Dr. M.J. Bazos, MD Patient Handout

About Your Diagnosis
Primary open angle glaucoma is a condition where the pressure inside the eye (intraocular pressure) is greater than normal. If the intraocular pressure were to be measured in everyone across the country, the average pressure would be 16 mm Hg. A pressure above 21 mm Hg is considered elevated. There are some patients with intraocular pressures of between 21 and 25 who do not go on to develop glaucoma. However, these patients need to be watched closely. The exact causes of primary open angle glaucoma are not well understood. Aqueous fluid is constantly produced within the eye and travels throughout the eye, ultimately draining through a trabecular meshwork to be reabsorbed back into the rest of the body. It is believed that in individuals with glaucoma, the trabecular meshwork does not allow the fluid to leave the eye as quickly as in “normal” patients and as a result, the pressure in the eye becomes elevated. Primary open angle glaucoma can be detected on examination. Except in advanced cases, there are no symptoms associated with it. One of the tests which is helpful for diagnosing glaucoma is called a visual field test. In this test, the patient stares at a screen and lights flash in different positions to check the patient’s peripheral vision. In glaucoma, the first sign of damage to the eye is a decrease in peripheral vision. Therefore the visual field test can be examined by the patient’s eye doctor to assess whether there is early damage to peripheral vision. In addition, the patient’s eye doctor will carefully examine the inside of the eye to look at the appearance of the optic nerve. As glaucoma worsens, there is a central depression or a “cup” in the optic nerve that will enlarge. Glaucoma can be treated with medications, laser surgery, or formal glaucoma surgery.

Living With Your Diagnosis
In the early stages, there are no signs or symptoms of glaucoma. The usual damage that occurs from glaucoma can occur slowly over time, so it is often not until years later that patients will finally notice that their vision is reduced. Unfortunately, once vision has been damaged from glaucoma, it is not possible to restore.

Glaucoma can be treated with eye drops, laser surgery, or formal glaucoma surgery. The type of treatment used depends on the degree of glaucoma present when the diagnosis is first made, and how difficult it is to normalize the intraocular pressure. The mainstay of all glaucoma treatment is to lower the elevated intraocular pressure to a more normal range. In some patients, this can be accomplished through the use of one or two different eye drops, where as in other patients, eye drops alone are ineffective. In these instances, either laser surgery or sometimes formal surgery is recommended. The eye drops used to treat glaucoma can have systemic side effects. Eye drops that fall into the class of beta blockers should be used only with great care in patients with asthma, breathing problems, or cardiac problems. Laser surgery for glaucoma can be quite effective. Unfortunately, not all patients who have laser surgery for glaucoma have their pressure normalized. In many instances, patients need to continue using eye drops after the laser surgery. Surgery for glaucoma involves creating a new “drain” for the eye to allow the aqueous to filter out faster, thereby lowering the eye pressure. As with any operation on the eye, there are potential complications that can occur which could ultimately lead to worsening of vision or complete loss of vision.
The DOs
If patients are going to be treated medically for glaucoma, it is important that they use their drops exactly as directed and do not miss using the medication. The drops only work when used. If patients have an elevated intraocular pressure, the drops will not cure the problem but will help control it. Therefore once patients begin medication, they typically will use it indefinitely. You can exercise in most normal fashions but should avoid yoga and other exercise that involve “standing on the head.”
The DON’Ts
It is important to take your medications as directed. They should let their internist and other physicians know what eye drop medications they are taking inasmuch as these medicines can have systemic side effects. In addition, some cold remedies can aggravate glaucoma, and before using these or any medication, patients should check with their eye doctor.
When to Call Your Doctor
When there is worsening of vision, pain, or redness in the eye, the doctor should be called.
Websites: www.eyenet.org.