Early detection and proper use of eye drops are essential to preventing vision loss.
Glaucoma is a leading cause of irreversible blindness and is more common with aging. The condition affects peripheral vision at first, but eventually becomes more widespread. Treatment with daily eye drops helps to slow the process, but it’s best to start early. “Glaucoma tends to be like a snowball,” says Dr. Brian Song, a glaucoma specialist at Harvard-affiliated Massachusetts Eye and Ear Infirmary. “It’s easier to control it early than if you wait for it to build momentum.”
Early glaucoma typically has no noticeable symptoms, so it’s important to get regular eye exams and take medicine exactly as prescribed in order to prevent or reduce vision loss in the long term.
What is it?
Glaucoma is a group of related diseases that damage the optic nerve, which connects the back of the eye to the brain. Several types account for most cases of glaucoma:
Open-angle glaucoma. This is the most common form of glaucoma. The clear fluid inside the front of the eye passes freely through an anatomical structure, called the angle, but drains too slowly further on. Pressure builds up inside the eye, damaging the
Closed-angle glaucoma. Less commonly, the angle structure at the front of the eye is narrow or closed entirely. If the pressure rises suddenly, it can trigger severe eye pain, nausea, seeing halos around lights, and blurry vision.
Normal-tension glaucoma. In about a third of all cases, eye pressure remains in the normal range, but optic nerve damage still occurs. Normal-tension glaucoma is more common in East Asian people.
Applying eye drop medications properly is key to getting
Eye drop tips
1 Wash your hands and don’t touch the eyedropper tip.
2 While standing, sitting, or lying on your back, gently pull the lower lid down to form a pocket, and apply the drop.
3 Don’t apply more than one drop unless directed. Too large a dose can make certain medications less effective. Try allowing the drop to be drawn out on its own by gravity, which naturally regulates the dose.
4 Close your eye and gently press on the inside corner of your eye where the lids meet the nose to temporarily block the eye’s tear drainage. This will help retain the medication in the eye. Wait for at least a minute to open your eye.
5 If you need to apply additional drops or a different kind of eye drop, wait three to five minutes.
How do you know you have it?
Early on, glaucoma may cause no symptoms or only subtle changes in peripheral vision. As the disease progresses, it may begin to affect central vision, which is important for detail-oriented tasks like reading text or watching television.
Glaucoma can be detected early with a comprehensive eye exam, in which the doctor carefully inspects the optic nerve and retina at the back of the eye and measures eye pressure. When glaucoma is suspected, visual field tests may be helpful to detect early peripheral vision loss.
How is it treated?
Major clinical trials have shown that even if a person’s eye pressure is still in the normal range, lowering the pressure can prevent optic nerve damage from getting worse.
In glaucoma’s early stages, a single prescription eye medication may be enough to control pressure adequately. If the condition worsens, it may require additional medications. There are multiple glaucoma drugs, each with its own risks and side effects.
If medication is not effective for any reason, your ophthalmologist may recommend laser treatment or eye surgery to either improve the eye’s natural drainage or create a new route for fluid to drain. These are not always permanent solutions, however.
Treatment needs to be carefully tailored to each individual. “There is no magic formula or cocktail that is right for everybody,” Dr. Song says. “There are a lot of different types of glaucoma, and not all are treated the same way.”
What can you do right now?
African American men and all men who have a family history of glaucoma are at higher risk of glaucoma. For these groups, it’s wise to undergo a comprehensive eye exam at age 40 or sooner, Dr. Song says. The American Academy of Ophthalmology recommends that people over 65 get exams every one to two years.
If you’ve already been diagnosed, you will have regular eye exams by your ophthalmologist to manage the disease. In addition, your best bet for preventing vision loss is taking medications as directed. “There is nothing we can do to recover vision loss that has already occurred from glaucoma,” Dr. Song says. “That’s why taking medications correctly is so important.”