Glaucoma is the second leading cause of blindness in the U.S., affecting some 3 million, causing blindness in about 120,000. Chronic glaucoma usually develops after age 35 and is often called "the silent thief of sight" because it gives no warning sign that anything is wrong. Glaucoma gradually reduces your peripheral vision, and by the time it's noticed, permanent damage has already occurred. Eventually, tunnel vision develops and only straight-ahead vision may be possible.

An acute attack of narrow-angle glaucoma (also called acute angle-closure glaucoma) produces sudden symptoms such as eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting. These signs may last for a few hours, then return again for another round. Each attack takes part of your field of vision. Other signs include headaches, blurred vision, difficulty adapting to darkness, or haloes around lights.

The best way to prevent vision loss from glaucoma is early diagnosis and treatment. See your eye care practitioner regularly for a complete examination, including an intraocular pressure check. People at high risk for glaucoma due to high intraocular pressures, family history, age or optic nerve appearance may need more frequent visits.

The main objective for treating glaucoma is preserving eyesight by slowing the damage to the nerve in the back of the eye (optic nerve). Most treatment aims to prevent further damage to the optic nerve by lowering the pressure in the eyes. Though glaucoma can usually be treated with medications, such as eye drops, laser treatment or surgery is often required. Surgery for glaucoma helps to maintain the health of the optic nerve and reduces the pressure in the eyes. There are three basic types of surgery for glaucoma in adults. Ask your doctor about what type of surgery is best for you.

What is glaucoma?
Glaucoma is a disease of the optic nerve, which is the part of the eye that carries the images we see from the eye to the brain. The optic nerve is made up of many nerve fibers (like an electric cable containing numerous wires). Glaucoma damages nerve fibers, which can cause blind spots in our vision and vision loss to develop.

Normal optic nerve	Abnormal optic nerve

Visual field loss from glaucoma

Glaucoma has to do with the pressure inside the eye, or intraocular pressure. When the clear liquid called the “aqueous humor”, which normally flows in and out of the eye, cannot drain properly, pressure builds up in the eye. The resulting increase in pressure can damage the optic nerve.

Measurement of intraocular pressure.

The most common form of glaucoma is primary open-angle glaucoma, where the aqueous fluid that normally circulates in the front portion of the eye is blocked from flowing back out of the eye through a tiny drainage system. This causes the pressure inside your eye to increase, which can damage the optic nerve and lead to vision loss. Most people who develop primary open-angle glaucoma notice no symptoms until their vision is impaired.

Open-angle glaucoma

Open-angle glaucoma may be treated with eye drops, laser treatment and surgery. In most cases topical medications are all that are needed. In order for glaucoma to be controlled, taking eye drops everyday is important.

A laser can be used to treat open-angle glaucoma. The laser is aimed at the part of the eye responsible for draining the fluid in the eye, to open it up. This is called Selective Laser Trabeculoplasty.

Finally, surgery can be performed to create a hole in the eye so that fluid can drain out in a controlled fashion. This procedure is called a trabeculectomy.

In angle-closure glaucoma, the iris (the colored part of the eye) may drop over and completely close off the drainage angle, abruptly blocking the flow of watery fluid and leading to increased intraocular pressure. In acute angle-closure glaucoma, there is a sudden increase in pressure due to the buildup of fluid. This condition is considered an emergency because optic nerve damage and vision loss can occur within hours of the problem. Symptoms can include nausea, vomiting, seeing haloes around light, and eye pain.

If you have a narrow angle or if you have had an attack of angle-closure glaucoma, future attacks may be prevented by a laser treatment called laser peripheral iridectomy.

Even people with normal intraocular pressure can experience vision loss from glaucoma. This condition is called normal tension glaucoma. In this type of glaucoma, the optic nerve is damaged even though it is considered normal. Normal tension glaucoma is not well understood, but we do know that lowering optic nerve damage has been shown to slow progression of this form of glaucoma. This type is seen more commonly in people of Asian descent.

Childhood glaucoma is rare, and starts in infancy, childhood or adolescence. Like primary open-angle glaucoma, there are few, if any, symptoms in the early stages. Blindness can result if it is left untreated. Like most types of glaucoma, this type of glaucoma may run in families.

You are at risk for glaucoma if you have one or more risk factors, including elevated intraocular pressure, a family history of glaucoma, a particular ethnic background, advanced age, or certain optic nerve conditions. Regular examinations are important if you are at risk for any of these conditions.

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