heredity has been established as a cause of glaucoma.

Increased intraocular fluid pressure 

Although this is an important risk factor, only half of all Americans with glaucoma will show increased intraocular pressure when measured randomly because eye pressure constantly fluctuates.

It's important to screen for glaucoma with an ophthalmologist by taking intraocular pressure measurements over time to look for trends of elevated pressure.

Other ocular conditions

Various ocular manifestations, such as conjunctivitis, uveitis, retinal vasculitis, thin corneas, severe nearsightedness, or farsightedness, and some prior eye injuries have been attributed to an increased risk of glaucoma.

Pre-existing medical conditions

Other risk factors include diabetes, high blood pressure (hypertension), patients with HIV/AIDS and chronic steroid use, such as inhaled steroids used by those with asthma and COPD.

Can you prevent glaucoma?

Sadly, there is no way to prevent glaucoma. Annual eye exams with your ophthalmologist or eye doctor are the only way to detect and begin treating glaucoma early.

What are the different types of glaucoma?  

Chronic (primary open-angle) glaucoma 

This is the most common type of glaucoma in which ocular fluid drains too slowly or is over-produced, causing pressure inside the eye to build up. It usually results from an aging and under-functioning eye drainage system. Younger people can also get this form of glaucoma, although rarely.

Normal-tension glaucoma 

Also called low-tension glaucoma, this is a form of open-angle glaucoma where eye pressure is “within the normal range;” but there is evidence of optic nerve damage. It is thought that reduced blood flow to the optic nerve may play a role in normal-tension glaucoma.

A recent large study showed that the incidence of dementia was 1.9 times higher in those with newly diagnosed normal-tension glaucoma than those with glaucoma-free.

Acute (angle-closure) glaucoma

Acute angle-closure glaucoma (also called narrow-angle glaucoma) occurs when the drainage system within the eye suddenly becomes blocked, causing a rapid rise in eye pressure. The onset of symptoms is immediate, and because this can result in blindness, it is a medical emergency requiring immediate urgent medical attention.

Chronic angle-closure glaucoma

This non-emergent variation of acute angle-closure glaucoma may present gradually with mild symptoms. Those of Asian and Native American descent are at higher risk for this type of glaucoma.

Secondary glaucoma 

Secondary glaucoma, also called Neovascular glaucoma, may occur due to another eye disease or condition like diabetes, asthma and COPD (due to chronic steroid or corticosteroid use of over three months), a tumor, and those who suffered from Covid 19, to name a few.

Congenital glaucoma 

Congenital glaucoma is a rare, inherited eye condition affecting infants and young children. It occurs when there is a problem with the drainage system in the eye, leading to increased pressure inside the eye. The increased pressure can damage the optic nerve, resulting in vision loss if left untreated.

What are the treatments for glaucoma?

While there is no cure for glaucoma, its progression can be slowed down through various means. Treatment options are influenced by how advanced the disease is and if the patient is an appropriate candidate for a given treatment.

Treatment options fall into one of 3 categories:

Glaucoma medications 

The most common treatment for glaucoma is prescription eye drops (pills are also used but only as a temporary measure before surgery). The goal of these medications is to decrease intraocular pressure by either promoting drainage of excess eye fluid or reducing eye fluid production.

For those patients who have difficulty taking daily medicated eye drops for glaucoma, the Durysta dissolvable implant may be a great option. During a brief, in-office procedure, our doctor will insert the implant that will slowly and continuously release medication to help lower eye pressure. Durysta’s sustained and targeted drug delivery, which can last for months, eliminates the need for daily eye drops.

Laser eye surgery for glaucoma 

At Assil Gaur Eye Institute, we utilize a variety of laser procedures to treat both open and closed-angle glaucoma, tailoring our approach to each patient's particular need.

Laser surgeries for glaucoma include Endocyclophotocoagulation (ECP), Selective Laser Trabeculoplasty (SLT), Laser Peripheral Iridotomy (LPI), and Transscleral and Micropulse Cyclophotocoagulation.

Minimally Invasive Glaucoma Surgery (MIGS) 

In certain circumstances, patients with early to moderate glaucoma benefit from surgery, where the doctor makes an incision and works on the inner structures of your eye.

Congenital glaucoma is primarily treated with surgery because the cause of the problem is a very distorted drainage system that requires delicate repair.

Learn more about our minimally invasive glaucoma surgeries here. 

Assil Gaur Eye Institute, nationally recognized experts in glaucoma treatment 

Assil Gaur Eye Institute adheres to the highest standards of ophthalmology and patient care in the country. They have assembled a team of top glaucoma doctors from around the country who continue AGEI’s tradition of offering patients the highest quality of specialist eye care. 

Our Director of Glaucoma Services, Dr. Avneet K. Sodhi Gaur, is a Board-Certified, Fellowship trained Cataract and Glaucoma Specialist and a member of ‌the American Academy of Ophthalmology.

She has extensive experience in conventional glaucoma laser treatments and surgical procedures, such as trabeculectomy and glaucoma drainage implants. Dr. Gaur also performs state-of-the-art minimally invasive glaucoma procedures, including iStent, iStent inject, Hydrus, endocyclophotocoagulation (ECP), OMNI 360, and Xen gel stent. 

 

Glaucoma FAQs

Is glaucoma hereditary? 

The most common form of glaucoma, called primary open-angle glaucoma (POAG), can have a genetic component. Not everyone who has a genetic predisposition to glaucoma will develop the condition. Other factors, such as age, race, and overall health, also play a role in the development of glaucoma.

What does glaucoma vision look like?

Glaucoma can cause gradual and permanent vision loss, starting with the peripheral (side) vision and then affecting the central vision.

 

As the condition progresses, you may begin to experience the following symptoms:

 

• Loss of peripheral vision: The loss of peripheral vision is often one of the first signs of glaucoma. You may notice that your visual field is gradually decreasing or you're having trouble seeing objects to the side.
• Tunnel vision: As the loss of peripheral vision worsens, you may experience tunnel vision, where you can only see objects directly in front of you.
• Halos around lights: Some people with glaucoma may see halos or bright circles around lights, particularly at night.
• Blurred vision: Glaucoma can cause blurred or hazy vision, particularly in the early stages.
• Difficulty adjusting to low light levels: Glaucoma can make it more challenging to see in low light levels, such as when driving at night. 

Does glaucoma cause blindness?

Yes, glaucoma can cause blindness if it is not detected and treated early. Glaucoma is a leading cause of irreversible blindness worldwide. It is estimated that up to 10% of people with glaucoma who receive appropriate treatment still experience vision loss. If left untreated or if treatment is delayed, glaucoma can lead to complete blindness.

Is glaucoma painful?

In general, glaucoma itself is not painful. And because it often has no symptoms in its early stages, it can be very challenging to diagnose glaucoma early. However, some forms of glaucoma can cause discomfort, particularly when intraocular pressure is elevated.

How is glaucoma diagnosed?

Glaucoma can be diagnosed through a comprehensive eye exam with several tests and procedures. These may include:

 

• Tonometry: This test measures the pressure inside your eye (intraocular pressure).
• Visual field test: This test checks for any loss of peripheral (side) vision, a common sign of glaucoma.
• Optical coherence tomography (OCT): This test uses light waves to create a detailed image of the optic nerve and can detect any changes or damage to the nerve fibers.
• Dilated eye exam: During this exam, your ophthalmologist will use eye drops to widen your pupils and examine the inside of your eye, including the optic nerve and retina.
• Gonioscopy: This test uses a unique lens to examine the drainage angle of the eye, which can help determine if there is a risk for angle-closure glaucoma.

Is glaucoma cancer?

No, glaucoma is not a type of cancer. Glaucoma is a group of eye diseases that damage the optic nerve, which is the nerve that carries visual information from the eye to the brain. This damage is usually caused by increased pressure within the eye, known as intraocular pressure.

Can glaucoma cause headaches?

Glaucoma can cause headaches through increased eye pressure, a common symptom of the disease. This increased pressure can lead to eye pain and discomfort, which may result in headaches. It's important to note that not all people with glaucoma experience increased eye pressure, and even if they do, it may not necessarily cause headaches.

Can glaucoma be reversed?

Unfortunately, there is currently no cure for glaucoma, and the damage to the optic nerve caused by the disease cannot be reversed. However, with early diagnosis and appropriate treatment, it is often possible to slow or halt the progression of the disease and prevent further damage to the optic nerve.

Does diabetes cause glaucoma?

While diabetes does not cause glaucoma, it is a risk factor for developing the disease. This is because high blood sugar levels associated with diabetes can damage blood vessels in the eye, leading to changes in the optic nerve and an increased risk of glaucoma.

Does glaucoma affect both eyes?

Glaucoma can affect one or both eyes. However, it's important to note that having glaucoma in one eye also increases the risk of developing the condition in the other eye. This is because the risk factors for glaucoma, such as high intraocular pressure, tend to be similar in both eyes.

 

In some cases, glaucoma may be more severe in one eye than the other, and the progression of the disease may differ between the two eyes. This can lead to differences in vision between the two eyes.

How successful is glaucoma surgery?

The success rate of glaucoma surgery depends on several factors, including the type of surgery, the severity of glaucoma, and the individual patient's response to the surgery. In general, however, surgery to treat glaucoma can effectively lower intraocular pressure (IOP) and slow or halt the progression of the disease. 

Can cataracts cause glaucoma?

While cataracts themselves do not cause glaucoma, the two conditions can be linked in several ways:

 

• Some risk factors for cataracts and glaucoma, such as age and family history, are the same.
• Some types of glaucoma, such as angle-closure glaucoma, can be caused by a blockage in the eye’s drainage system. In some cases, a severe cataract can cause a blockage in this system, increasing the risk of angle-closure glaucoma.
• Cataract surgery is a standard procedure that involves removing the eye’s cloudy natural lens and replacing it with an artificial lens. While cataract surgery does not cause glaucoma, some studies have suggested that certain types of glaucoma may be more likely to develop or progress.

 

Research Sources:

Aqueous Humor - American Academy of Ophthalmology | https://www.aao.org/eye-health/anatomy/aqueous-humor

Optic Nerve - American Academy of Ophthalmology | https://www.aao.org/eye-health/anatomy/optic-nerve-3

What Is Chronic Angle-Closure Glaucoma? - American Academy of Ophthalmology | https://www.aao.org/eye-health/diseases/what-is-chronic-angle-closure-glaucoma 

Glaucoma | National Eye Institute | https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma

What is Angle-Closure Glaucoma? | https://glaucoma.org/what-is-angle-closure-glaucoma/

What is Primary Open-Angle Glaucoma? | https://glaucoma.org/what-is-primary-open-angle-glaucoma/

Intraocular Pressure - StatPearls - NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK532237/

Glaucoma in the African American and Hispanic Communities | BrightFocus Foundation https://www.brightfocus.org/glaucoma/article/glaucoma-african-american-and-hispanic-communities

Risks, Benefits & Side Effects of Glaucoma Surgery | BrightFocus Foundation https://www.brightfocus.org/glaucoma/article/glaucoma-surgery-series-risks-and-benefits-glaucoma-surgery