Glaucoma is often referred to as the ‘sneak thief’ of vision. More than 3 million Americans have glaucoma, but less than half of these are diagnosed. Thousands lose vision every day, yet are unaware of its insidious progress.
Glaucoma is incurable and vision loss is irreversible. Some 8% of people over 70 have glaucoma and it is six to eight times more prevalent among African Americans.
Glaucoma is treated progressively with a wide range of therapeutic options. All are focused on reducing intraocular pressure, glaucoma's leading symptom.
Primary open angle glaucoma (POAG) is the most common form of glaucoma, a disease where elevated pressures of intraocular fluid (referred to as aqueous humor or aqueous) in the eye slowly damage the optic nerve.
POAG is defined by a progressive reduction in the visual field of the affected patient, gradually narrowing vision from the periphery. It is generally associated with an elevation in intraocular pressure, to a level exceeding 21 mm Hg. While it is easily defined and diagnosed, it is an insidious disease with a slow but ongoing progression to eventual blindness. There are typically no symptoms of elevated intraocular pressure, e.g. pain, etc. If first diagnosed by a patient's measurable loss of visual field, the disease has already progressed to an irreversible stage.
Glaucoma is as yet incurable and vision loss is irreversible. Management of glaucoma typically aims at limiting and/or halting the potential loss of vision. It is estimated that up to 10% of patients that are diagnosed and receive treatment for their glaucoma will still experience irreversible loss of vision. Approximately 120,000 Americans are blind due to glaucoma, accounting for 9% - 12% of all blindness in the U.S.
POAG is six to eight times more prevalent among African Americans than other ethnic group. In addition to this higher frequency, glaucoma often occurs earlier in life in African Americans - on average, about 10 years earlier than in other ethic populations. The reasons for this higher rate and subsequent blindness remain unknown.
Patients over the age of 60 are six times more likely to have glaucoma when compared to patients under the age of 60.
As the disease progresses the treatment for glaucoma increases in complexity and invasiveness.
Beta blockers (Betimol®, Betoptic S®, Betagan®, Ocupress®, Timoptic®, etc.) are the most widely used of all glaucoma medications and are typically the first prescribed. Secondary medications include sympathomimetic alpha-adrenergic agonists (Alphagan® and Iopidine®); carbonic anhydrase inhibitors, both oral (Diamox® and Neptazane®) and topical (Trusopt® and Azopt®); miotics such as Ocusert®, Pilocar®, Pilopine®, etc; and, most recently, prostaglandin analogues (Xalatan®, Travatan®, Lumigan®, Rescula®).
All of these agents are widely used and all have minimal (but well understood) side effect profiles. Usage will depend on the progression of the disease, clinical evidence, or your physician's preference.
The most commonly available laser procedures are:
Selective Laser Trabeculoplasty (SLT): SLT uses a laser to target specific cells within the trabecular meshwork, the natural pathway for outflow of aqueous. Minimal damage to the surrounding trabecular tissue is sustained, while inducing a biological response that leads to reduction in intraocular pressure. SLT may be a repeatable procedure - up to twice each year -- but the data establishing this as fact are still being accumulated.
Argon Laser Trabeculoplasty (ALT): ALT uses an argon laser to open fluid pathways in the trabecular meshwork. Intraocular pressure is reduced, as aqueous outflow is increased. As it is inherently destructive, this procedure may be repeated only twice in a lifetime.
Using an infrared laser, regions of the ciliary body are targeted and destroyed. With the means for producing aqueous humor irreversibly destroyed, intraocular pressure is controlled. Understandably, this treatment is generally regarded as a last and final option, typically employed on patients with little to no useful remaining vision. Performance of the procedure is designed not to preserve vision, but to reduce patient pain and/or discomfort.
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