What if you were losing your vision and didn’t know it? Open-angle glaucoma, the most common form of glaucoma, often develops without warning.
Unfortunately, there’s not a lot you can do to prevent open-angle glaucoma, which occurs when fluid doesn’t drain properly from your eye, causing pressure to build. This then damages your optic nerve over time. Doctors don’t know why this happens, and most of the risk factors are things you can’t change—your age (it tends to affect people over the age of 60), your race (Black people are at higher risk) and your family history.
That might sound scary, given that glaucoma is one of the leading causes of blindness in the United States. But here’s the good news: You do have control over whether glaucoma leads to vision loss.
“People who go blind from glaucoma usually started treatment too late, when they already had restricted vision,” says UNC Health ophthalmologist Rodolfo Bonatti, MD. “The other group that goes blind are the people who forget to follow up with their doctor once they’re diagnosed. They lose contact, and when they come back, there’s been too much progression.”
Dr. Bonatti explains how to find out you have glaucoma before your vision is affected and how treatment can protect your sight.
Regular Eye Exams Find Glaucoma Before Symptoms Start
In its early stages, open-angle glaucoma has no symptoms.
“With glaucoma, you lose vision from the periphery to the center, which means you typically don’t notice until the center of the eye is affected, and that can be too late,” Dr. Bonatti says. “This is why it’s so important to have an annual eye exam, especially if you’re over 40.”
If you have a family history of glaucoma, you should be getting regular eye exams even earlier—ideally, as soon as you learn of a family member’s diagnosis.
“If you’re the one diagnosed with glaucoma, we recommend that your direct family members get evaluations,” Dr. Bonatti says. “It doesn’t mean they’re definitely going to have glaucoma, but it’s important to see if there are any signs and observe them more closely.”
During a comprehensive eye exam, your doctor will check the pressure of your eye to be sure its within normal range. If it’s elevated, you’ll have additional tests: a visual field test, which measures your peripheral vision, and optical coherence tomography (OCT), which uses ultrasound and a special eye laser to look at your optic nerve fiber.
After these tests, your doctor can definitively diagnose glaucoma and create a plan to lower the pressure in your eyes.
Treatment Options for Glaucoma
The typical first step for glaucoma treatment are special eye drops called prostaglandin analogues.
“These eye drops help the eye produce more liquid to increase drainage, which reduces the pressure in the eye,” Dr. Bonatti says. “You have to use them every day, and some of them you use more than once a day.”
Unfortunately, people can forget to use their eye drops daily. Unlike eye drops for a condition like dry eye, you don’t notice an immediate effect from these eye drops, since you can’t feel the pressure in your eye dropping. They can also cause side effects, such as eye redness or irritation.
If you’re struggling to remember your eye drops, a new option has emerged in the past two decades for open-angle glaucoma: selective laser trabeculoplasty. During this in-office procedure, your doctor aims a laser at the drainage system of your eye.
“The laser causes inflammation, and then your body heals it so there’s better drainage,” Dr. Bonatti says. “It’s very safe and efficient—it has the same effect as eye drops, and it’s more economical in the long-term than the eye drops. The effects last for three to five years, and we can repeat it if it’s not controlling the glaucoma.”
If eye drops or laser treatment do not reduce the pressure in the eye, or these treatments lose their effectiveness over time, there are surgical options, some of which can be done at the same time as cataract surgery (which also can help lower pressure in the eye, in addition to helping you see more clearly).
Your doctor can place a tube called a stent or a shunt into your eye to help fluid drain better, or they can perform a trabeculectomy, which involves making a new tiny opening that will become the eyes’ new drainage system.
“That one does require a patient who is committed to following up with the post-op schedule, because we have to see you three or four times in the first month,” Dr. Bonatti says.
No matter which option you pursue, regular visits with your eye doctor are a must so that they can monitor your eye pressure and keep it low to prevent further damage.
“Follow your treatment, continue to go to your doctor and we can keep you below that threshold,” Dr. Bonatti says. “With treatment, most people keep their full vision.”
If you’re concerned about your eyes, talk to your doctor or find one near you.