Glaucoma: Symptoms, Diagnosis & Treatment at Relf EyeCare Specialists

What is Glaucoma?

Glaucoma is an eye disease in which the pressure inside the eye or intraocular pressure (IOP) is high enough to damage the optic nerve. The optic nerve is the “cable” which connects your eyeball to your brain, allowing you to see. All eyes have aqueous fluid inside of them. This fluid is needed to maintain a healthy pressure inside of the eye. When the amount of fluid inside of the eye increases, the pressure inside the eye increases.

According to the Mayo Clinic, glaucoma typically occurs in patients 60 years of age and older. It is not uncommon to find younger people with early signs of glaucoma. Our clinic may screen younger patients with risk factors like family history, diabetes, migraine, high blood pressure, sickle cell anemia, etc. Early detection and treatment are essential in preventing vision loss.

Glaucoma most often happens when the eye’s fluid does not drain as efficiently as it should, raising eye pressure and stressing the optic nerve. In some cases, optic nerve damage can occur even when eye pressure is in the normal range.

3 Types of Glaucoma: Open-Angle, Narrow Angle, & Normal Tension

The three most common types of glaucoma include primary Open-Angle, Low or Normal Tension, and Narrow-Angle. Let’s review each of them below.

Primary Open Angle Glaucoma (POAG)

Primary open-angle glaucoma is the most common type of glaucoma. Clinical research continues to evolve regarding the exact pathophysiology of POAG and what actually causes POAG. Some believe it is an issue with the eye making too much aqueous fluid, or the fluid not being able to drain out, though it is a combination of both.

Narrow Angle Glaucoma

The “angle” in the eye refers to the structure between the iris and the cornea, where a good portion of the eye’s aqueous fluid leaves the eye. If there is a problem with this structure, it can prevent the fluid from draining properly, causing increased eye pressure.

Normal Tension Glaucoma (Low Tension Glaucoma)

Normal or Low Tension Glaucoma occurs in the presence of normal or low eye pressure. Again, the exact cause is still up for debate, but factors like blood flow to the optic nerve may play a role. Diabetes, low blood pressure, and Obstructive sleep apnea (OSA) are all risk factors. The National Institutes of Health study of 4.5M patients, Obstructive sleep apnoea and glaucoma: a systematic review and meta-analysis states that, “patients with OSA had up to 40% higher odds of glaucoma.”

It’s believed that the optic nerve itself is weak and cannot withstand even a slightly abnormal eye pressure. Treatment still focuses on lowering eye pressure to protect the optic nerve.

Glaucoma Symptoms

Most forms of glaucoma have no early symptoms and are not painful. Vision loss is typically slow and at the edges, or periphery, of vision. It is impossible to detect without an eye exam. Some less common forms, such as acute angle-closure glaucoma, can cause sudden symptoms such as nausea, halos around lights, severe eye pain, and require urgent care.

Understanding Your Risk Profile: What are the risk factors for glaucoma?

Glaucoma risk is not uniform; it is a complex intersection of genetics, systemic health, and ocular anatomy. While anyone can develop glaucoma, clinical data show that certain populations face significantly higher risks:

African and Hispanic Ancestry: Individuals of African and Hispanic descent are statistically more likely to develop Primary Open-Angle Glaucoma (POAG). In fact, research indicates that African Americans are 6 to 8 times more likely than Caucasians to develop glaucoma, often at an earlier age and with more rapid progression.
Asian Ancestry: Those of Asian descent have a significantly higher predisposition for Angle-Closure Glaucoma, which can account for nearly half of all glaucoma-related blindness worldwide, despite being less common than open-angle variants.
Northern European Ancestry: This group is specifically linked to Pseudoexfoliation Syndrome, a condition where flake-like material deposits in the eye’s drainage angle, leading to a difficult-to-treat form of high-pressure glaucoma.

Medical & Physical Predispositions

Beyond heritage, your systemic health plays a vital role in optic nerve resilience. We monitor the following “comorbidities” or the simultaneous presence of two or more diseases or medical conditions in a patient closely:

Vascular Health: Diabetes mellitus, chronic hypertension (high blood pressure), and even hypotension (low blood pressure) can compromise blood flow to the optic nerve.
Sleep & Neurological Factors: Obstructive sleep apnea and chronic migraines are recognized indicators of increased susceptibility.
Ocular Anatomy: Patients with extreme myopia (nearsightedness) or hyperopia (farsightedness), as well as those with thin or “fragile” optic nerves, require more frequent screening.

Medication Risks

A critical, often overlooked factor is the prolonged use of corticosteroids (cortisone). Whether administered via eye drops, inhalers, or oral tablets, steroids can significantly increase intraocular pressure in “steroid responders.” If you are on long-term steroid therapy, specialized monitoring at Relf EyeCare is essential to prevent secondary glaucoma.

Treatment

Glaucoma is a treatable disease. Treatment always involves obtaining a lower or healthier eye pressure. This healthy pressure is different for everyone and will be determined by your eye doctor. At Relf EyeCare, our approach to initial treatment usually begins with a single eye drop once a day, and additional drops may be added as needed. Eye drops may include prostaglandin analogs, beta blockers, alpha agonists, carbonic anhydrase inhibitors, rho kinase inhibitors, nitric oxide-donating analogs, or combination drops. Each of these are prescription drops and cannot be found over-the-counter.

If eye drops aren’t effectively managing your eye pressure, we offer more permanent solutions, including laser therapy like Selective Laser Trabeculoplasty (SLT) and advanced surgical options like MIGS (Micro-Invasive Glaucoma Surgery). Our goal is always prevention; if your diagnostic testing shows you are at a significantly high risk for the disease, our doctors may recommend starting a preventative treatment plan now to protect your vision for the future.

The best way to prevent vision loss from glaucoma is early detection, consistent treatment, and follow-up, since the damage has already occurred and cannot be reversed.

Glaucoma FAQ’s

Can I drive after a glaucoma test?

Most glaucoma testing does not prevent you from driving. However, if your eyes are dilated during your exam, your vision may be blurry and light-sensitive for a few hours. If you’re unsure whether dilation will be used, plan to bring sunglasses and consider having someone drive you. Talk to your eye doctor before your appointment.

How high does my eye pressure have to be to damage my optic nerve?

Because intraocular pressure (IOP) varies significantly between patients, a single pressure reading is insufficient for a glaucoma diagnosis. At Relf EyeCare, we utilize a multi-faceted diagnostic approach. This includes Goldmann Applanation Tonometry, the definitive standard for pressure measurement, combined with optic nerve head analysis and visual field testing. This comprehensive data allows us to detect subtle changes and tailor a treatment plan specific to your eye’s physiology.

How could I have glaucoma? I see perfectly!

Early vision loss from glaucoma is subtle and impossible to notice, even by those who are very visually attentive! If a person waits until they notice vision loss from glaucoma, the disease is advanced and difficult to treat. These people are at great risk of going blind. It is important for those at risk for glaucoma to be examined on a regular basis.

How do I know if I am at risk of getting glaucoma?

Following your comprehensive eye examination, your doctor will inform you of any risk factors predisposing to glaucoma and recommend follow-up accordingly.

What is vision loss due to glaucoma like?

In the early stages of the disease, vision loss is typically in the peripheral visual field where it cannot be picked up without specialized testing. Vision loss then gradually progresses into the middle part of your vision, where it eventually interferes with activities such as driving and reading. Vision loss from glaucoma is permanent. Untreated, and sometimes in spite of treatment, glaucoma can lead to total blindness.

Are there different kinds of glaucoma?

There are many different kinds. The comments above are most pertinent to those who have “open-angle” glaucoma; this is by far the most common kind of glaucoma that we see in our patients. If you are at risk of a less common type of glaucoma, your doctor will certainly inform you and provide treatment as appropriate.

Where can I get more information about glaucoma?

Get more information about glaucoma on the American Academy of Ophthalmology website.

What if I have glaucoma and cataracts?

Patients who have glaucoma and cataracts might benefit from a new medical device which can lower intraocular pressure. This device, the iStent, is implanted during cataract surgery. It may reduce the need for glaucoma eye drops.

What are the risk factors for glaucoma?

There are many. Some of the more common risk factors include family history, fragile optic nerves, pseudoexfoliation (white material found inside the eye, common among those of northern European heritage), and high pressure inside the eye.

Are there glaucoma laser treatments available at Relf?

Yes. Selective Laser Trabeculoplasty (SLT) is a procedure our doctors perform. SLT targets only specific pigmented cells to increase fluid drainage from the eye. SLT may reduce the need for lifelong use of eye drops. Your Relf EyeCare doctor will let you know if this is a good option for you.

Can I stop using my glaucoma drops after getting an iStent?

Many patients can significantly reduce or eliminate their dependence on eye drops. However, this is a clinical decision made during your follow-up care based on your specific pressure trends and optic nerve health. Click here to learn more about iStent.

Glaucoma Diagnosis & Treatment