Glaucoma is mysterious. Glaucoma is a group of different diseases of the eye which can result in serious loss of vision and even blindness. Whether from birth or acquired from injury, from genetics or from aging, the damage to the optic nerve can be similar but the path getting there can be as different as the Old Portland Road and Interstate 95.
Glaucoma is often described as a disease of eye pressure. Newer definitions don’t even include eye pressure. We now look at glaucoma as the damage of the optic nerve and the typical patterns of vision loss on a test called the visual field. High eye pressure can be a cause of that visual field loss but 40-50% of new glaucoma cases DO NOT have high eye pressure. There is also a condition called Ocular Hypertension where the eye pressure is high but there is no loss of vision or detectable damage to the optic nerve. Thankfully, there are many more people with ocular hypertension than glaucoma. Glaucoma is rather rare accounting for only 1-2% of the population (almost 30,000 people in Maine) and Ocular Hypertension about 6-8% of the population.
When we treat glaucoma, whatever the cause, we lower the eye pressure from the baseline level. Sometimes we have to treat another underlying problem that has contributed to glaucoma. Ocular Hypertension can be watched or sometimes treated to reduce risk of developing glaucoma. Different kinds of treatment exist, from eye drops to laser to surgery, the common aim is to lower the pressure to prevent or delay more loss of vision.
New developments in glaucoma diagnosis include new ways to determine the health of the optic nerve. In the last few years, a revolution in monitoring the actual nerve has occurred. Devices like Optical Coherence Tomography (OCT) and Heidelberg Retinal Tomography (HRT) have given new understanding to the structure of the optic nerve. For example the OCT can evaluate the optic nerve with a resolution of 3-4 microns (a fraction of an inch) allowing us to see microscopic changes in the optic nerve. In addition, easier to use and more accurate visual field tests with advanced software to detect changes over time have helped detection and improved our ability to monitor glaucoma.
Glaucoma treatments continue to evolve with better and safer eyedrops and surgeries to lower eye pressure. It is now possible to try to devise a treatment plan for each individual patient to meet their specific needs. Long gone are the “one size-fits all” medications that caused headaches, blurred vision and other side effects.
Glaucoma diagnosis and treatment has advanced in many ways over the last few years. It will be exciting to follow all of the new and upcoming methods in the near future.