What are the risk factors for glaucoma?

Glaucoma is a multifactorial disease with several risk factors associated:

• Age: Glaucoma is found more often in those over the age of 50.
• Race: African Americans are 3-4 times more likely to develop glaucoma. Hispanics are 1-2 times more likely to develop glaucoma.
• Intraocular pressure (IOP): Increased IOP is a risk factor for developing glaucoma. Understand that IOP can have diurnal fluctuation and may be consistently “normal” at certain times during the day, yet abnormal at other times during the day.
• Family history: Patients with immediate family members who have Primary Open Angle Glaucoma (the most common type) are 4-9 times more likely to develop glaucoma.
• Corneal thickness: Patients with thinner corneas are at a greater risk to develop glaucoma.
• Steroid usage: Topical steroids used chronically have been shown to increase IOP in a certain percentage of the population. Patients who take topical steroids on a chronic basis should have their eye pressure checked throughout the year.
• Eye injuries: Blunt injuries to the eye that result in damage to the iris or drainage angle of the eye can lead to increased IOP. The increased IOP can occur immediately following the injury or sometimes 10-20 years following the incident.

What are the different types of glaucoma?

There are several different types of glaucoma, all of which have progressive optic nerve damage and visual field loss in common. Below is a list of the more common types:

• Primary Open Angle Glaucoma (most common type): This is the most common type of glaucoma in the United States. It happens gradually, where the eye does not drain fluid as well as it should (like a clogged drain). As a result, eye pressure builds and starts to damage the optic nerve. This type of glaucoma is painless and causes no vision changes at first. Some people can have optic nerves that are sensitive to even normal eye pressure. Regular eye exams are important to find early signs of damage to the optic nerve.

• Angle Closure Glaucoma / Narrow Angle Glaucoma This type of glaucoma occurs when someone's iris is very close (or even blocking) the drainage mechanism within the eye. One can think of this like a piece of paper sliding over a sink drain. When the drain gets completely blocked, the eye pressure can rise very quickly. This is called an acute attack and is a true eye emergency. Angle-closure glaucoma can cause irreversible blindness if not treated right away.

What are the symptoms?

Primary Open Angle Glaucoma:

• Has no "real" symptoms until late in the disease, when patients can notice patchy blind spots in their peripheral vision
• Glaucoma vision simulator: https://www.aao.org/eye-health/diseases/glaucoma-vision-simulator

Angle Closure Glaucoma:

• Severe eye pain.
• Nausea and vomiting (accompanying the severe eye pain)
• Sudden onset of visual disturbance, often in low light.
• Blurred vision.
• Halos around lights.
• Reddening of the eye.
• Patchy blind spots in your side (peripheral) or central vision, frequently in both eyes.
• Call your doctor immediately if these are present or you might be at risk for permanent vision loss.

iStent inject

• The iStent inject is a micro-shunt device that creates two bypasses, or openings between the front part of your eye and its natural drainage pathway to increase the flow of fluid. The improved outflow results in eye pressure lowering.
• Video of Dr. Bettis performing iStent inject: click here
• More information regarding iStent inject: click here

Trabectome

• The Trabectome uses electrocautery, irrigation and aspiration to create an opening in the natural outflow pathway of the eye, thereby lowering eye pressure.

Kahook Dual Blade

• The Kahook Dual Blade is used to perform a goniotomy which opens the path of fluid outflow to lower eye pressure.
• More information regarding Kahook Dual Blade: click here

XEN Gel Stent

• The XEN Gel Stent (pronounced "Zen") is a surgical implant that creates a small channel in the eye to drain fluid and help lower eye pressure.
• More information regarding XEN Gel Stent: click here

Hydrus Microstent

• The Hydrus Microstent is a surgical implant that is placed in the drainage area of the eye to increase fluid outflow and reduce eye pressure.
• More information regarding Hydrus Microstent: click here

Ahmed Tube-Shunt Surgery

• The Ahmed Tube-Shunt or Valve is a type of aqueous shunt used to reduce eye pressure by draining the fluid from inside the eye to a small collection area (bleb) on the outside surface of the eye.
• There are differences in the design of all tube shunts that your doctor will consider to customize to your particular eye.

Baerveldt/Molteno Tube Surgery

• The Baerveldt Tube and The Molteno Tube are both types of aqueous shunts used to reduce eye pressure by draining the fluid from inside the eye to a small collection area (bleb) on the outside surface of the eye.
• There are differences in the design of all tube shunts that your doctor will consider to customize to your particular eye.

Endocyclophotocoagulation (ECP)

• Endocyclophotocoagulation is a surgical procedure that applies laser to the fluid making area of the inner eye. This treatment results in a decreased production of eye fluid and thus, reduced eye pressure.

MicroPulse P3 cyclophotocoagulation (MP3) with G6 Probe

• Micropulse P3 cyclophotocoagulation is a non-incisional surgical procedure that applies laser to the fluid making area of the inner eye without the need of entering the eye. This treatment results in a decreased production of eye fluid and thus, reduced eye pressure.