Can glaucoma be reversed or cured in older adults?
Glaucoma is an eye condition that causes the build-up of fluids inside the eyes. These fluids, accumulate in the eye and then damages the eye’s optic nerve. These fluids drain either very slowly or not at all; resulting in accumulation in the eye and increases the pressure in the eye which in turn damages the eye.
- According to the American Academy of Ophthalmology, Glaucoma is the major cause of blindness for older adults over 60 years old. However, the blindness that results from glaucoma can often be prevented with early treatment.
- According to the centre for disease control (CDC), African Americans are 6 to 8 times more likely to get glaucoma.
- Glaucoma is not curable but immediate diagnosis and treatment can help prevent further damage to the eye’s that can lead to blindness.
Who is at risk of developing glaucoma?
The following individuals are at a greater risk of developing glaucoma:
- Older adults: Older adults are at a greater risk of developing glaucoma because an aged optic nerve is more impacted by an elevated eye pressure. Also, as one ages, the pathway by which the eye fluid leaves the eye could also become blocked.
- Diabetic patients: One of the complications of diabetes, diabetes retinopathy, damages the blood vessels in the eye retina, this makes abnormal blood vessels to begin to grow in the eye. This abnormal blood vessels blocks the pathway by which fluid leaves the eye and the accumulation of fluid in the eye can cause glaucoma.
- African Americans: Thin corneas are one of the major risk factors of glaucoma and most African Americans have thin cornea.
- Other factors include having family members that have glaucoma, having eye problems or eye injury, long term use of steroids.
- Some unrelated illness such as migraines, blood pressure may also be risk factors for glaucoma.
Stages of glaucoma in older adults
- Stage 0 (normal visual field): At this stage, a test is carried out to check the vision of the individual in the visual field. The vision of the older adult is said to be normal if the older adult can see as well as anyone does in the centre or edges of a visual field but if the results show abnormal, that means vision in some areas of the eye is not as sensitive as normal.
- Stage 1 (early): This is the early stage of glaucoma, at this stage, glaucoma begins with an alteration to the pathway in the eyes and this alteration, causes increased intraocular pressure in the eyes.
- Stage 2 (moderate): This is the stage when you notice the first change in your eye, these changes can be eye pain or blurry visions.
- Stage 3 (Advanced): At this stage the intraocular pressure in the eye increases and this results to intense eye pain and blurry vision.
- Stage 4 (severe): At this stage, the increased intraocular pressure damages the optic nerve of the eye.
- Stage 5 (End stage): At this stage, the glaucoma has spread to various parts of the eye and there is some visual field loss and if this visual field loss is not corrected quickly it can lead to blindness.
Types, signs, and symptoms of glaucoma in older adults
We have basically two (2) types of glaucoma in older adults namely:
- Primary open angle glaucoma
- Angle closure glaucoma
Primary open angle glaucoma
This is the commonest type of glaucoma. It occurs gradually, when the eye does not drain fluid as well as it should have drained. As a result of the accumulation of the fluids, the intraocular pressure of the eye builds and gradually starts to damage the eye optic nerve. This type of glaucoma is painless and causes no vision changes at first.
At the early stages of primary open angle glaucoma, there are no warning signs or obvious symptoms, people with primary open angle glaucoma, do not notice any change in their vision until the damage becomes severe. That is why is advisable to regularly visit an Ophthalmologist to check the eyes.
Signs and symptoms of primary open angle glaucoma
As mentioned earlier, some patients will not notice any sign or symptom of primary open angle glaucoma until the damage to the eye becomes severe but some of the noticeable signs and symptoms includes:
- Patchy blind spots in the side or central vision of the individual and this occurs frequently in both eyes.
- At the advanced stages, the individual begins to experience tunnel vision.
- Swollen or bulging cornea
- Redness in the white of the eye
- When the eye is exposed to light, the pupil dilates to a medium size that does not change.
Angle closure glaucoma
This type occurs when the iris is very close to the drainage angle, that is the route by which the fluids leave the eye. If proper care is not taken, the iris can end up blocking the drainage angle. When the drainage angle gets completely blocked, it causes an attack called acute attack. When there is an acute attack, the intraocular pressure of the eye rises quickly.
Signs and symptoms of angle closure glaucoma
At the first stage of the acute attack, the patient might begin to experience some signs of:
- Sudden blurred visions
- Severe eye pain
- Seeing rainbow-coloured rings around lights
- Eye redness
Diagnosis of glaucoma
During your appointment with your Ophthalmologist, the Ophthalmologist will carry out different tests on you to find out if you have glaucoma or not. First, the ophthalmologist will place some certain drops of eye drops into the eye to anesthetize it before testing and some of the test includes:
- Tonometry: This calculates the pressure inside the eye, the ophthalmologist uses a small probe to gently flatten some part of your cornea to measure eye pressure and a microscope called a slit lamp to look at your eye.
- Pachymetry: it is a test that measures the corneal thickness of the eyes. A probe known as a pachymeter is gently placed on the front of the eye cornea to measure its thickness. The normal thickness of the eye corneal is about 540 microns which is half a millimetre.
- Gonioscopy: The size of the angle between the iris and cornea is measured. Gonioscopy is performed with the head positioned in the slit lamp the slit lamp is a special microscope used to look at the eyes. After the ophthalmologist must have numbed the eye with some drops of eye drop, a special contact lens is placed directly on the eye and a beam of light is used to illuminate the angle.
He also may look at the condition of your optic nerve, look at your peripheral vision, and test for any vision loss.
Treatment of glaucoma in older adults
Glaucoma is mainly controlled with the use of eye drops. The eye drops lower eye pressure. Some eye drops do this by reducing the amount of aqueous fluid the eye makes, others reduce pressure by helping fluid flow better through the drainage angle in the eye.
Other treatment methods can be by surgery and below are some surgical methods that can be used to treat glaucoma. Namely:
- Trabeculoplasty: This surgery is for people who have open-angle glaucoma and can be used instead of or in addition to medications. The eye surgeon uses a laser to make the drainage angle work better. That way fluid flows out properly, and eye pressure is reduced.
- Iridotomy: This is for people who have angle closure glaucoma. The ophthalmologist uses a laser to create a tiny hole in the iris. This hole helps fluid flow to the drainage angle.
Frequently asked questions (FAQ)
Can I use glaucoma eyedrops after my eyes are dilated?
There should be no problem using your glaucoma drops after your eyes are dilated.
Can glaucoma be reversed or cured?
Glaucoma cannot be cured or reversed. However, with treatment, the damage progression may be slowed, and blindness prevented.
What are the warning signs of glaucoma?
Most times, there are no warning signs so regular eye check-ups are recommended. However, if you experience eye pains, tunnel vision, any form of vision loss and any form of sensitivity to lights; you should have it checked out.
Treating glaucoma successfully is a team effort between you and your doctor. Your ophthalmologist will prescribe your glaucoma treatment. It is up to you to follow your doctor’s instructions and use your eye drops.
If you have any questions about your eyes or your treatment, talk to your ophthalmologist.
Javitt et al, Undertreatment of Glaucoma Among Black Americans. National England Journal of Medicine. 1991.
Mills R.P. Budenz D. L.Lee P.P.et al. Categorizing the stage of glaucoma from prediagnosis to end-stage disease. American Journal of Ophthalmology. 2006; 141: 24-30
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