It refers to a group of eye conditions that lead to the damage of the optic nerve, which carries the visual information from the eyes to the brain.  The optic nerve is damaged when the pressure of the eye is increased uncontrollably.  When the optic nerve is damaged due to glaucoma, it damages the peripheral field first then, centrally.  Most people don’t realize if they have glaucoma until it gets really worst.  The eye is filled with fluid called aqueous humor inside, and always producing more fluid in the back of the eye 24hr per day.    The fluid produced must be drained out via channels of the anterior chamber angles.   If these channels are blocked anatomically, or blocked by any other means, the pressure in the eyes will increase, and pushes the optic nerve and retina in the back of the eye, eventually damages the tissue around the optic nerve.

It is very important to get annual eye exam to screen for glaucoma.  A typical eye exam should include screening for glaucoma such as eye pressure measurement, screening visual field test, and optic nerve evaluation.  Therefore, any patient should have an idea if they have glaucoma or not, at the end of the eye examination.  

                There are many types of glaucoma.  Here are the most common ones.

  1. 1.Open angle glaucoma (chronic)
    1. a.This is the most common form of glaucoma that tends to run in the family and African AmericanIt damages the peripheral field of vision slowly and painlessly over time without any obvious symptoms.  The only way to detect the glaucoma is to get comprehensive eye exam.   Treatment is simply to lower down the eye pressure with eye drops, laser or surgery if needed.
    2. 2.Angle closure glaucoma (acute)
      1. a.This form of glaucoma is very painful and happensIt is not as common as open angle glaucoma.  It can happen to anybody who has anatomically narrow angle by chance.  There are many people with anatomically narrow angle, who never had an angle closure attack.  They may or may not get them in the future.   The only way to prevent is to get a prophylactic minor surgical procedure called laser peripheral iridotomy (LPI). 
      2. 3.Normal tension glaucoma (NTG)
        1. a.It is a type of open angle glaucoma with normal range of eyeNTG is present when there is optic nerve damage and visual field defect consistent with glaucoma when eye pressure is measured below 22 mmHg.  Although it is an eye pressure dependent disease, one must rule out other optic nerve disease due to neurological issue.  It is understood that NTG occur either because of a fragile optic nerve that could not withstand a normal eye pressure, or simply ischemia (reduced blood flow) to the optic nerve.   In either case, the studies suggest that it is beneficial to lower the eye pressure by 30% or more either with drops, laser or surgery to slow down the rate of progression of the disease.
        2. 4.Secondary glaucoma due to underlying disease (steroid usage, diabetes, iritis, trauma, and surgery)
          1. a.Sometime eye pressure can increase due to underlying systemic conditions such as advanced diabetes/hypertensive eye disease,  steroid (oral and drop) usage, Iritis (inflammation), cataract induced, trauma, pigment dispersions syndrome, pseudo-exfoliation and any other eyeIt is important to differentiate the real cause of glaucoma and treat them accordingly.   

The bottom line is there are many types of glaucoma.  The most common one is the open angle glaucoma.  The treatment is simply lower down the eye pressure either through drops, oral medications, laser or in-patient surgery.

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