January is Glaucoma Awareness Month, so now is the perfect time to review this condition and discuss its impact on seniors. It’s the second leading cause of blindness in the world, affecting around 3 million people. In fact, the American Academy of Family Physicians reports that one in three people are affected by some form of vision- reducing eye disease by the age of 65.  Age- related macular degeneration, glaucoma, cataracts and diabetic retinal disease are the most common causes of vision loss among the elderly.

What is Glaucoma?

Glaucoma is defined as a collection of eye conditions that damage the optic nerve, the main nerve controlling vision. One of the primary problems leading to the development of glaucoma is the build-up of fluid in the eye, resulting in excess pressure.  Under normal conditions, fluid is produced and should be able to flow in and out of the eye continually. With glaucoma, this fluid is either produced in excess, or doesn’t flow out normally, leading to increased pressure. This could be compared to blowing up a balloon with water and watching the pressure build.  This increased pressure is one cause of damage to the optic nerve associated with glaucoma. Unfortunately, once the damage has occurred there is no repair or recovery of the lost vision.  

Causes of Glaucoma

The most common forms of glaucoma are hereditary, meaning that it’s carried in our DNA and can be passed down to future generations.  Genes that correlate with high eye pressure and optic nerve damage have been identified. 

There are several types of glaucoma described, including open- angle, closed- angle, normal tension, and pigmentary glaucoma. 

Open-angle glaucoma- This is the most common form of the disease.  This occurs when the flow of fluid out of the eye is blocked, leading to a gradual increase in eye pressure.  This happens slowly, so most people are not even aware that they are losing their sight. The Glaucoma Research Foundation actually reports that half of the people who have glaucoma do not even know they have it yet. 

Angle-closure glaucoma (also called closed-angle glaucoma)- This occurs when the iris (the colored portion of the eye) bulges forward and narrows or blocks the drainage angle.  This prevents fluid circulation through the eye, and as a result increases pressure.

Normal-tension glaucoma- With this condition the optic nerve is damaged even though the pressure in the eye is within normal limits.  Doctors do not know the exact reason this happens, but suspected causes include a sensitive optic nerve, decreased blood supply to the optic nerve, and atherosclerosis (the buildup of fatty deposits within arteries).

Pigmentary glaucoma- This form of glaucoma results when pigment granules from the iris flake off and clog up the drainage system of the eye.  This is predominantly seen in active, younger patients and is often hereditary. 

 

Risk Factors for Glaucoma Development

There are several important risk factors for glaucoma that, if you haven’t yet considered for yourself or your loved one, you should rule out.

  •  Any cause for increased intraocular pressure (high internal eye pressure).
  • Being over the age of 60.
  • African American, Asian or Hispanic descent.
  • Family history of glaucoma.
  • Medical conditions like diabetes, heart disease, high blood pressure and sickle cell anemia.
  • Extreme nearsightedness or farsightedness.
  • Eye trauma or history of certain types of eye surgery.

 

Certain medications, especially if used over a long period of time, including tropicamide and phenylephrine eye drops, and the antihistamine Promethazine.

Prevention and Early Detection of Glaucoma

It’s important to detect glaucoma in its earliest stages, when possible, to reduce damage to the optic nerve.  There are some self-care steps you can take to help with early detection, or better yet, prevention of glaucoma. These include having regular eye examinations performed, knowing your family history, wearing eye protection when indicated, and leading a healthy, active lifestyle. 

Although the most common symptom of glaucoma has no symptom at all, there can be clues that advanced stages of glaucoma are brewing. Blind spots in your peripheral vision, tunnel vision (where you can only see what is directly in front of you) and eventually complete vision loss are the symptoms described with open- angle glaucoma. 

The only way to diagnose glaucoma is to have your eyes examined by a physician. The American Academy of Ophthalmology has recommendations for the frequency of eye exams based on age. Despite the fact that any vision lost due to glaucoma cannot be recovered, with early diagnosis, careful monitoring and regular use of treatments when prescribed, the vast majority of people retain useful sight for life. 

Glaucoma Resources

Beyond vision loss, glaucoma can lead to other health risks including depression, increased chances of falling and the resulting injuries, and an overall reduction in a senior’s daily activities and therefore quality of life. There are numerous resources available about glaucoma and the aging senior population, and below are a few good places to get started. 

Remember, there are no early symptoms for glaucoma, and there is no cure. Please refer to a medical professional for specific guidance regarding the health of you and/or your loved one’s eyes.

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