Glaucoma and My Commentary

Overview

Open-angle glaucomaEnlarge image

Glaucoma is a group of eye conditions that damage the optic nerve. The optic nerve sends visual information from your eye to your brain and is vital for good vision. Damage to the optic nerve is often related to high pressure in your eye. But glaucoma can happen even with normal eye pressure.

Glaucoma can occur at any age but is more common in older adults. It is one of the leading causes of blindness for people over the age of 60.

Many forms of glaucoma have no warning signs. The effect is so gradual that you may not notice a change in vision until the condition is in its later stages.

It’s important to have regular eye exams that include measurements of your eye pressure. If glaucoma is recognized early, vision loss can be slowed or prevented. If you have glaucoma, you’ll need treatment or monitoring for the rest of your life.

Products & Services

• A Book: Mayo Clinic Guide to Better Vision

Symptoms

The symptoms of glaucoma depend on the type and stage of your condition.

Open-angle glaucoma

• No symptoms in early stages
• Gradually, patchy blind spots in your side vision. Side vision also is known as peripheral vision
• In later stages, difficulty seeing things in your central vision

Acute angle-closure glaucoma

• Severe headache
• Severe eye pain
• Nausea or vomiting
• Blurred vision
• Halos or colored rings around lights
• Eye redness

Normal-tension glaucoma

• No symptoms in early stages
• Gradually, blurred vision
• In later stages, loss of side vision

Glaucoma in children

• A dull or cloudy eye (infants)
• Increased blinking (infants)
• Tears without crying (infants)
• Blurred vision
• Nearsightedness that gets worse
• Headache

Pigmentary glaucoma

• Halos around lights
• Blurred vision with exercise
• Gradual loss of side vision

When to see a doctor

If you experience symptoms that come on suddenly, you may have acute angle-closure glaucoma. Symptoms include severe headache and severe eye pain. You need treatment as soon as possible. Go to an emergency room or call an eye doctor’s (ophthalmologist’s) office immediately.

Request an appointment

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

Email

Learn more about Mayo Clinic’s use of data.

Subscribe!

Causes

Glaucoma develops when the optic nerve becomes damaged. As this nerve gradually deteriorates, blind spots develop in your vision. For reasons that doctors don’t fully understand, this nerve damage is usually related to increased pressure in the eye.

Elevated eye pressure happens as the result of a buildup of fluid that flows throughout the inside of the eye. This fluid also is known as the aqueous humor. It usually drains through a tissue located at the angle where the iris and cornea meet. This tissue also is called the trabecular meshwork. The cornea is important to vision because it lets light into the eye. When the eye makes too much fluid or the drainage system doesn’t work properly, eye pressure may increase.

Open-angle glaucoma

This is the most common form of glaucoma. The drainage angle formed by the iris and cornea remains open. But other parts of the drainage system don’t drain properly. This may lead to a slow, gradual increase in eye pressure.

Angle-closure glaucoma

This form of glaucoma occurs when the iris bulges. The bulging iris partially or completely blocks the drainage angle. As a result, fluid can’t circulate through the eye and pressure increases. Angle-closure glaucoma may occur suddenly or gradually.

Normal-tension glaucoma

No one knows the exact reason why the optic nerve becomes damaged when eye pressure is normal. The optic nerve may be sensitive or experience less blood flow. This limited blood flow may be caused by the buildup of fatty deposits in the arteries or other conditions that damage circulation. The buildup of fatty deposits in the arteries also is known as atherosclerosis.

Glaucoma in children

A child may be born with glaucoma or develop it in the first few years of life. Blocked drainage, injury or an underlying medical condition may cause optic nerve damage.

Pigmentary glaucoma

In pigmentary glaucoma, small pigment granules flake off from the iris and block or slow fluid drainage from the eye. Activities such as jogging sometimes stir up the pigment granules. That leads to a deposit of pigment granules on tissue located at the angle where the iris and cornea meet. The granule deposits cause an increase in pressure.

Glaucoma tends to run in families. In some people, scientists have identified genes related to high eye pressure and optic nerve damage.

Risk factors

Glaucoma can damage vision before you notice any symptoms. So be aware of these risk factors:

• High internal eye pressure, also known as intraocular pressure
• Age over 55
• Black, Asian or Hispanic heritage
• Family history of glaucoma
• Certain medical conditions, such as diabetes, migraines, high blood pressure and sickle cell anemia
• Corneas that are thin in the center
• Extreme nearsightedness or farsightedness
• Eye injury or certain types of eye surgery
• Taking corticosteroid medicines, especially eye drops, for a long time

Some people have narrow drainage angles, putting them at increased risk of angle-closure glaucoma.

Prevention

These steps may help detect and manage glaucoma in its early stages. That may help to prevent vision loss or slow its progress.

• Get regular eye examinations. Regular comprehensive eye exams can help detect glaucoma in its early stages, before significant damage occurs. As a general rule, the American Academy of Ophthalmology recommends a comprehensive eye exam every 5 to 10 years if you’re under 40 years old; every 2 to 4 years if you’re 40 to 54 years old; every 1 to 3 years if you’re 55 to 64 years old; and every 1 to 2 years if you’re older than 65.

If you’re at risk of glaucoma, you’ll need more frequent screening. Ask your health care provider to recommend the right screening schedule for you.

• Know your family’s eye health history. Glaucoma tends to run in families. If you’re at increased risk, you may need more frequent screening.
• Wear eye protection. Serious eye injuries can lead to glaucoma. Wear eye protection when using power tools or playing sports.
• Take prescribed eye drops regularly. Glaucoma eye drops can significantly reduce the risk that high eye pressure will progress to glaucoma. Use eye drops as prescribed by your health care provider even if you have no symptoms.

Diagnosis

Your health care provider will review your medical history and conduct a comprehensive eye examination. Your provider may perform several tests, including:

• Measuring intraocular pressure, also called tonometry
• Testing for optic nerve damage with a dilated eye examination and imaging tests
• Checking for areas of vision loss, also known as a visual field test
• Measuring corneal thickness with an exam called pachymetry
• Inspecting the drainage angle, also known as gonioscopy

Treatment

The damage caused by glaucoma can’t be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially if you catch the disease in its early stages.

Glaucoma is treated by lowering intraocular pressure. Treatment options include prescription eye drops, oral medicines, laser treatment, surgery or a combination of approaches.

Eyedrops

Glaucoma treatment often starts with prescription eye drops. Some may decrease eye pressure by improving how fluid drains from your eye. Others decrease the amount of fluid your eye makes. Depending on how low your eye pressure needs to be, you may be prescribed more than one eye drop.

Prescription eye drop medicines include:

• Prostaglandins. These increase the outflow of the fluid in your eye, helping to reduce eye pressure. Medicines in this category include latanoprost (Xalatan), travoprost (Travatan Z), tafluprost (Zioptan), bimatoprost (Lumigan) and latanoprostene bunod (Vyzulta).

Possible side effects include mild reddening and stinging of the eyes, darkening of the iris, darkening of the pigment of the eyelashes or eyelid skin, and blurred vision. This class of drug is prescribed for once-a-day use.

• Beta blockers. These reduce the production of fluid in your eye, helping to lower eye pressure. Examples include timolol (Betimol, Istalol, Timoptic) and betaxolol (Betoptic S).

Possible side effects include difficulty breathing, slowed heart rate, lower blood pressure, impotence and fatigue. This class of drug can be prescribed for once- or twice-daily use depending on your condition.

• Alpha-adrenergic agonists. These reduce the production of the fluid that flows throughout the inside of your eye. They also increase the outflow of fluid in your eye. Examples include apraclonidine (Iopidine) and brimonidine (Alphagan P, Qoliana).

Possible side effects include irregular heart rate, high blood pressure, fatigue, red, itchy or swollen eyes, and dry mouth. This class of drug is usually prescribed for twice-daily use but sometimes can be prescribed for use three times a day.

• Carbonic anhydrase inhibitors. These medicines reduce the production of fluid in your eye. Examples include dorzolamide and brinzolamide (Azopt). Possible side effects include a metallic taste, frequent urination, and tingling in the fingers and toes. This class of drug is usually prescribed for twice-daily use but sometimes can be prescribed for use three times a day.
• Rho kinase inhibitor. This medicine lowers eye pressure by suppressing the rho kinase enzymes responsible for fluid increase. It is available as netarsudil (Rhopressa) and is prescribed for once-a-day use. Possible side effects include eye redness and eye discomfort.
• Miotic or cholinergic agents. These increase the outflow of fluid from your eye. An example is pilocarpine (Isopto Carpine). Side effects include headache, eye ache, smaller pupils, possible blurred or dim vision, and nearsightedness. This class of medicine is usually prescribed to be used up to four times a day. Because of potential side effects and the need for frequent daily use, these medicines are not prescribed very often anymore.

Because some of the eye drop medicine is absorbed into your bloodstream, you may experience some side effects unrelated to your eyes. To minimize this absorption, close your eyes for 1 to 2 minutes after putting the drops in. You also may press lightly at the corner of your eyes near your nose to close the tear duct for 1 or 2 minutes. Wipe off any unused drops from your eyelid.

You may have been prescribed multiple eye drops or need to use artificial tears. Make sure you wait at least five minutes in between using different drops.

Oral medications

Eye drops alone may not bring your eye pressure down to the desired level. So your eye doctor may also prescribe oral medicine. This medicine is usually a carbonic anhydrase inhibitor. Possible side effects include frequent urination, tingling in the fingers and toes, depression, stomach upset, and kidney stones.

Surgery and other therapies

Other treatment options include laser therapy and surgery. The following techniques may help to drain fluid within the eye and lower eye pressure:

• Laser therapy. Laser trabeculoplasty (truh-BEK-u-low-plas-tee) is an option if you can’t tolerate eye drops. It also may be used if medicine hasn’t slowed the progression of your disease. Your eye doctor also may recommend laser surgery before using eye drops. It’s done in your eye doctor’s office. Your eye doctor uses a small laser to improve the drainage of the tissue located at the angle where the iris and cornea meet. It may take a few weeks before the full effect of this procedure becomes apparent.
• Filtering surgery. This is a surgical procedure called a trabeculectomy (truh-bek-u-LEK-tuh-me). The eye surgeon creates an opening in the white of the eye, which also is known as the sclera. The surgery creates another space for fluid to leave the eye.
• Drainage tubes. In this procedure, the eye surgeon inserts a small tube in your eye to drain excess fluid to lower eye pressure.
• Minimally invasive glaucoma surgery (MIGS). Your eye doctor may suggest a MIGS procedure to lower your eye pressure. These procedures generally require less immediate postoperative care and have less risk than trabeculectomy or using a drainage device. They are often combined with cataract surgery. There are a number of MIGS techniques available, and your eye doctor will discuss which procedure may be right for you.

After your procedure, you’ll need to see your eye doctor for follow-up exams. And you may eventually need to undergo additional procedures if your eye pressure begins to rise or other changes occur in your eye.

Treating acute angle-closure glaucoma

Acute angle-closure glaucoma is a medical emergency. If you’re diagnosed with this condition, you’ll need urgent treatment to reduce the pressure in your eye. This generally will require treatment with medicine and laser or surgical procedures.

You may have a procedure called a laser peripheral iridotomy. The doctor creates a small hole in your iris using a laser. This allows fluid to flow through the iris. This helps to open the drainage angle of the eye and relieves eye pressure.

Request an appointment

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

Email

Learn more about Mayo Clinic’s use of data.

Subscribe!

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

These tips may help you control high eye pressure or promote eye health.

• Eat a healthy diet. Eating a healthy diet can help you maintain your health, but it won’t prevent glaucoma from worsening. Several vitamins and nutrients are important to eye health, including zinc, copper, selenium and antioxidant vitamins C, E and A.
• Exercise safely. Regular exercise may reduce eye pressure. Talk to your health care provider about an appropriate exercise program.
• Limit your caffeine. Drinking beverages with large amounts of caffeine may increase your eye pressure.
• Sip fluids carefully. Drink moderate amounts of fluids. Drinking a quart or more of any liquid within a short time may temporarily increase eye pressure.
• Take prescribed medicine. Using your eye drops or other medicines as prescribed can help you get the best possible result from your treatment. Be sure to use the drops exactly as prescribed. Otherwise, your optic nerve damage could get worse.

Alternative medicine

Some alternative medicine approaches may help your overall health, but none is an effective glaucoma remedy. Talk with your doctor about their possible benefits and risks.

• Herbal remedies. Some herbal supplements, such as bilberry extract, have been advertised as glaucoma remedies. But further study is needed to prove their effectiveness. Don’t use herbal supplements in place of proven therapies.
• Relaxation techniques. Stress may trigger an attack of acute angle-closure glaucoma. Try to find healthy ways to cope with stress. Meditation and other techniques may help.
• Marijuana. Research shows that marijuana lowers eye pressure in people with glaucoma, but only for 3 to 4 hours. Other, standard treatments are more effective. The American Academy of Ophthalmology doesn’t recommend marijuana for treating glaucoma.

Coping and support

When you receive a diagnosis of glaucoma, you’re potentially facing lifelong treatment, regular checkups and the possibility of progressive vision loss.

Meeting and talking with other people with glaucoma can be very helpful, and many support groups exist. Check with hospitals and eye care centers in your area to find local groups and meeting times. Look for online resources, including support groups.

Preparing for your appointment

You may start by seeing your primary health care provider. Or you may be referred immediately to an eye specialist (ophthalmologist).

Here’s some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there’s anything you need to do in advance, such as fasting before having a specific test. Make a list of:

• Your symptoms, including any that seem unrelated to the reason for your appointment
• Key personal information, including major stresses, recent life changes and family medical history
• All medications, vitamins or other supplements you take, including the doses
• Questions to ask your doctor

Take a family or friend along, if possible, to help you remember the information you’re given.

For glaucoma, some basic questions to ask include:

• What’s likely causing my symptoms?
• Other than the most likely cause, what are other possible causes for my symptoms?
• What tests do I need?
• Is my condition likely temporary or chronic?
• What’s the best course of action?
• What are the alternatives to the primary approach you’re suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there restrictions I need to follow?
• What other self-care measures might help me?
• What is the long-term outlook in my case?
• Should I see a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don’t hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you several questions, such as:

• When did your symptoms begin?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

What you can do in the meantime

Avoid doing anything that seems to worsen your symptoms.

Good Day Everyone!!  My name is Anthony Joseph Hopkins and I am from Dayton, Ohio.  I want all of you to know that I have been suffering from Primary Open Angle Glaucoma for a total of 19 years now.

 I ended up getting Glaucoma from taking a medication called Tegretol for over 10 years for seizures and depression.  I have been taking Depakote for a total of three years.  I also had taken a series of medications for depression that has affected my vision for a very long time.  I have been consulting with Dr. Spencer for the past three years now.  His medical Practice is located at Grandview Hospital and Southview Hospital in Dayton, Ohio.

Next, I want to inform all of you that I am currently taking a total of 38 pills per day.  My eyedrops that I am taking for Glaucoma is called Dorzolamide and Latanoprost.  I take these medications three times per day.  I have been dealing with vision problems since I was 37 years old. 

I have been dealing with Glaucoma for 21 years now.  It has not been very easy taking medications for various physical and mental health problems.  I want you to know that it has not been easy handling all of these problems at one time.  I am very sorry for typing all of this information regarding Glaucoma.  This is something that I want to share with all of you about because this is very serious.

Finally, I want all of you to please keep me in your prayers and thoughts.  I know that I have been using the eyedrops and other medications for all of my health problems.  It has been a journey when it comes to taking with this eye disease.  Glaucoma and Diabetes runs in our family.

 I guess that I will have to take medication for the rest of my life for Glaucoma.  I am the only one out of my mother’s children who have a lot of health problems.  My sister passed away from a rare blood disease on Friday June 2, 2017.  It has been almost seven years since my mother and sister died.  I had just recently lost my Uncle last year.  He lived to see 80 years old.  I am only 58 years old and I hope and pray that I can see 80 years on Planet Earth.  God Bless All of You!!

For Where Your Treasure is There Your Heart Will be Also.  What does this Bible verse mean?  It means that your heart determines where you should go.  Where is your treasure is right now? Treasure is like your possessions and or desires that you have for yourself.  I know that my mind is on achieving for God.  How do you achieve the things for God?  The first thing you are supposed to do is share the Gospel of Peace with everyone.  No matter how you feel, you are supposed to be pleasing in the eyes of the Lord.  Before you talk to another person about God, you are supposed to ask God to change your attitude.  What is an attitude?  An attitude is a state of mind or a particular feeling.  A treasure is a valuable possession.  The Bible says that a treasure is desires that someone may have about numerous of things.  Treasure is also how we define ourselves while we are in the presence of God.  Treasure is how we feel about ourselves.  I love the Lord God because I am very happy to be a Child of the Most High God.  I tell everyone that I love them for the person that they are.  My heart has a lot to do with my feelings on a subject or how I feel about myself.

Next, I feel really good about myself and others.  You see, I feel much better now.  I have to be honest by saying that I always pray and read the Bible each day.  I always tell someone that I love you.  I am content with myself and with God.  Dear God, when we are struggling with believing you will answer our prayers, help us to remember that you are capable of all things. Help us to place our trust in your promises and to believe that you know what we need and when we need it. Do not allow me to place faith in myself or anyone else but you, O Lord. Jesus, you are all we need. Give us peace knowing you have a plan for our lives. May our belief in you and your endless possibilities draw others to you. In Jesus’ name, amen.  God has delivered me of all of my fears.  Please allow me to be a vessel of truth for all people.

Finally, I want to say Thank You for understanding me for the person that I am.  I thank you Lord for allowing me to share Your Good News with everyone.  Please keep me inside of Your Precious Hands.  Lord God, I am ready to serve you.  Lord God, I am willing to share Your Precious Word with everyone.  I Love Your Creation.  Please allow me to be a Leader for you.  To know you is to know about You.  Thank You for reading my essay.

Peace I leave with you, My peace I gives to you; not as the world gives do I give to you ; Let not your hearts be troubled, neither let them be afraid.  This means that Jesus Christ is responsible for giving us true peace and not as the world gives to you.  Let not your hearts be troubled.  This means that we should not worry and become stressful over needful things.  I know that for me Jesus Christ is responsible for giving me the right peace that I am talking about.  I will admit that I used to cry out and be stressful over small things and not of matters of the heart.  

Next, I used to be a person who would demand things from other people.  What really changed my overall behavior tremendously is that I got into a car accident with my best male friend in Dayton, Ohio on the Corner of East Third Street and Keowee back on April 9, 1984.  I was going on 19 years old during that time.  I will also admit that I was intoxicated due to drinking alcohol and smoking marijuana two hours earlier that day. I was rushed to Miami Valley Hospital for 72 hours of observation.  Three months later, I had  broken my left hand playing basketball intoxicated due to drinking alcohol and smoking marijuana earlier that day.  I had hand surgery on my entire left hand.  I remember when I was playing basketball with some friends and suddenly I got faked out by one of my friends on the basketball court at Edison Elementary School in Dayton, Ohio.  I was not able to play basketball for almost two years.  I had to go through Physical and Occupational Therapy for two years.  Afterwards, I started having seizures in public.  I have had seizures more than several times during a three year period.

Further, whenever I think of this Bible verse, it reminds me of Jesus Christ walking on the water, and the Disciples thought He was a ghost.  Jesus Christ said to them be of good cheer, it is I do not be afraid.  That is in Matthew 14:27.  This is the truth about the disciples on the boat and Peter asked Him can he walk on the water with Him, He said Come! This reminded me of all of my fair weather friends who used to use and abuse me in the process.  It has taken me a long time, but I forgave everyone who had used me and abused me physically and mentally.

Moreover, I consider myself a very good person for forgiving all of my accusers.  There are people who are still angry with me over their foolish deeds that were done by them to me.  I am very happy that God has spared my life right now.  I am very happy for being among the living right now.  My life up to this point is based on my ups and downs behaviorally for the past 28 years now.  Although I was seeking help for my behavior issues.  I have been through a lot of adversity during the past 14 years now.

Finally, I am better right now.  I do not argue with anyone else anymore.  I pray and read the Bible every day of the week.  I have to admit that I am suffering from Alzheimer’s and Schizophrenia right now.  I also suffer from Type 2 Diabetes Full Blown.  I have a lot of pills to take each day of the week for a long number of ailments physically and mentally.  The Lord God has been right by my side.  I am losing my memory right now.  I love all of you for your friendship, prayers, and support.  I am trying to complete my fourth book.  Authorhouse Publications in Bloomington Indiana is my Publishers.  Thank you for keeping me and my family members in your prayers and thoughts.  Lord Jesus, please teach me how to cope with my mental illness called Schizoid Affective Disorder and Schizophrenia.  Thank all of you understanding my situation and praying for me and my family members.  Thank you for reading my essay.