Glaucoma: Symptoms, Causes, Diagnosis and Treatment

Glaucoma describes a group of diseases that damage your eye’s optic nerve, and they are the leading causes of vision loss. People with glaucoma often do not notice their initial symptoms, which makes it difficult to catch the conditions in an early stage.

Glaucoma does not have a cure, but you can protect yourself from vision loss by seeking early treatment, which includes medication, laser therapy and surgery.

You can undergo a comprehensive eye examination to determine if you have glaucoma.

What is Glaucoma?

Glaucoma is one of the leading causes of blindness for people over the age of 60 and can occur at any age but is more common in older adults.

Mayo Clinic

Glaucoma is a broad category of eye disorders that damage the optic nerve and cause visual field defects. The optic nerve at the back of the eye is an important link between your brain and your eye. Glaucoma can affect one or both eyes.

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Types

There are several types of glaucoma, including:

• Open-angle glaucoma
• Angle-closure glaucoma
• Norma-tension glaucoma
• Congenital glaucoma
• Pigmentary glaucoma

Open-Angle Glaucoma

Glaucoma is one of the leading causes of blindness for people over the age of 60 and can occur at any age but is more common in older adults.

Open-angle glaucoma develops gradually as the eye fails to drain fluid as efficiently as it should. Consequently, eye pressure builds up and starts damaging the optic nerve.

Open-angle glaucoma accounts for more than 80% of glaucoma cases in the United States. People with diabetes or high blood pressure are at greater risk for this form of glaucoma.

Angle-Closure Glaucoma

Angle-closure, narrow-angle, or closed-angle glaucoma occurs when the eye’s drainage angle — formed by the iris and cornea — closes or is blocked. The fluid in the eye becomes blocked as the drainage angle narrows, leading to an increase in eye pressure. Angle-closure glaucoma can be acute (occurring suddenly) or chronic (progressing gradually).

Normal-Tension Glaucoma

In this type of glaucoma, eye pressure is within normal ranges, but signs of glaucoma are present.

Congenital Glaucoma

Babies born with congenital glaucoma, also known as pediatric glaucoma, have a problem that prevents eye fluid from draining properly. It is rare in the United States, with only one in 10,000 babies having it.

Pigmentary Glaucoma

This type of glaucoma occurs when the pigment to the iris blocks fluid in the eye from draining as it should.

Symptoms

Glaucoma symptoms often vary based on the type of glaucoma.

Open-Angle Glaucoma Symptoms

Open-angle glaucoma typically develops slowly without warning signs in the early stages. The first symptom usually occurs after you lose some vision. Blind spots may first develop in your side (peripheral) vision. Over time, you may lose central vision and find it difficult to see things.

Angle-Closure Glaucoma Symptoms

Before an angle-closure glaucoma attack, people with the condition usually do not show any symptoms. The symptoms of an attack include:

• Blurred vision
• Eye pain
• Headache
• Appearance of halos
• Nausea
• Vomiting

Normal-Tension Glaucoma Symptoms

If you have normal-tension glaucoma, you will have glaucoma signs like a damaged optic nerve and blind spots in the field of vision despite eye pressure remaining in the normal range.

Congenital Glaucoma Symptoms

If a child has congenital glaucoma, you will notice signs that include:

• Cloudy eyes
• Production of extra tears
• Sensitivity to light
• Larger-than-normal eyes

Pigmentary Glaucoma Symptoms

If you have this form of glaucoma, you may have blurry vision or see halos after activities like playing basketball, jogging or exercising.

Causes

Glaucoma is generally associated with elevated pressure in the eye (intraocular pressure or IOP). Nevertheless, glaucoma can develop even within normal intraocular pressure. Again, the causes vary by type:

• Open-angle glaucoma: At the front of your eye, there is a space through which fluid moves in and out. Open-angle glaucoma results when the fluid drains too slowly, creating pressure that pushes on your optic nerve.
• Angle-closure glaucoma: In angle-closure glaucoma, the iris blocks the opening completely. The fluid buildup causes eye pressure to rise.
• Normal-tension glaucoma: Experts do not know why normal-tension glaucoma happens. People with the condition are thought to have an optic nerve that is overly sensitive or reduced blood flow to the nerve. In these circumstances, normal pressure can still damage the optic nerve.
• Pigmentary glaucoma: In this type of glaucoma, the pigment flakes off of your iris and blocks fluid. The eye pressure rises and results in pigmentary glaucoma.

Diagnosis

The most accurate way to diagnose glaucoma is through a comprehensive eye exam.

The most accurate way to diagnose glaucoma is through a comprehensive eye exam. During the exam, your ophthalmologist will:

• Measure the eye pressure
• Measure visual acuity
• Examine the optic nerve
• Measure corneal thickness
• Inspect the drainage angle

Treatment

Early glaucoma diagnosis and continuous treatment can help preserve your eyesight over a long period. Doctors treat glaucoma with one or more of the following regimens:

Medication

Several prescription medicines (typically eye drops) are available, most of which aim to lower elevated eye pressure. Medicated drops reduce pressure by reducing the aqueous fluid your eye makes or helping the fluid drain better.

Laser Treatment

Doctors use a laser beam to make it easier for excess fluid to drain more easily from the eye.

Surgery

If laser therapy and medication do not work, a doctor may recommend one of several surgeries. Most of the procedures aim to drain the eye fluid, such as making a tiny drainage flap, destroying the tissue that creates eye fluid or inserting drainage implants.

Questions to Ask Your Doctor

You should not hesitate to ask your doctor any questions you may be having about your eyes or treatment. For instance, you can ask questions about:

• The type of glaucoma you have
• Vision rehabilitation devices or services that could help
• The possible side effects or dangers of various treatment options
• Activities you should avoid

Lifestyle Changes & Home Remedies

As medicine evolves and as interest grows in holistic treatments, people turn to lifestyle modifications to manage and treat their glaucoma. Research shows the following lifestyle improvements and home remedies to help reduce eye pressure and improve eye health – and overall health:

• Meditation
• Exercise
• Sleeping position
• Diet
• Quitting smoking
• Eliminating some yoga positions

Meditation

Glaucoma patients tend to have higher anxiety and depression levels. Anxiety and depression increase the release of cortisol, which can lead to elevated IOP. Meditation may benefit glaucoma patients as it can help reduce stress biomarkers and IOP.

Exercise

Moderate-intensity exercise can lead to a drop in IOP. Additionally, moderate exercise can have other health benefits like lowering blood pressure, which is beneficial for IOP control.

Sleeping Position

Sleeping with your head elevated and avoiding sleeping on one side constantly can lower IOP and reduce the progression of glaucoma.

Diet

Studies have found an association between lower intake of nutrients and higher rates of glaucoma. Eating a well-balanced diet and maintaining a healthy nutritional status can offer benefits in glaucoma management.

Quitting Smoking

Some studies have found a risk between smoking and glaucoma. Smoking can increase optic nerve damage by increasing free radical concentration and decreasing antioxidant levels in the aqueous humor and ocular tissue. Quitting smoking can improve your eye health.

Avoiding Some Yoga Positions

Popular yoga positions like forward bend, downward dog and handstands have been found to significantly elevate IOP, which poses the risk of glaucoma progression. Doctors recommend that people with glaucoma avoid yoga exercises with head-down positions.

Tips for Living with Glaucoma

You can still live a full life after receiving a glaucoma diagnosis. But you must stay on top of the condition and be more attentive to how you deal with it. For instance:

• Take the medicine your doctor prescribes every day.
• See your doctor regularly for checkups.
• Inform your doctor of any side effects resulting from your glaucoma medication.
• Do not operate machinery or drive if your medication makes you drowsy or tired.
• Try to travel mostly during the day if you have trouble seeing and driving at night.
• Take care of your psychological and emotional health by reducing stress, scheduling time to relax, and sharing your feelings and ideas with someone you trust.

Prevention

Glaucoma causes irreversible visual loss, so it is critical to take steps to prevent it. Studies have hinted at the habits below helping prevent glaucoma:

• Regular exams: Get screened for glaucoma regularly, especially if you are at risk for the condition, for example, because of family history.
• Eat well: Eat plenty of eye-healthy foods like leafy green vegetables, colored fruits, and berries.
• Get treatment for obstructive sleep apnea (OSA): OSA has been linked with a higher risk for developing or aggravating glaucoma. Therefore, people with OSA should seek appropriate treatment.
• Protect eyes from sunlight: Ultraviolet rays can lead to exfoliation glaucoma. Wear high-quality polarized sunglasses when outdoors.
• Maintain oral hygiene: Gum disease can affect the optic nerve, contributing to glaucoma. Brush and floss daily and see your dentist regularly.
• Exercise carefully: Intense exercise can elevate IOP, so exercise in moderation.

FAQs

What are the early symptoms of glaucoma?

Glaucoma usually has no early symptoms. Population-level studies suggest 50 to 90 percent of people with glaucoma are unaware they have it.

Can glaucoma be stopped?

Glaucoma has no cure, but treatment helps to slow or stop further damage to your optic nerve and continuous loss of vision.

How long does it take to go blind from glaucoma?

Most people with glaucoma do not go blind, but it does happen. How long glaucoma takes to progress to blindness depends on the type of glaucoma and the extent of its advancement before diagnosis, to name two factors. 

Acute angle-closure glaucoma, for instance, can cause quick and irreversible blindness in only a few days if it is not treated. In more common forms of glaucoma, the damage that can lead to blindness usually happens more slowly, within several years.

Without treatment, glaucoma can result in faster development of vision loss. Nevertheless, even with treatment, about 15 to 20 percent of glaucoma patients become blind in one or both eyes within 15 to 20 years.

References

1. Why Do People (Still) Go Blind from Glaucoma? (March 2015). Translational Vision Science & Technology.

2. Lifetime Risk of Blindness in Open-Angle Glaucoma (October 2013). American Journal of Ophthalmology.

3. Blindness and Glaucoma: A Multicenter Data Review from 7 Academic Eye Clinics (August 2015). PLOS ONE.

4. The Pathophysiology and Treatment of Glaucoma: A Review (May 2014). JAMA.

5. Mindfulness Meditation Can Benefit Glaucoma Patients (January 2019). Journal of Current Glaucoma Practice.

6. Modifiable factors in the management of glaucoma: a systematic review of current evidence (April 2017). Graefe’s Archive for Clinical and Experimental Ophthalmology.

7. Metabolic Health, Obesity, and the Risk of Developing Open-Angle Glaucoma (December 2019). Diabetes & Metabolism Journal.

8. Relationship of lifestyle, exercise, and nutrition with glaucoma (March 2019). Current Opinion in Ophthalmology.

9. Prevalence of glaucoma in patients with moderate to severe obstructive sleep apnea (August 2014). Nature Portfolio.

10. Glaucoma (September 2021). National Eye Institute.

11. Glaucoma (n.d.). American Optometric Association.

12. What Is Glaucoma? Symptoms, Causes, Diagnosis, Treatment (September 2021). American Academy of Ophthalmology.

13. Understand Your Glaucoma Diagnosis (October 2017). Glaucoma Research Foundation.

14. Types of Glaucoma (September 2021). National Eye Institute.

15. Glaucoma: What’s new and what do I need to know? (March 2021). Harvard Health Publishing.

16. Lifestyle Habits and Glaucoma (October 2021). American Academy of Ophthalmology.

17. Alternative Treatments for Glaucoma (October 2021). American Academy of Ophthalmology.

18. 10 Things To Do Today To Prevent Vision Loss From Glaucoma (February 2020). American Academy of Ophthalmology.

19. 8 Healthy Habits That (Possibly) Prevent Glaucoma (November 2017). American Academy of Ophthalmology.

20. Glaucoma Eye Drops (December 2021). American Academy of Ophthalmology.

21. Daily Life with Glaucoma (June 2020). Glaucoma Research Foundation.

22. What Is Chronic Angle-Closure Glaucoma? (December 2021). American Academy of Ophthalmology.

23. Don’t lose sight of Glaucoma (2021). National Eye Institute.

24. Talk With Your Doctor About Glaucoma (n.d.). National Eye Institute.