Stopping “Sneak Thief” Glaucoma in Its Tracks

Glaucoma is often referred to as the “sneak thief of vision” because the disease progresses at an almost imperceptible rate until it suddenly causes a severe loss of vision. The disease affects nearly 3 million people in the U.S. and 60 million worldwide, but only about half the people with the disease know they have it, according to the Glaucoma Research Foundation.

One of the most famous examples of glaucoma’s subtle progress is professional baseball player Kirby Puckett, whose career was ended abruptly in 1996 when he woke one morning to find he had no vision in his left eye. Puckett, who was a Hall of Fame outfielder, had been completely unaware that he had the illness until it was too late to save the sight in his left eye.

Puckett’s experience with glaucoma serves as a cautionary tale concerning the importance of glaucoma awareness, and the importance of early detection and treatment. Specialized medical equipment, including Diaton Tonometers, can help doctors catch glaucoma and begin treatment early.

What Is Glaucoma?

Glaucoma is a disease that causes damage to the optic nerve of the eye. This damage occurs when fluid builds in the front of the eye, increasing pressure on the eye. The increased pressure results in damage to the optic nerve.

The optic nerve is linked to a layer of light-sensitive tissue inside the eye called the retina. The optic nerve carries signals from the retina to the brain, which interprets the signals, thus allowing you to see. A clear fluid called aqueous humor circulates through the front part of the eye. This humor helps provide nutrients to the eye, supports immune functions, and helps regulate pressure in the eye.

In a healthy eye, the aqueous humor flows in and out of the front portion of the eye, but in eyes affected by glaucoma, the fluid does not flow out of the eye properly. This results in a build-up of pressure and damage to optic nerve fibers.

Left untreated, glaucoma can cause blindness. In the U.S., more than 120,000 are blind as a result of glaucoma, accounting for about 9 percent to 12 percent of all cases of blindness. The World Health Organization reports that glaucoma is the second leading cause of blindness worldwide.

Certain groups of people are more at risk of developing glaucoma than others. African Americans are 15 times more likely to have visual impairments related to glaucoma, and the disease is six to eight times more prevalent among African Americans than whites. People who are diabetic, people over 60 years of age, and people with severe nearsightedness are also at elevated risk of developing glaucoma.

Types of Glaucoma

Open-angle glaucoma affects more people than any other form of glaucoma. Open-angle glaucoma occurs when the trabecular meshwork of the eye gradually loses its effectiveness in draining fluid. This results in increased intraocular pressure and damage to the optic nerve. In the early stages of open-angle glaucoma, no symptoms are present, but over time blank spots will begin to appear in patients’ field of vision. These blank spots are often unnoticeable for some time until they become severe enough to affect vision to a degree that patients’ day-to-day activities suffer.

  • Normal-tension glaucoma - This form of glaucoma is particularly subtle, as eye pressure remains within the range considered “normal” by doctors - less than 21 mmHg - while optic nerve damage and vision loss still occur.
  • Angle-closure glaucoma - This form of glaucoma occurs when a patient’s iris is close to the draining angle in their eye, resulting in the iris blocking the drainage angle. When the drainage angle is blocked, it can result in a quick rise in pressure that can result in an acute closed-angle glaucoma attack, which is a medical emergency. An acute closed-angle glaucoma attack has a number of symptoms, including sudden development of blurry vision, nausea, severe eye pain and headache. People suffering from a closed-angle glaucoma attack need to seek medical attention immediately.
  • Congenital glaucoma - This form of glaucoma is rare, and develops in children and infants. Early treatment is needed to prevent permanent damage to the eyes of young patients suffering from this condition.
  • Secondary glaucoma - This form of glaucoma results from another eye disease or condition. Often, eye injuries may result in this form of glaucoma. Other common causes include tumors or long-term steroid therapy.

Glaucoma Symptoms?

Unfortunately, symptoms of glaucoma often do not become noticeable until damage to the optic nerve has occurred. In many cases, these symptoms are mistakenly attributed to age-related vision problems. Some symptoms of glaucoma that may occur include:

  • Difficulty in adjusting to dark rooms
  • Difficulty in focusing on near or far-off objects
  • Double vision
  • Excess tearing
  • Seeing spots

Regular examinations by ophthalmologists using quality medical equipment can aid in the early detection of glaucoma. Eye doctors will use several medical devices and tests to evaluate patients’ eyes. Some of these include:

  • Tonometry - Ophthalmologists will use a tonometer to gauge patients’ eye pressure. During tonometric tests, eye drops are used to numb the eye before the doctor uses a tonometer to measure the inner pressure of the eye by applying a puff of air to the eye. The normal pressure range is 12 to 22 mmHg. Patients with higher pressure may have glaucoma.
  • Pachymetry - Doctors use the pachymeter to gauge central corneal thickness. Numbing drops are applied to the eyes before the doctor places a small probe perpendicular to the central cornea. This helps the doctor get a more accurate estimate of eye pressure, as some patients with thin CCT have higher pressure than tonometry suggests.
  • Visual field test - This test helps doctors determine how much damage has occurred from glaucoma. The field test consists of exercises used to evaluate the patient’s field of vision.
  • Ophthalmoscopy - Using a medical device called anophthalmoscope, an eye doctor will look through the pupil to examine the optic nerve. Doctors can evaluate color and appearance to determine whether damage to the nerve has occurred.
  • Goniosocpy - This test consists of dilating and numbing the eye and then placing a specialized type of contact lens with mirrors inside on the patient’s eye. This device allows the doctor to determine whether open or narrow angle glaucoma may be present and also allows the doctor to see whether abnormal blood vessels or excessive pigment may be impairing aqueous humor drainage.

Glaucoma Treatment

There are a number of glaucoma treatment options available, depending on the severity of the patient’s glaucoma and other factors. In most cases, if glaucoma is detected early, most patients with the condition will not lose their sight. Some common treatment include:

  • Eye drops - Absorbed into the blood stream, eye drops will help regulate the patient’s eye pressure.
  • Pills - When eye drops aren't enough to control eye pressure, doctors may prescribe pill-based medication to help IOP. This medication typically has more side effects than eye drops, however.
  • Surgical procedures - When medication isn't working, doctors may have to take the surgical route. Laser surgery to make drainage easier is one option. In some cases, a trabeculectomy may become necessary. This procedure creates a passage in the sclera to allow excess eye fluid to escape. Another option is to insert a tiny device in the eye to facility drainage.

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