Why might someone be losing their vision? Orthopedic surgeons Brad Weaning, M.D. and Paul Zalzal, M.D. welcomed ophthalmologist Rajiv Bindlish, M.D., to their YouTube channel Talking With Docs, to provide a concise and accessible overview of glaucoma, a leading cause of blindness in people over 60 when left untreated.*

What is glaucoma?

Glaucoma is actually a group of disorders affecting the optic nerve, a sort of “computer cable” that connects the eye to the brain, Bindlish explains. Glaucoma occurs when this nerve becomes damaged, leading to loss of peripheral (side) vision.

• A major risk factor for glaucoma is elevated internal eye (intraocular) pressure, or IOP, where eye pressure is above the normal range of 10-22 mmHg (millimeters of mercury). This is a common symptom of glaucoma. That said, having elevated IOP doesn’t necessarily mean that you have glaucoma, he says.

Fluid that nourishes the eye and keeps it inflated is made continuously, with the excess draining from the eye back into the body to maintain a steady level of pressure. If the drainage path becomes blocked, fluid will build up (like in a sink with a clogged drainpipe), resulting in higher IOP. IOP naturally rises as we age, which increases our glaucoma risk but doesn’t guarantee that we’ll develop it.

Symptoms and diagnosis 

Glaucoma is mostly asymptomatic, which is why it’s called “the silent thief of sight.” It’s often discovered during a regular eye exam. If you notice you’re losing peripheral vision, you should see your eye doctor for an evaluation. 

Your optometrist may refer you to an ophthalmologist (an eye doctor who can also perform eye surgery) who will look for signs of optic nerve damage. If damage is detected after photographing the optic nerve and testing the visual field, the doctor may present a diagnosis of early, moderate, or advanced glaucoma. 

Mostly controllable 

Though there’s currently no cure for glaucoma, the majority of cases are controllable. “Very, very few people actually lose their vision from glaucoma,” Bindlish says, if they are diagnosed and begin treatment early, and stay consistent with that treatment. 

How is glaucoma treated? 

Treatment options for glaucoma include:

• Eye drops
• Laser
• Surgical procedures

Eye drops and laser

Current treatments are aimed at lowering IOP. First-line therapy has long been eye drops, which generally reduce IOP by about 30%. Several years ago, however, a study found laser therapy to be as good as or better than eye drops. Now, laser is sometimes used right away.

Laser essentially clears and rejuvenates the part of the eye’s drainage system that’s blocked. In this way, the inconvenience and possible side effects of eye drops can be avoided, and eye drop compliance—”the biggest issue in glaucoma,” says Bindlish—is no longer an issue.

Eye drop medications to control glaucoma are taken for life. Bindlish says the disease worsens over time, and multiple treatments are typically needed. Follow-up care is, therefore, just as important as initial treatment.

Surgery

A number of surgical options are also available for treating glaucoma. Besides trabeculectomy and tube shunt, there is a large class of surgeries called MIGS (minimally invasive glaucoma surgery) that minimize risks and side effects common to the older forms of glaucoma surgery. 

Typically, MIGS is combined with cataract surgery. As the cataract is removed, the eye’s drainage system is cleared to lower IOP through the same incision.

Any surgery comes with risk, though, cautions Bindlish. IOP may stay high or drop too low. Other risks include bleeding, infection, and blindness. Risks are “very low,” however, he says, while the success rate for glaucoma treatment is 80%-90%.

*Talking With Docs. (2023, March 29). Glaucoma: Why You May Be Losing Your Vision [Video file]. YouTube. Retrieved from https://www.youtube.com/watch?v=tu5C-6ROO8A