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What is Glaucoma
Glaucoma is a group of conditions where the pressure inside the eye causes damage to the optic nerve, resulting in reduced vision.
Most people with glaucoma are unaware of any problems; your vision may seem normal and there is no pain. This is because the centre of the vision, which you use for detail is not affected until the most advanced stages of the disease. Instead you may lose peripheral patches of vision without you knowing.
Glaucoma cannot be cured but it is possible to control the disease in most cases by drops or, in some cases, surgery. Without treatment patients usually lose vision gradually over the course of many months or several years. Once lost, it is not possible to restore the vision.
The aim of treatment is to minimise any further damage to your vision and to help you keep useful vision for as long as possible.
Because glaucoma is a condition which can deteriorate without you noticing changes to your vision, it is important to attend for regular review, where any problems can be picked up early and treatment given accordingly.
Some patients have high pressure in the eye but never develop any glaucoma damage. These are called ocular hypertensives. As it is impossible to tell who will go on to develop damage and who will not, all patients with high eye pressure need to have their eyes checked on a regular basis.
For other patients they may have some feature that makes one suspect glaucoma but there is not enough evidence to require long-term medication. These patients require monitoring over a life time.
How we treat Glaucoma
Glaucoma cannot be cured but it can be controlled.
What happens at each visit?
At each visit we will assess:-
· your vision
· your eye pressure (tonometry)
· your optic nerve (the seeing nerve)
In addition we may carry out the following:-
· perimetry -assessment of your side vision or peripheral field of vision
· photographs and/or a scan of the optic nerve.
You should follow the recommended treatment and attend the main consultant clinic on a regular basis until your condition is stabilised. Your treatment may need to be changed a few times before this stability is achieved.
Throughout this period you will remain under the direct supervision of your consultant until they are sure that your disease is under control.
For many people, once the glaucoma is under control, treatment can remain unchanged for many years. However you still need regular reviews to monitor your condition. This is done in the Stable Glaucoma Service by a specially trained team of optometrists and nurses.
Medication (eye drops)
The first choice of treatment usually for glaucoma is eye drops. These drops lower the pressure inside the eye and so reduce the chance of further damage to the optic nerve and your vision.
As the high pressure is caused by an imbalance between how much fluid you make in your eye and how quickly you can drain it away, eye drops that lower the pressure, work in different ways. Some reduce how much fluid you make and others help you to drain it away faster.
It is important to use all your drops as directed. Failure to take glaucoma medication regularly can cause large changes in your eye pressure which have been shown to be just as bad as a constant high pressure.
All medications have known side effects, but not everyone will experience them. If you are experiencing problems with your drops please let one of the Glaucoma team know and we shall try to provide an alternative.
You will be provided with a separate information sheet about your drops which will tell you how the drug works, how often to use it and the common side effects to expect in some cases.
Laser and surgical treatment
In some cases eye drops are not enough to control your pressure. We then have to consider laser treatment or surgery. The consultant will discuss this with you in detail should this become necessary.
Treatment for your Glaucoma
You will find information on your medications on the sheets provided. Each sheet provides information on how your drops work, how often to use them and how to keep them fresh. Most people have no problems using eye drops. Common side effects are also listed so you know what to look out for if you do have problems.
When taking more than one drop, please allow at least 10 minutes between each drop so that the first one has a chance to sink in before you instil the other one.
Some words you might hear
1. IOP –This stands for Intra-Ocular Pressure (pressure inside the eye). The eye is constantly producing a clear fluid which nourishes the inside of the eye (aqueous humor), and this can be measured. The balance between how quick the fluid is made and drains away determines the Intra-ocular pressure.
Some people may have high pressure but do not experience the changes associated with glaucoma. This is called ocular hypertension. This may need treatment in some cases and always needs to be watched in case any glaucoma damage occurs.
Some people may have some changes in the eye or vision that looks like glaucoma but may not be. These people are called glaucoma suspects. They need to be watched in case the change gets worse
High tension glaucoma occurs when the eye pressure is above normal limits and there are the changes in the eye associated with glaucoma. This almost always needs treatment.
Normal tension glaucoma is when the eye pressure is within normal limits but the eye and vision has the changes associated with glaucoma. This often needs treatment.
In all these conditions the aim of treatment is to stop the pressure causing damage at the back of the eye and retaining vision.
2. Perimetry or visual fields-This is a special test which looks at how much you can see around the edges of your vision. In glaucoma you can lose this vision without realising it. Changes in your visual fields may mean a change in treatment is required. This would be discussed with you.
3. HRT-This stands for Heidelberg Retinal Tomography. This is a state of the art camera which takes digital photographs of the optic nerve (the part of the eye which is damaged in glaucoma). It is painless. Usually no dilating drops are needed. It produces instant pictures and with the aid of computer technology will help to decide how your condition is doing.
Common questions answered
These are some of the commonly asked questions. If you have any queries at all, please ask when you attend the hospital or contact a member of the Glaucoma team. (See your glaucoma service for contact details at the end of this booklet)
Will I go blind?
The majority of people with glaucoma do not go blind. In the United Kingdom around 95% of those diagnosed with early glaucoma, will retain useful sight for life with treatment. Most damage is done prior to diagnosis. If the condition goes untreated there is a big risk of reduction in vision. 13% of people on the blind register have some form of glaucoma.
What about my family?
As glaucoma can run in families, any parent, siblings and children over the age of 40 should be checked by an optometrist. The test is simple and painless. Where a first degree relative has glaucoma, the test is free to those over 40. Just tell your optometrist that you have a family member with the disease. People from families with glaucoma should be tested from the age of 35 if the disease was diagnosed earlier in the family. In general you are four times more likely to develop glaucoma if some one in
the family already has the condition. This is more so if two or more family members are affected.
Is there any other treatment?
Some people may need surgery or laser treatment to help control their glaucoma. For the majority of people their condition is successfully managed with drops.
What if I forget to put my drops in?
Do not panic if you forget to put in your drops. As soon as you remember put one in. However in order for glaucoma to remain well controlled it is important to use your drops regularly as instructed. If you are going away from home remember to take the bottles with you. Always keep a spare bottle so that you have a constant supply and cannot run out.
Am I able to still drive?
The vast majority of people with glaucoma can continue to drive. However you must, by law, inform DVLA. They will then arrange a special driving visual field, and obtain a report. If you then meet the minimum standards of vision required for driving you will be allowed to continue to do so. It is also advisable to inform your insurance company. If you have any concerns regarding driving please ask the doctor or optometrist at your next appointment.
Other sources of information
The following is a small list of helpful organisations and websites:
For information regarding driving contact DVLA:
Address: Drivers Medical Branch
For information regarding glaucoma, support from others with glaucoma and up-to date news on treatments there is the International Glaucoma Association or IGA
Their symbol is a green frog.
15, Highpoint Business Village,
For general information there is the Glaucoma Foundation. It is mainly geared towards the American patient but has very useful information around eye drops.