Eye on Glaucoma

Glaucoma is a group of diseases in which elevated eye pressure causes irreversible damage to the fragile fibers of the optic nerve. Glaucoma is chronic—it can be controlled but not cured. But any resulting vision loss is irreversible, too, so early detection and treatment are vital.

According to the advocacy and education group Prevent Blindness Wisconsin, some 41,000 Wisconsinites over age forty already have glaucoma. Although it can affect anyone, the risk of developing glaucoma increases with age. This is of heightened concern to the twenty percent of Madisonians in the baby boom generation—and to their medical providers, who fear a significant rise in glaucoma diagnoses as the boomers grow ever older.

What to Do

A thorough screening is more than the “puff” test we’re all familiar with. Instead, healthy people should check in with an ophthalmologist at least every other year for vision acuity and visual-field tests, along with intraocular pressure exams and an assessment of the condition of their optic nerves. Anyone with an illness such as diabetes, or with a family history of glaucoma, or with risk factors such as age, should be monitored more closely. Be aware that symptoms of glaucoma are usually absent in early stages; warning signs such as a change in peripheral vision often don’t pop up until the later stages of the disease.

Treatment Today and Tomorrow

“The eye is like a little sink,” says Dr. Judith Fitzgerald, an ophthalmologist with Davis Duehr Dean in Madison. “Fluid is either coming or going out.”

Glaucoma can disrupt that system with varying severity, so treatment options range from eyedrops to surgery. Some patients choose selective laser treatment, which allows eye fluid to drain, thereby relieving pressure on the optic nerve. It takes only a few minutes but typically needs to be repeated, says Fitzgerald, every two years or so.

Lately, researchers are trying contact lenses as a means of monitoring glaucoma or delivering medication. The sensor-loaded Triggerfish lens is now available in Europe, for example; it continuously measures the curvature of the eye to track changes, which could be caused by intraocular pressure. And experimental, vitamin E-infused lenses may someday help with eyedrop absorption.

At present, though, tissue-removing or tube-implanting surgeries remain the treatment of choice in many instances. “We’re always trying to improve procedures and looking for new technologies,” says Fitzgerald, “[but] there’s nothing out there right now that’s better than the standard trabeculectomy or tube shunt procedures.”

Quick Read: Childhood Glaucoma

Glaucoma can happen to anyone, at any age. I know, because I was diagnosed at age eleven. My story is uncommon, but not unheard of. One in ten thousand babies are born with congenital glaucoma and, while also rare, glaucoma can manifest in childhood and adolescence.

Yasmin Bradfield, a pediatric glaucoma expert and associate professor of pediatric ophthalmology at UW Hospital and Clinics, says abnormal development of tissue that helps fluid drain from the eye is typically to blame in cases of juvenile-type glaucoma like mine.
The tough part, she adds, is assessing the problem. “It’s hard to diagnose children younger than 7 or 8,” she says, explaining that kids don’t understand the concept of looking forward while seeing sideways, which is the basis of testing peripheral vision. As a result, indicators such as enlarged eyes, excessive tearing or cloudy-looking corneas more often bring children to the attention of specialists such as Bradfield.

Happily, UW Hospital houses one of only a few brain wave-monitoring centers in the nation capable of checking central vision in infants and children too young to read eye charts. And, as I can attest—I’ve had no significant vision loss for eighteen years now—the sooner glaucoma is discovered, the more helpful proper intervention can be.

Catherine Erhard is a freelance writer based in Madison.

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