Glaucoma Health Article

Definition

Glaucoma is a condition where the optic nerve is subject to damage—usually, but not always, because of excessively high intraocular pressure (pressure within the eye, also called IOP). If untreated, the optic nerve damage results in progressive, permanent vision loss, starting with unnoticeable blind spots in the field of vision, progressing to tunnel vision, and then to blindness.

Description

More than 2 million people in the United States have glaucoma, and 80,000 of them are legally blind as a result. It is the leading cause of preventable blindness in the United States and the most frequent cause of blindness in African-Americans, whose glaucoma risk is three times higher than the rest of the population. The risk of glaucoma increases with age, but it can strike any age group, even newborns and fetuses.

Glaucoma is a class of diseases. There are at least 20 different forms that can be divided into two categories: open-angle glaucoma and narrow-angle glaucoma. To understand glaucoma, it is useful to understand eye structure.

The eyes are spherical. A tough, non-leaky protective sheath (the sclera) covers the eye with the exception of the clear cornea at the front and the optic nerve at the back. Light comes into the eye through the cornea, then passes through the lens, which focuses it onto the retina (the innermost surface at the back of the eye). The rods and cones of the retina transform the light energy into electrical messages, which are transmitted to the brain by the optic nerve.

The iris is located between the dome-shaped cornea and the lens. It controls the amount of light that enters the

eye by opening and closing the pupil. The iris, cornea, and lens are bathed in a liquid called the aqueous humor, which is similar to plasma. This liquid is continually produced by the nearby ciliary body and moved out of the eye into the bloodstream by a system of drainage canals (the trabecular meshwork). The drainage area is located in front of the iris, in the angle formed between the iris and the cornea.

Glaucoma occurs if the aqueous humor is not removed rapidly enough or if it is made too rapidly, causing pressure to build up. This high pressure distorts the shape of the optic nerve and destroys nerve cells. The destruction of nerve cells results in blind spots—spots where the image from the retina is not transmitted to the brain.

Open-angle glaucoma accounts for over 90% of all cases. It is called "open-angle" because the angle between the iris and the cornea is open, allowing drainage of the aqueous humor. It is usually chronic and progresses slowly. In narrow-angle glaucoma, the angle where aqueous fluid drainage occurs is narrower than normal, thus causing the fluid to drain more slowly and increasing the risk that the flow may be blocked. When the drainage area is blocked, a closed-angle glaucoma attack results. This can occur, for example, if the iris and lens suddenly adhere to each other and the iris is pushed forward. In patients with very narrow angles, this can occur when the eyes dilate (e.g., when entering a dark room or when taking certain medications).

One rare form of open-angle glaucoma is different. People with normal-tension glaucoma have optic nerve damage in the presence of normal IOP. As of 2001, the mechanism of this disease is unknown.

Glaucoma is also a secondary condition of over 60 widely diverse diseases and can result from injury as well.

Causes and symptoms

The cause of vision loss in all forms of glaucoma is optic nerve damage. There are many underlying causes and forms of glaucoma. Most causes are not known, but it is evident that different processes are involved, and a malfunction in any one of them could cause glaucoma. For example, eye trauma may result in the angle becoming blocked, or, as a person ages, the lens may become larger and push the iris forward. The cause of optic nerve damage in normal-tension glaucoma is also unknown, but there is speculation that the optic nerves of these patients are susceptible to damage at lower pressures than what is usually considered to be abnormally high. It is probable that most glaucoma is inherited. At least 10 defective genes that cause glaucoma have been identified.

Initially, chronic open-angle glaucoma has no noticeable symptoms. The pressure build-up is gradual and there is no discomfort. Moreover, the vision loss is gradual and one eye fills-in the image where its partner has a blind spot. However, left untreated, vision loss becomes evident, and the condition can be painful.

Acute closed-angle glaucoma is obvious from the beginning of an attack. The symptoms are blurred vision, severe pain, sensitivity to light, nausea, and halos around lights. The normally clear cornea may be hazy. This is an ocular emergency and needs to be treated immediately. Similarly, congenital glaucoma is evident at birth. Symptoms include bulging eyes, cloudy corneas, excessive tearing, and sensitivity to light.