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Glaucoma blinds slowly: Get an eye exam

January is coming to an end, but there's still time to get in the spirit of Glaucoma Awareness Month and take steps to mitigate the risk of the leading, preventable cause of blindness.

Glaucoma is a disease of the eye where damage to the optic nerve, which carries visual information from the retina at the back of the eye into the brain where it is interpreted and perceived as "seeing" something, gradually leads to blindness, according to Thomas Brunner, president and CEO of the Glaucoma Research Foundation, the nation's largest nonprofit focused specifically on glaucoma.

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"Think of it as the cell tower is suddenly gone, so you have your cellphone and it's working fine, but you're not able to call anybody because the network is gone," Brunner said. "That's what's happening in glaucoma; the network, the connection to the brain is what's damaged."

Glaucoma affects about 1 percent of the U.S. population, and about 120,000 of those people are blind from the disease, according to the foundation's website. Although it does affect young people — about one in 10,000 babies in the U.S. are born with the disease annually, according to Brunner — glaucoma is primarily a disease of age.

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The prevalence, by the time people get to be 80 can be as much as 10 to 15 percent, so one in eight people could have glaucoma if they get to that age," he said.

If there is a good side to glaucoma, it's that it is generally a slowly progressing disease, according to Brunner, and while it cannot yet be cured, there are treatments to slow or arrest the development of the disease process, as long as an individual is aware they have it. That's why Glaucoma Awareness Month is about taking action to see what your personal risk factors for glaucoma might be.

"We would hope that people do two things. One would be to get an eye exam," Brunner said. "As we get less young, as I like to say, it's more important to get eye exams. By the time they are 40, they should be getting an eye exam every two to four years. By the time they are 65, maybe every year."

A complete eye exam is the standard, he said, and includes a test of eye pressure using an air "puff" and dilation of the pupils so that the eye doctor — an ophthalmologist or optometrist — can visually inspect the optic nerve.

"If they haven't dilated your eye, you haven't had a complete exam," Brunner said.

The second thing people can do is have a frank conversation with their family. According to Brunner, the risk factors for glaucoma are advancing age, ethnicity — for reasons that are not yet understood, other races are at higher risk than Caucasians — and a family history of the disease. While the first two factors are self-evident, family history requires communication.

"It doesn't mean because the grandparent or an aunt or uncle had glaucoma that this person is going to get it, but family history is a key factor," Brunner said. "This one college student that I remember was so upset because she actually had a grandparent that was blind from glaucoma, but it was never discussed in the family. Nobody knew what had happened and then when [the student] was diagnosed, and they said, 'Oh yeah, well, your grandmother had glaucoma!'"

Those with higher risk factors for glaucoma should consider getting complete eye exams earlier in life, in their 20s and 30s, and while there is no nutrition or lifestyle plan that can prevent the development of glaucoma, Brunner said some good, basic health habits can be helpful.

"People do also ask, 'What about food, is there something else I can do to prevent the disease?'" he said. "What we always tell people is that it's the same things for any disease: Don't smoke, because that is clearly a factor in many diseases and in eye disease as well, eat healthy and exercise. Those are the three things."

For those who discover that they do have glaucoma, Brunner said the three current treatments are medical eye drops, laser interventions and surgery, all designed to reduce the pressure inside the eye.

Although there are some atypical cases, research funded by the Glaucoma Research Foundation has established that glaucoma is generally associated with a buildup of the clear fluid that fills the eye — called the aqueous humor — and provides the nourishment and waste removal for the eye's lens and cornea. Normally, this fluid drains from the eye at the juncture of the iris and the cornea, according to Brunner.

"What happens in glaucoma is that the proper drainage of that fluid isn't happening. So when the fluid builds up in the eye, it's like a basketball, it can't expand, it's not like a balloon that can get bigger, so the pressure goes up," Brunner said. "What we do in treating glaucoma is provide eye drops that help get the outflow of the fluid improved or reduce the inflow."

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Surgery or laser light at the junction where the fluid drains from the eye can also offer improvement, he said.

More information on glaucoma and some of the research into new treatments the Glaucoma Research Foundation is funding can be found on the foundation's website at www.glaucoma.org, where patients and families can also order a free booklet about the condition.

The other thing people might consider during Glaucoma Awareness Month, Brunner said, is making a contribution to the foundation. First created in 1978 by two glaucoma specialists in San Francisco with a generous $1 million donation from one of their patients, the foundation continues to fund research scientists seeking to understand how glaucoma works, and how it might be finally cured.

"Our mission today is to prevent vision loss from glaucoma through investment innovative research, education and support," Brunner said. "And 85 cents out of every dollar donated goes to programs — we have low overhead — so we think we are a good investment."

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