News
Glaucoma steals your sight
In what's become almost a weekly occurrence at Brilliant Eyecare at the Clock Tower Place in Annapolis, a 42-year-old man wanders in thinking he needs glasses, only to discover he has glaucoma.
"My eyesight has been getting blurry the past couple years," he informed optometrist Dr. Andrew Servinsky. "Maybe glasses will help." The doctor quickly discovers the man has never had an eye exam. Worse, though he drove to the Forest Drive location, he was legally blind. He had glaucoma.
"He'd lost his peripheral vision and had a small island of vision central," said Dr. Servinsky. "If he looks at you face-to-face, at arm's length, he could see your face to the ears and from your eyes to your chin. He couldn't see anything else." "He thought glasses would help, but his vision is gone," the optometrist said. "Had he gone for an eye exam in his teens or younger, his vision could have been stabilized." Glaucoma is a leading cause of blindness. If left untreated, you could lose part or all of your sight. Even with treatment, 10 percent of glaucoma sufferers will go blind. It is an incurable disease, but, with proper treatment - in most people - it can be stopped or slowed. It is a sneaky disease. It doesn't usually hurt; there's no sensation of pressure. Over a period of time, your eyesight simply, slowly, slips away. Commonly thought of as an "old folks" disease, one out of 10,000 infants is born with it. There are many different types of glaucoma, and doctors aren't completely sure why glaucoma attacks one person and not another.
According to the San Francisco-based Glaucoma Research Foundation: Over 3 million Americans have glaucoma but only half of those know they have it; Approximately 120,000 are blind from glaucoma, accounting for 9 percent to 12 percent of all cases of blindness in the U.S.; About 2 percent of the population ages 40 to 50 and 8 percent over 70 have elevated intraocular pressure; Glaucoma is the second leading cause of blindness in the world; Glaucoma is the leading cause of blindness among African-Americans; Glaucoma is 6 to 8 times more common in African-Americans than Caucasians; African-Americans ages 45-65 are 14 to 17times more likely to go blind from glaucoma than Caucasians with glaucoma in the same age group; The most common form in the U.S., Open-Angle Glaucoma, accounts for 19 percent of all blindness among African-Americans compared to 6 percent in Caucasians; Other high-risk groups include: people over 60, family members of those already diagnosed, diabetics, people with hypertension and people who are severely nearsighted; Steroid users, such as those who use steroid inhalers to control asthma, are susceptible to glaucoma, as are people with traumatic eye injuries; Glaucoma accounts for over 7 million visits to physicians each year in the U.S.; In terms of Social Security benefits, lost income tax revenues and health care expenditures, the cost to the U.S. government is estimated to be over $1.5 billion annually.
"Most optometrists and all ophthalmologists are required to do screenings for glaucoma," said Dr. Servinsky. "We do a pressure test - it's a good screening test but not always indicative of glaucoma. Some people can have high eye pressure and not get glaucoma." Another, more sensitive test is the Applanation test, which uses "touching tenometry" to measure the level of pressure in the eye. "We also do a Visual Field Test if a patient has lost peripheral vision," said Dr. Servinsky. The Visual Field Test is a highly sensitive test that maps out peripheral vision. If pressure is high and peripheral vision shows a loss, he said, "It's a good bet they have glaucoma. That's when we look at the optic nerve. We do that with a Fundus Photography test, photographing the optic nerve." Consider, he said, that your optic nerve looks like a cantaloupe, cut in two with the seeds scooped out. The orange meat is the optic nerves. There's no meat - or nerves - in the scooped-out area. If the scoop grows bigger as the nerves die, that's indicative of glaucoma.
"I am shocked at the number of patients around 40 years old with advanced damage to their optic nerve," said Dr. Lily Im, of The Glaucoma Center in Annapolis, affiliated with the Anne Arundel Medical Center. "They've lost their field of vision. Many are young African-Americans." She said the most common form of glaucoma in the U.S. is open-angle glaucoma caused by high pressure inside the eye that damages the eye. "You can't look at a person and say they have glaucoma. If you have a family history, you need to get screened. If you have glaucoma, tell your siblings and children to get screened," she said. Eyes should be tested for glaucoma at ages 35 and 40. From age 40 to 60, eyes should be tested every two to four years; after age 60, get a glaucoma test every one to two years. If you have high risk factors, consider getting tested every year or every other year after age 35. During a glaucoma test, the doctor dilates the eyes with special drops. Then the eye pressure is checked, usually with a Pneumatonometer that blows a puff of air into the eye. If an optometrist conducting the test gets a positive result, it triggers a referral to a general ophthalmologist or a glaucoma specialist for a more detailed exam.
If glaucoma is the diagnosis, said Dr. Im, "We can treat it and prevent further vision loss and reduce the pressure in the eye with drops, laser treatment or surgery. The drops contain drugs to decrease the amount of fluid production in the eye. In open angle glaucoma, the drain is not working properly. We can increase the outflow in the eye with another class of drugs, or use a 'cocktail combination' of eye drops." "Our response and treatment depends upon the individual. Some have glaucoma that can be controlled with one drop a day." Simone Hill, 35, of Crofton, works in a Target Pharmacy and has a 9-year-old son, Isaiah. She has mild glaucoma in her right eye. Dr. Im has been monitoring her eyes for two years, watching to see if her left eye gets the disease. "I went to my eye doctor, an optometrist, in Bowie for a regular eye exam," she said. "He saw something during his test and referred me here to The Glaucoma Center." She was prescibed Xalantim drops - one drop in each eye at bedtime - which she took religiously. Six months ago, her condition stabilized and she was taken off the drops. She comes in every six months just to monitor the disease. Both Mrs. Hill's parents have glaucoma and her mother is diabetic, too. "Everybody should get their eyes checked," she said. "Finding I had glaucoma surprised me because I'm young. I thought it was a disease of the elderly, but anyone can get it."