Frequently Asked Questions

What is glaucoma?
Glaucoma is a group of diseases which affect the function of the optic nerve. A healthy optic nerve is necessary to have normal eyesight and side vision. There is correlation between high eye pressure and glaucoma but it is not always the case. In certain cases, the structure of drainage system is different than that found in normal eyes. In one type called exfoliative glaucoma, there is protein-like substance that originates from multiple sites and seems to flake off like dandruff and slowly clogs up the drainage of the eye, thus causing fluctuation of the pressure in the eye from high to low throughout the day.
However, in most patients, we still do not know exactly what causes glaucoma.

Who gets it? Why did I get it?
It can be seen in almost any age. One in every 10,000 children may have glaucoma from birth which is called congenital glaucoma. It can be hereditary, meaning it can be inherited from your mom’s side of the family or your dad’s side or it can happen without any known reason. It causes excessive tearing, sensitivity to light, large and cloudy eyes.
The exact reason for glaucoma is not yet known. Genetics as well structure of the eye and other associated diseases might play role.

Will my children have glaucoma also?
If your spouse also has glaucoma, the risk that your child will have glaucoma considerably increases. In addition, if one of your children has glaucoma, your other children will have higher risk to develop it.

Does everyone have pressure in their eye?
Yes, normal pressure for a healthy eye is usually between 10-20 mmHg.

Does eye pressure have to be high to have glaucoma?
Not necessarily. In a different form of glaucoma, low-tension glaucoma also called normotensive (normal pressure) glaucoma, intraocular pressure is not high but even just a small increase in intraocular pressure and/or a decrease in blood flow to the optic nerve may play crucial role. Therefore, the goal of treatment is to decrease the intraocular pressure.

Does exercise help to drop pressure?
Yes, aerobic exercise performed on regular base can drop eye pressure. Swimming, biking, and walking are the other sports that might be helpful. Any strenuous activity that will put pressure on neck vessels will increase the pressure. Therefore, heavy lifting, certain yoga positions would not be recommended.

There is one type of glaucoma called pigmentary glaucoma and is a part of a pigment dispersion syndrome. It usually affects male, nearsighted patients between the ages of 20-50. The colored part of the eye (iris) rubs against the zonules (thin fibers holding the lens in place) and small dark–colored particles from iris fall into the front part of the eye and on to the drainage system. Exercise is one of the factors that increase the rubbing of the iris through pupil movement and consequently increases the pressure. Thus, discussion with your doctor prior to any planned exercise activity is important.

Are there activities that I need to avoid if I have glaucoma?
As mentioned above, any activities that increase the pressure in the head and neck will increase the pressure in eye. In addition, blowing musical instruments may not be best hobby to pursue. Scuba divers also need to consult their doctors if they have had surgery for glaucoma.

What do I do? The cold medication I want to take has a warning on it about glaucoma!
Cold medications dilate the pupil and it may be risky in narrow angle glaucoma but your glaucoma might be open-angle. It is a good idea to ask your doctor what type of glaucoma you have. If you have the open-angle type which is the most common form, you can safely use these cold medications.

How will I know if my pressure goes up?
Most of the patients can not tell if their pressure is up or normal but if pressure arises remarkably in a short period of time, eye pain and/or headache occurs. In this instance, decreased vision can be also sign for elevated pressure. The symptoms of the narrow angle glaucoma are eye pain, blurry vision, redness in the eye, cloudy cornea and even vomiting. In this case, the flow of the produced fluid is disrupted due to increased blockage in an already narrow drainage system. Precipitating factors could be cold medications, stress, watching movie in dark, anything that would increase the pupil size (very center, dark part of the eye). Laser treatment is first option for this type of glaucoma.

I also have cataract, are they related?
They are not related, however, we know that steroids, for example, cause both cataract and glaucoma in sensitive eyes. And, both glaucoma and cataracts are more common in the elderly population. Advanced cataracts can actually cause narrowing of the drainage system and other pressure problems in the eye.

I also have macular degeneration, are they related?
Again, both cataracts and macular degeneration are more common in the elderly population.

When I get upset, does it affect my eye pressure?
As far as we know there is not such correlation but emotional stress might increase your blood pressure.

Is it related to my blood pressure? When my blood pressure increases, does it affect my eye pressure? Does the medication I take to control my blood pressure, also help lower my eye pressure?
There is no relationship between the two diseases but some studies found out that glaucoma is more common in patients who have high blood pressure. When your blood pressure is up you might experience headaches that sometimes radiate toward the eye and this might be interpreted as eye pain related to increased eye pressure. But, there is not instant eye pressure elevation with increased blood pressure. Medications you use for blood pressure might also lower your eye pressure some but, most likely, you will still need eye medications.

Is it related to diabetes?
It is more commonly seen in diabetic patients. There is one particular form of glaucoma, neovascular glaucoma, which is found in diabetic patients whose eyes have been affected seriously from the disease. Diabetes causes a decreased oxygen supply to the eyes and this stimulates new the growth of tiny, fine vessels. These vessels block the circulation of fluid inside the eye and also cause bleeding in the eye. Laser treatment is first option for this type of glaucoma.

Are there specific foods that I need to avoid?
Excess amount of coffee or high amount of water intake in short period of time may not be recommended.

I take herbal medications for other medical problems. Will these medications affect my eye pressure?
Herbal medications have not been found beneficial in the treatment of glaucoma. These medications however might produce some side effects. It is good idea to tell your glaucoma doctor about all the medications take including herbal remedies.

Diagnosis

How often do I need to see doctor when I am diagnosed with glaucoma?
It depends how straightforward your diagnosis is. In most cases, it takes more than one visit to diagnose glaucoma and sometimes, it takes years to show the progression of the optic nerve damage, the ominous sign for glaucoma. Once it is diagnosed, depending of severity of disease, your doctor might ask you to return to clinic anywhere from monthly to every 6 months.

What does visual field test do?
It tests the side vision for dark, unseen spots that might be an early sign for glaucoma. The patient may not be aware of these spots initially. During the test, a patient is asked to respond to the light stimulus when seen by clicking a button.

Are there other tests rather than visual field test?
Yes, there are new tests that measure the optic nerve and nerve fiber layer around it. Scanning laser tomography, scanning laser polarimetry and optical coherence tomography are some of the tests we use in clinic. Since results do not depend on the patient’s response as in visual field test, these test can give us more objective information.

Treatment

Is glaucoma treatable?
Yes, it is treatable. There are several ways to treat it depending on the kind and stage of the disease including eye drops, laser and surgery.

How long do I need to use drops?
Glaucoma is a long-term disease similar in a way to high blood pressure and diabetes. In most cases, as long as pressure is controlled with drops, you will be using them for your lifetime. However, let’s say, if you needed cataract surgery in future, your doctor might offer you glaucoma surgery in the same session. In that case, you may stop all your glaucoma medications, although, you might be using different kind of eye drops after surgery for a short term. Overall, some patients may still need glaucoma drops even after glaucoma surgery.

What happens if I miss a drop?
You just use the drop on the next scheduled time. But not using the drop for different reasons such as running out of it, redness, itching is not recommended. When you think you are almost running out of drop, it is crucial to make arrangements for refill. You need to ask your doctor before stopping the drop because s/he assumes that you will be using the drop all the time. If you are not using your drop and your pressure is up, that means treatment protocol has to be revised and started allover again. It also means you will need more frequent doctor visits until pressure is stabilized. This gap in your treatment may cost you money and time.

Are there side effects associated with eye drops?
Yes, there are some side effects including itching and redness of the eye and changes such as blood pressure, heart beat and more. However, overall, benefits of the drops outweigh the risk of side effects. And side effects to your body may be minimized by closing your eyes for at least 1 minute and pressing over the corner of your eye with your index finger as shown in figure below.

I heard that marijuana decreases eye pressure, is that correct?
It decreases the eye pressure to certain extent but side effects of it may not be tolerated by most patients.


Figure1. Position of a patient at the laser machine

May I choose laser over drops?
This depends upon the type of glaucoma. With narrow angle glaucoma you might be offered laser surgery as a first treatment option. In open angle-glaucoma, the most common form of glaucoma, eye drops are the usually first choice of treatment unless some general health or eye conditions make them impossible to use or drops are not effective. In general, laser treatment is used along with eye drops. In narrow-angle glaucoma, sometimes, the patient does not need eye drop after laser.

Figure 2. Applying pressure over tear duct to minimize absorption

What kinds of surgeries are available?
Although laser is referred as to as surgery in some eye institutes and clinics, at Jones Eye Institute surgery means a procedure that is done in operating room with the use of several cutting and sewing instruments. In narrow angle glaucoma, a laser is used to open a hole in the eye. A laser is used in open-angle glaucoma to improve the function of small drainage channels. When these procedures are not effective, creating a small hole inside the eye –called trabeculectomy or inserting a tube inside the eye – called glaucoma drainage devices are the most commonly used surgical procedures. Other different types of lasers and surgeries are available for certain conditions. Glaucoma surgery is evolving rapidly in search of finding the most effective and safest technique.

Can glaucoma treatment be done with laser instead of surgery?
A stepwise approach is used in glaucoma patients. Generally one does not replace the other.

How successful is the surgery?
Surgery is quite successful with a 90% chance for lowering the eye pressure.

What do I need to be careful about after surgery?

May I have cataract surgery when I have glaucoma?
Yes, cataract surgery is a safe procedure for glaucoma patients.

If surgery fails, then what?
As soon as a sign of failure appears, the surgeon tries to salvage the surgery site through different methods and meanwhile, glaucoma drops may be added. If the eye pressure is still elevated, this time, repeating the surgery is recommended. This could be same type of surgery at different site of the eye or different kind of surgery.

What happens, if I don’t have surgery? Glaucoma is slowly progressing disease, however, when pressure is not controlled in an already damaged eye, vision loss and blindness can be unavoidable if nothing is done.

Will my glaucoma totally be eliminated after surgery?
Your glaucoma will be under control but not eliminated.

What is the most important thing I need to know about glaucoma?
Glaucoma is a long term disease and is treatable. However, a long term commitment to the inconvenience of using eye drops, regular doctor visits and tests is necessary. Most of the patients do not go blind from glaucoma, especially when they are under doctor’s care. You can enjoy your life without fear of loosing your sight. Also, remember that you play a very important role by informing your family members about your eye condition, so they can be aware of the possibly hereditary disease.

Resources for Glaucoma and Low-vision Patients

American Glaucoma Society’s website: www.glaucomaweb.org

Glaucoma Foundations’ website: www.glaucomafoundation.org

Glaucoma Service Foundation to Prevent Blindness: www.wills-glaucoma.org

Children’s Glaucoma Foundation: www.childrensglaucoma.com

Lions Clubs: www.LionsClubs.org

Light House International: www.lighthouse.org Tel:212-821-9200

Arkansas Regional Library for Blind and Physically Handicapped-One Capitol Mall, Little Rock, AR 72201 TOLL Free: 1-866-660-0885 or 501-682-1155

Website: www.asl.lib.ar.us
Library of Congress-National Library Service for the Blind and Physically Handicapped: www.loc.gov/nls/ Tel: 800-424-8567

American Printing House for the Blind: www.aph.org Tel: 800-223-1839

National Association for Visually Handicapped: www.navh.org Tel: 212-889-3141

Help with the medications for the patients who can’t afford them

Go to website: www.needymeds.com
You need to know the generic or brand name of your drops. Those most commonly used are: Acetozolamide pills ,Brimonidine, Brinzolamide, Bimatoprost, Betaxolol, Carteolol, Dorzolamide, Dorzolamide with Timolol , Latanoprost, Levolbunalol, Methazolamide pills, Pilocarpine,Timolol maleate, Travoprost

Prepared by Inci Irak Dersu, M.D.
Author thanks OMTI students and JEI staff for supporting this project.
Author also thanks the JEI patients who helped a great deal by asking questions.