Glaucoma: Irreversible but preventable blindness

glaucoa visual field defect - croppedAfter reading Dr. Weiss’ article last week on early detection of glaucoma, I was back in my office seeing one of my patients that drives this point home. My patient, let’s call him Jim, is a 59 year old gentleman who has lost vision from glaucoma. My partner and I had been seeing Jim for his annual exams and providing glasses to correct his vision since 1999. Beginning in about 2004, the pressure in his eyes started to increase. Normal intraocular pressure (IOP) is between the range of 10 to 20 millimeters of mercury (mmHg). Over a few years, his IOP slowly increased until they were running in the 20 to 21 range – not too bad – but enough that we discussed that we needed to monitor this more closely. In 2008 Jim’s IOP was 20, so he decided to skip his 2009 exam.

When, Jim came in for his “annual” exam in 2010, he had a very different complaint. He complained that if he covered his right eye, he could not see the lower part of his vision.  This fast loss of vision could be caused by a retinal detachment, but would be a very unusual symptom for glaucoma.

Vision loss with glaucoma usually takes years, or decades to advance to the point where it is noticeable to the patient. After ruling out a retinal tear or detachment, I took some time to look at glaucoma. The pressure in his eyes was up to 30mmHg, and close examination of the back of the eye showed glaucomatous damage to the optic nerve consistent with his visual field loss. We started treatment right away, and luckily stopped the progression of vision loss.

Over the years, my partners and I have created a large practice with increasing population of glaucoma patients. I am always amazed with the fact that no two patients progress in the same way. I have seen “normal pressure” glaucoma patients who have damage to their optic nerves even with “normal” pressures. I have patients with significantly high pressures who have no damage to their optic nerves. I have patients that we are able to control with eye drop medications that are only used one time each day. And, I have patients that need surgery to lower their eye pressure to prevent blindness. I am treating as many patients who have a family history of glaucoma as who have no family history. I have patients with glaucoma from 21 to 94 year old. The only way to prevent blindness from glaucoma is to catch it early with annual eye exams.

~ Steven Sage Hider, OD
California Optometric Association

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