Glaucoma is a common eye condition people can develop as they age. It happens when a person suffers vision loss because the optic nerve has been damaged.

The risk of developing glaucoma goes up as people age, so most people develop it later in their lives. In fact, around 3% of people over 40 in Singapore have it.

The insidious aspect of glaucoma is perhaps best described by its other moniker: “the silent thief of sight”. This is because glaucoma tends to progress silently, with hardly any symptoms, until sudden vision loss occurs.

Today, we’ll explore this eye condition as well as its causes, signs, and treatment options. This should help you understand glaucoma better.

What is glaucoma?

To understand exactly what glaucoma is, one should remember that each eye has an optic nerve. These nerves carry visual information from the eyes to the brain.

This means the optic nerves have to be intact for optimal transmission of that information for our brains to process what our eyes see. Unfortunately, these nerves can be damaged.

While there are many causes of glaucoma, one of the most common causes is increased pressure in the eyeball.

When pressure increases in an eyeball, it can press on the optic nerve, which then damages it. This is also why treatments for glaucoma are focused on lowering this pressure.

Unfortunately, there’s no proven way yet of preventing glaucoma. That being said, the visual loss from it can be averted or alleviated if treatment begins before the optic nerve is actually damaged.

This is why regular eye exams are so important. An ophthalmologist can help you identify this disease before you lose vision.

At Shinagawa Eye Centre, early diagnosis is made possible through our comprehensive and advanced glaucoma imaging technology. This includes confocal scanning laser ophthalmoscopy with topographical change analysis, optical coherence tomography, and visual field perimetry with glaucoma progression analysis.

The Types of Glaucoma and Their Symptoms

There are several types of glaucoma, and what distinguishes them from each other is typically the cause of the condition, as you’ll see below.

1. Primary Open-Angle Glaucoma

This is the most common type of glaucoma. It occurs when fluid builds up in the eye due to the normal drainage system being impaired.

The result is increased pressure in the eye from the fluid buildup. It tends to manifest over time through patchy blind spots in your peripheral vision, although it is usually almost undetectable early on.

As such, primary open-angle glaucomas typify the glaucoma referred to as the “silent thief of sight”. They’re usually painless and unnoticeable until you reach the advanced stage.

That’s when the central area of your field of vision also gets affected, which can lead to complete vision loss.

2. Primary Angle-Closure Glaucoma

This is a curious type of glaucoma that seems to present more often in middle-aged and older females of Chinese ancestry. 

Fluid buildup is the culprit here once again. However, in this case, it’s not a degenerated eye drainage system causing the fluid buildup. Rather, it is a blockage to the system because of the anatomy of the eye.

In acute primary angle-closure glaucoma, people with this glaucoma often suffer from nausea, headaches, and vomiting. Because it is an acute condition, it’s also classed as a medical emergency.

Hence, people with it should try to alleviate pressure in the eye with the help of an ophthalmologist urgently. Doing so will reduce the chances of vision loss.

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3. Congenital Glaucoma

Congenital glaucoma is typically inherited. Some people’s genetics make them more likely to develop abnormal or suboptimal eye drainage systems.

This is why most eye doctors will advise you to get checked early and regularly for the condition if you have a family history of it. Indeed, people with a family history of glaucoma may even be six times more likely to develop it than others.

4. Secondary Glaucoma

Secondary glaucoma is what happens when another condition raises the pressure in the eyeball, damaging the optic nerve. There are many diseases that can do this, from mature cataracts to diabetes.

You can even get secondary glaucoma from trauma to the eye, such as a blow from an accident or physical activity. Generally, anything that may cause inflammation or bruising to the area around your eyes should prompt a visit to the doctor, for safety.

Treatment Options for Glaucoma

As noted earlier, there is no way yet to prevent glaucoma. Treatment can manage it, but controlling this lifelong ailment involves a lot of regular monitoring.

Our eye doctors are glaucoma specialists with years of experience treating patients with glaucoma. Generally, the goal of our treatment is to reduce the high eye pressure to a level that is safe for the optic nerve.

Depending on the type and severity of glaucoma, this is achieved with the following options:

Medication

This is the most common treatment. The basic prescription involves eye drops, although these drops can sometimes cause the patient to develop some eye redness.

In cases where pressure in the eyeball has gone up to a significant degree, other medication such as oral or intravenous solutions for pressure reduction may be called for as well.

Laser treatment

Laser treatment is most often performed on patients with acute cases of angle-closure glaucoma. 

The principle behind laser treatment is to alleviate blockages to the eye’s drainage system, ensuring fluid can drain properly so it no longer causes pressure buildup.

Surgery

Surgery is another option when the patient’s condition can no longer be addressed by medication. Generally speaking, we can divide the surgical options into two categories: laser and incisional options.

Laser surgical procedures for glaucoma

These are usually the first choice. Among other things, they have the benefit of being less invasive than incisional options and of being possible outpatient procedures.

• Laser peripheral iridotomy (LPI) - Chiefly for people suffering from narrow-angle glaucoma. It involves the creation of a small hole in the iris to help with eye fluid drainage.
• Argon laser trabeculoplasty (ALT) - A laser targets and opens the clogged drainage channels in your eye. It is considered one of the more effective methods.
• Selective laser trabeculoplasty (SLT) - This is similar to ALT but uses a lower-energy laser for even more targeted work. The key perk of this procedure is that it’s relatively safe to repeat.‍
• Cyclophotocoagulation (CPC) - The laser targets the ciliary body that produces aqueous humour. It reduces fluid production in the eyes, so it’s only considered if other treatments haven’t produced successful results.

Incisional surgical procedures for glaucoma

Because laser treatments are less invasive, they are generally attempted before doctors recommend an incisional procedure. If the laser procedure does not work,  incisional surgery may be the next feasible option.

• Trabulectomy - Like most incisional procedures for glaucoma, this is focused on the creation of more drainage paths for eye fluid. In this procedure, the surgeon does that by cutting a small opening in the white part of the eye, the sclera. This procedure generally requires the patient to use anti-scarring medications afterwards, to keep the new drainage pathway open.
• Minimally invasive glaucoma surgery (MIGS) - This procedure is often recommended because it creates only small incisions, which means faster recovery and lower odds of complications. There are several types of MIGS procedures, so depending on your case, the surgeon may aim to create drainage paths or reduce fluid production.‍
• Aqueous shunt surgery - This procedure requires implanting a tiny tube in the eye to serve as a fluid drain. Again, this is similar to CPC in that it is usually tried only after all other attempts or procedures have failed.

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Get screened for glaucoma today

If there’s anything you need to know about glaucoma, it’s that the sooner it’s detected, the better for the patient. Glaucoma damage is permanent and irreversible, but it’s possible to manage the damage before it happens.

As with many degenerative conditions, early detection and treatment is vital. If you want to check whether or not you may have this condition, reach out to us. Our eye doctors can assess you to see if you need treatment.

Call us to enquire or book an appointment for an eye screening today.