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Glaucoma


Overview :

Between two to three million people in the United States have glaucoma, and 120,000 of those 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, who are at about a three-fold higher risk of glaucoma than the rest of the population. The risk of glaucoma increases dramatically with age, but it can strike any age group, even newborn infants and fetuses.

Glaucoma can be classified into two categories: open-angle glaucoma and narrow-angle glaucoma. To understand what glaucoma is and what these terms mean, it is useful to understand eye structure.

Eyes are sphere-shaped. A tough, non-leaky protective sheath (the sclera) covers the entire eye, except for 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 bundle of nerves known as the optic nerve.

The iris, the colored part of the eye shaped like a round picture frame, is between the dome-shaped cornea and the lens. It controls the amount of light that enters the eye by opening and closing its central hole (pupil) like the diaphragm in a camera. The iris, cornea, and lens are bathed in a liquid called the aqueous humor, which is somewhat similar to plasma. This liquid is continually produced by nearby ciliary tissues and moved out of the eye into the bloodstream by a system of drainage canals (called the trabecular meshwork). The drainage area is located in front of the iris, in the angle formed between the iris and the point at which the iris appears to meet the inside of 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. The high pressure distorts the shape of the optic nerve and destroys the nerve. Destroyed nerve cells result in blind spots in places where the image from the retina is not being 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 narrow, and therefore may drain slowly or may be at risk of becoming closed. A closed-angle glaucoma attack is usually acute, occurring when the drainage area is blocked. 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 if taking certain medications).

Congenital glaucoma occurs in babies and is the result of incomplete development of the eye's drainage canals during embryonic development. Microsurgery can often correct the defects or they can be treated with a combination of medicine and surgery.

One rare form of open-angle glaucoma, normal tension glaucoma, is different. People with normal-tension glaucoma have optic nerve damage in the presence of normal IOP. As of 1998, the mechanism of this disease is a mystery but is generally detected after an examination of the optic nerve. Those at higher risk for this form of glaucoma are people with a familial history of normal tension glaucoma, people of Japanese ancestory, and people with a history of systemic heart disease such as irregular heart rhythm.

Glaucoma is also a secondary condition of over 60 widely diverse diseases and can also result from injury, inflammation, tumor, or in advanced cases of cataract or diabetes.




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