Column: Dr Daniel Liebman On Glaucoma & More
[Column written by Dr Daniel Liebman]
January is Glaucoma Awareness Month, a timely reminder that this eye disease is one of the leading causes of irreversible vision loss worldwide.
In Bermuda, where the population is steadily ageing – and the proportion of residents aged 65 and over is projected to approach one-quarter of the total by 2026 – conditions like glaucoma deserve extra attention. As we live longer and continue to enjoy active lives, early detection and management of glaucoma can make all the difference in preserving sight and quality of life.
What is glaucoma?
Glaucoma is a condition [technically, a group of related conditions] where the optic nerve becomes damaged. Since the optic nerve is the information pathway for the eye to communicate with the brain, this damage causes some of the signal to be lost, resulting in progressive loss of vision.
Who is most at risk?
The biggest risk factor is age – glaucoma usually develops later in life, and the likelihood of developing the condition increases as we age – though it can sometimes affect the eyes earlier in life, and even occasionally in childhood.
Genetics play a role in some cases, so people with a significant family history of glaucoma are at higher risk themselves, especially if multiple close relatives are impacted [e.g. parents, siblings]. People with African, Hispanic and East Asian heritage are also at somewhat higher risk than other ethnic groups.
Other common risk factors include prior trauma to the eye, being very near- or far-sighted and prolonged use of steroid medications.
What is the impact if left untreated?
If left untreated, glaucoma causes progressive irreversible loss of vision. In most cases, this occurs gradually, beginning with peripheral [outside the centre] vision, which may not even be noticeable at first. As glaucoma worsens, it begins to affect the centre of the vision, which can severely impact a person’s ability to see clearly, operate machinery, read or perform other necessary parts of life. At worst, glaucoma can cause complete blindness.
Is there any way to prevent it?
For those with healthy eyes, there is no specific way to “prevent” it from occurring. The best prevention is early detection!
What are the early signs to watch out for?
Most kinds of glaucoma have no signs or symptoms, which is part of what makes it so difficult to detect, and why it can be a particularly dangerous eye condition.
Sufferers will usually lose outside/peripheral vision, which can sometimes cause people to run into objects or have car accidents, because they didn’t see something.
Most glaucoma is painless, though there are certain kinds of glaucoma that cause eye pain. In this kind of glaucoma, known as angle closure glaucoma, the eye pressure can rise very suddenly, causing sudden severe eye pain, blurry vision, and eye redness. While relatively rare, if this happens, it is extremely important to see an eye doctor immediately, because irreversible vision loss can occur within hours.
What is the treatment for the disease – and is there any reversing it?
The optic nerve damage that occurs in glaucoma cannot be reversed once it happens, so our primary goal of treatment is to stop [or at least slow down] the damage to preserve remaining vision as soon as possible.
At this time, the only proven way to accomplish this is to lower the eye pressure, which we can achieve a number of different ways, including topical medications/drops, laser therapies and sometimes surgeries.
There is a lot of research right now looking into ways to regenerate optic nerves that have been damaged, and I’m hopeful in the future this will be possible.
- Dr Daniel Liebman, Instructor in Ophthalmology, Mass Eye and Ear/Harvard Medical School
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