The Premier Lifestyle Magazine of Florida's Black Communities
by Michael Paragon
Healthwise, January is national Glaucoma Awareness Month and as usual, Rise Magazine is committed to making a difference through education, informing and addressing the issue head-on. Far too many cases go undetected until it’s too late to offer any type of preventative solutions. As with most health challenges, an ounce of prevention is worth a pound of cure and glaucoma is no different. The very term glaucoma seems to have a singular definition but, once you look into it, there are more than one variety of affliction that can affect your vision.
Glaucoma is a group of diseases that attack the optic nerve. The optic nerve is actually a bundle of more than a million cells attached to the rear of the eye that transmit signals from your retinas to your brain. The greatest threat to your normal vision by way of glaucoma comes from a buildup of excess pressure within the eye itself.
In a normally functioning eye, there’s a fluid that flows continually in and out of a chamber at the front of the eye called the anterior chamber. This fluid nourishes the tissues of the eye as it exits at a point where the cornea and the iris meet known as the open angle. The fluid has to flow through a spongy network of mesh fibers as it exits the chamber of the eye.
When it passes too slowly through this drainage system, the backup builds up pressure. This damaging pressure is the enemy of the optic nerve. Essentially destroying it in the process and creating the condition referred to as “open-angle glaucoma”. Regardless of the source, the common culprit here is pressure.
The eye is uniquely sensitive to excessive pressure due to its damaging effects on the optic nerve. Which brings me to the next factor to be aware of: high blood pressure.
Fortunately, most folks are already aware of the risks of high blood pressure and are taking strides to maintain healthy levels through diet and exercise. Regular visits and consultations with a physician can keep you properly informed as to your condition and anything which should be addressed as preventative medicine.
Bear in mind though, that we all have unique tolerances for pressures within our eyes. Some people are simple better able to handle high pressure than others. This is where the doctors feedback becomes critical as effectively diagnosing how you handle your situation leads to the best course of action.
While anyone can find themselves forced to deal with glaucoma, there are certain groups that are hit hardest:
Needless to say, combinations of these groups, African Americans over the age of 40 with a history of glaucoma for example, increases the likelihood that glaucoma will be an issue to deal with at some point.
Glaucoma also has the reputation of being a sneaky disease in that it’s painless, happens gradually over time and can affect one or both eyes. Initially, the peripheral vision is affected. Over time, the vision will degrade to the point that some objects won’t be seen as easily as before. Eventually tunnel-vision sets in and any vision, other than directly in front, will deteriorate to the point of being useless.
A survey conducted for the Glaucoma Research Foundation found:
Typically glaucoma can be managed with proper medication. However, if that fails to relieve the damaging inner-eye pressures, surgery may be required. The most common process is called filtering microsurgery (also known as sclerostomy or trabeculectomy) and is generally painless and done while under a local anesthetic. The process involves creating a drainage hole by making a small incision in the sclera (the white part of your eye) to allow the fluid to exit the eye and thereby reduce the pressure. This type of treatment has a very high success-rate (70% – 90%) during the first year, especially in older patients. One challenge still remains in failing cases as the body senses the new drainage holes as damage to the eye and attempts to repair them – by healing them shut.
Laser surgeries have become increasingly effective in the treatment of glaucoma as they can be performed in a doctor’s office in an outpatient mode and don’t require any hospitalization. Listed below are the more common types of laser surgery procedures currently being used.
Argon Laser Trabeculoplasty (ALT) – ALT is typically used for the treatment of primary open angle glaucoma (POAG). The laser is used to open the drainage channels in the eye. Done in multiple sessions to prevent over-correction, half the drainage channels are opened at any one sitting. ALT has been successful in lowering the eye pressure in over 75% of the patients using this method.
Selective Laser Trabeculoplasty (SLT) – SLT is also used for the treatment of primary open angle glaucoma (POAG). Using a low-level laser source, select cells of the trabecular drainage network can be targeted and the surrounding areas remain unaffected. This type of treatment is much easier on the patient in terms of repeated exposures.
Laser Peripheral Iridotomy (LPI) – LPI is best suited for narrow-angle glaucoma. Narrow-angle glaucoma happens when the angle between the iris and the cornea is too small and creates an area of slow drainage and high pressure due to the buildup. LPI creates a small hole in the iris allowing it to retreat back and widen the opening between it and the cornea.
While laser surgeries are very successful in the long-term treatment for glaucoma, as with any procedures, they also carry a unique set of risks. The greatest risk of them is the potential for developing cataracts, however, the benefits do outweigh the risk associated here.
Medicines used to treat glaucoma are described by their active ingredients. Although medicinal marijuana had its spotlight moment during the late 1990′s, further research has shown that the positive effects are outweighed by the amount and frequency of marijuana that would need to be used. Though it was proven to reduce IntraOcular Pressure (IOP), the elevated heart rates produced proved to be too risky for elderly patients.
Alpha Agonist: – Alpha agonists work to both decrease production of fluid and increase drainage. Side effects from using Alphagan or Iopidine (two commonly available alpha agonist medications) include stinging and burning sensations in the eyes, dry mouth and nose as well as headaches and drowsiness.
Beta Blockers: – Beta blockers work by decreasing production of intraocular fluid. Generic variations are available so, prices can be relatively inexpensive. Side effects can be minimized by closing the eyes after applying the drops or by using a technique called punctal occlusion that prevents the drug from entering the tear drainage duct and systemic circulation. Timolol Maleate, Betimol, Timoptic XE, Betoptic are some of the current crop of medicines within this category. Side effects here are relative to lowered blood pressure, reduced heart rates and fatigue. Those with a history of asthma or other respiratory issues may also experience shortness of breath.
Carbonic Anhydrase Inhibitors: – Carbonic anhydrase inhibitors (CAIs) reduce eye pressure by decreasing the production of intraocular fluid. These can be found in either eye drops or pill form. If you need to use more than one type of eyedrop, you may need to take each medicine in a certain order as prescribed by your doctor and allow 5 minutes between applying medicines. The pill form is an alternative for people whose glaucoma is not controlled by eye drop medication. Azopt, Diamox Sequels and Trusopt are currently available Side effects of the pill form of these medications can include tingling or loss of strength of the hands and feet, upset stomach, mental fuzziness, memory problems, depression, kidney stones, and frequent urination. Since the eye drop form of this medication is relatively new, long-term studies are yet to be completed. Side effects of the eye drop include stinging, burning and other eye discomfort.