Glaucoma

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What is Glaucoma?

Glaucoma is an eye condition characterised by loss of vision due to damage of the optic nerve. The optic nerve carries sight images to the brain, and any damage to the nerve results in damage to sight. The eye needs a certain amount of pressure to keep the shape of the eyeball. Usually, but not always, the damage occurs because pressure within the eye increases and presses on the nerve, which damages it. Some people may have an eye pressure within normal limits but damage occurs because there is a weakness in the optic nerve. In most cases both factors are involved but to a varying extent.

There are different types of glaucoma:

The most common is Chronic (primary open angle) glaucoma – this form usually affects both eyes and develops slowly so that loss of sight is gradual. There is no pain, redness of the eye or dramatic change in vision.
With Acute (angle closure) glaucoma, there is a sudden increase in the pressure within one eye. The eye becomes red and painful. Often there is mistiness of vision and episodes of seeing haloes around lights.
Sometimes, other diseases of the eye cause a rise in the pressure within the eye – this group of conditions is called secondary glaucoma.

In the UK, 1 in 50 people over the age of 40 have this condition. Although it is not curable, blindness is preventable if the glaucoma is diagnosed and treated early enough.

As there are usually no warning signs it is important to have regular eye tests to help detect any early signs of the disease. We screen for glaucoma at every eye examination and can utilise retinal imaging to assess the optic nerve for any changes.

The eyeball is filled with a watery substance called aqueous humour, which creates pressure in the eye to give it shape. In healthy eyes, this fluid constantly flows in and out of the eye to nourish it. It drains back into the bloodstream at the same rate that it is produced in order to maintain the correct pressure.

Glaucoma occurs when the drainage tubes (trabecular meshwork) within the eye become slightly blocked, preventing the aqueous humour from draining properly. It can also occur if there is an obstruction within the eye.

When the fluid cannot drain properly, the pressure in the eye builds up and can cause damage to the optic nerves, and the nerve fibres from the retina.

It is unknown why the drainage tubes get blocked, or why other parts of the eye obstruct the tubes.

There are various other factors that can lead to glaucoma. These are listed below.

Age – chronic glaucoma becomes more likely as you get older, affecting about 1% of people who are between the ages of 40-65, and 5% of people who are over 65 years of age.
Ethnic origin – people of African, or Afro-Caribbean origin, tend to have a greater chance of developing chronic glaucoma. Also, people of Asian origin are more likely to develop acute glaucoma.
Short sightedness – people who are short-sighted are more likely to develop to chronic glaucoma.
Family history – if you have a close relative, such as a parent, brother, or sister who has glaucoma, you may also have a increased chance of developing the condition yourself. You should therefore have regular eye tests in order to monitor the condition of your eyes.
Medical history – research suggests that people with diabetes are also more likely to develop glaucoma than those without the condition.

If you have been diagnosed with glaucoma, this does not mean you will go blind, especially if you have been diagnosed with glaucoma at an early stage in the disease.

Drops and sometimes operations can stabilise the glaucoma, and, with regular check-ups, you will be able to manage the condition. You may experience some degree of sight loss but it will be minimised with effective treatment.

The modern goals of glaucoma management are to avoid nerve damage and preserve visual field and total quality of life for patients with minimal side effects. This requires appropriate diagnostic techniques and follow-up examinations and judicious selection of treatments for the individual patient. Although intraocular pressure is only one of the major risk factors for glaucoma, lowering it via various pharmaceutical drugs and/or surgical techniques is currently the mainstay of glaucoma treatment.

Glaucoma and driving

The legal standards for driving require not only good distance vision but also good peripheral (side) vision. As glaucoma can cause a loss to the field of vision it is important that this is checked to ensure that your sight meets the standards of the Driver and Vehicle Licensing Authority (DVLA). Most people can still drive if the loss of visual field is not advanced. It is your legal obligation to inform the DVLA about a medical condition that could have an impact on your driving ability. The Directgov website has advice about how to tell the DVLA about a medical condition

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