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What is Glaucoma?
Glaucoma is an eye condition that gradually steals your sight without warning. It does that by damaging your eye’s optic nerve - the nerve that sends images your eye sees to the brain.
It usually happens when fluid builds up in the front part of your eye - resulting in high pressure within the eye that pushes back on the optic nerve. If the damage worsens, glaucoma can cause permanent vision loss or even total blindness.
In Singapore, glaucoma affects about 3% of those aged over 40 and this risk increases with age. In 2020, about 80 million people worldwide have glaucoma and this number is expected to increase to over 111 million by 2040.
How Glaucoma affects the eye
The Eye is like a ball filled with fluid which provides oxygen and nourishment to the rest of eye. The ciliary body produces the fluid which is then drained out of The Eye via the trabecular meshwork.
In a normal functioning eye, the production must balance the drainage.
When the production increases or if the drainage is blocked - then The Eye pressure will go up.
Risk factors of Glaucoma
- Positive family history of glaucoma
- Older age group - the risk increases once you are above 40
- Ethnicity - Asians, Africans and Hispanics are at a higher risk
- Co-existing medical conditions like diabetes, hypertension or migraine
- Co-existing eye conditions like severe short-sightedness or previous eye injury
- Use of steroids
Types of Galucoma
There are three main types of glaucoma
- Open angle or wide angle glaucoma, which Is the most common
In open angle or wide angle glaucoma - the drainage system of the fluid is structurally open but is draining fluid slower than it should.
- Angle closure glaucoma which can either be sudden or longstanding
In angle closure glaucoma - the drainage system is blocked when the space between the iris and the cornea becomes too narrow.
- Normal tension glaucoma
In normal tension glaucoma, individuals can develop optic nerve damage even when their eye pressures are normal.
Symptoms of Galucoma
In most cases of open-angle glaucoma and long term angle-closure glaucoma, you may not notice any symptoms or visual loss till the advanced stage. Vision loss is gradual and peripheral vision is typically affected first.
As the condition progresses, the visual field narrows till only a small central island of vision is left.
In acute angle-closure glaucoma, symptoms are typically sudden and severe.
You may experience :
- sudden blurring of vision
- severe pain of The Eye or forehead
- redness of The Eye
- headache, nausea or vomiting
So if you experience any of the above symptoms, please go and see your family physician or eye specialist immediately.
Your eye specialist will go on to
- measure your eye pressure
- Inspect your eye’s drainage angle
- Examine your optic nerve for damage
- and assess your vision and visual field
Treatment of Galucoma
When an accurate diagnosis has been made - treatment can then be started
Most people with glaucoma who follow their treatment plan and have regular eye exams are able to keep their vision.
Treatment may involve
- Medical treatment by giving eyedrops and in some cases intravenous or oral anti-glaucoma medications
- Surgical treatment when medical treatment fails
- Laser therapy in certain situations.
Understand that glaucoma is a potentially blinding condition. In most cases, the good news is that the progression is usually gradual.
Pick it up early, treat early and follow the instructions of your eye doctor in terms of treatment and followup to prevent irreversible eye damage or blindness.
By : Dr Chen Yiming
Family Physician, MBBS (Singapore), GDFM (NUS), GDFP Dermatology (NUS)