It’s World Glaucoma Week, an awareness-raising campaign for this disease of the eye that affects almost three million Americans according to the Centers for Disease Control and Prevention and is a leading cause of blindness.
But Dr. Don Abrams, chairman of the department of ophthalmology at Sinai Hospital, isn’t having it.
“Every day should be [glaucoma week], really,” he said, but that’s not because glaucoma isn’t a big problem.
“Probably half of the glaucoma in this country is not even known to the patients. That’s because 80 to 85 percent of the glaucoma in this country is a type of glaucoma called open-angle glaucoma, which has no symptoms.”
What’s needed is more awareness, all the time, Abrams said, because glaucoma can be treated, and more effectively than in years past, so long as patients are screened and diagnosed.
Either way, Abrams said, the result is damage to the nerves that carry visual information from the retina at the back of the eye to the brain, which can eventually lead to blindness.
“It used to be we didn’t really diagnose somebody with glaucoma until we started to see loss of peripheral vision on what we call a visual field test, but that generally required 40 to 50 percent of the optic nerve to be damaged,” he said. “Nowadays with some of our scanners we can actually see some subtle changes to the optic nerve if there is even 10 or 15 percent damage to the optic nerve.”
This is crucial, Abrams said, because damage to the optic nerve generally cannot be reversed, and so any loss of vision is likely to be permanent. But, “if you can catch it early, you can treat it before people lose any vision, and if you get proper follow-ups, you’ll never lose vision.”
The way to catch glaucoma early and stand a chance at saving vision, Abrams said, is to get a quality eye exam, and not just a basic vision test to see if you need glasses.
“You do need an eye care professional and I would recommend an ophthalmologist,” he said. “Some optometrists are very good in determining if somebody has glaucoma or not. Going to an eye glasses store, the optician is not going to be able to tell you if you have glaucoma.”
For the average person without any risk factors and no family history of glaucoma, Abrams said, screening should take place every two to four years until they reach age 40, then every one to two years until age 60 and annual thereafter.
“If you are a high-risk person, meaning if you are African-American, all that stuff gets ratcheted back, so that over the age of 40 you should probably be seen annually,” he said.
Other people at elevated risk of developing glaucoma include Asian-Americans and people with a family history of glaucoma, according to Abrams.
“If you have parents or grandparents with glaucoma, that does increase your risk of getting it and if you have a sibling, then you definitely have a much higher risk of getting glaucoma,” he said. “I have many, many families of glaucoma patients where it’s very severe in a lot of them.”
People who have had any kind of eye trauma, including being hit in the eye by a ball while at play as a child, can also be at higher risk of glaucoma, Abrams said.
“That kind of trauma may seem to be relatively minor to you at the time, but that can actually accelerate the development of glaucoma in many people,” he said. “I have lots of patients who were injured, even minorly, when they were teenagers who are now in their 30s and 40s and have significant disease.”
“Even though glaucoma tends to be a disease of older people, older than 40, 50 60 70, I have many patients with regular old glaucoma in their 20s and 30s,” Abrams said. “Just because you are 25 doesn’t automatically give you a bye, that there is nothing wrong with you.”
The really good news, according to Abrams, is that with new screening techniques to identify glaucoma and better treatments, even those who develop severe glaucoma early may never lose any vision.
“In general, in the United States, basically we start treatment with eye drops,” he said. “There are lots of glaucoma medications in eye drop form that are available, and for the past 20 years we have had some really goods ones with few side effects that only need to be taken once a day.”
If eye drops are not enough to control the glaucoma, there are also laser and surgery-based interventions that help relieve pressure within the eye and protect the optic nerve, according to Abrams.
But all of those interventions could be too late to save your sight, if you don’t know you have glaucoma, Abrams said.