The physicians and surgeons at EyeHealth Northwest are committed and experienced in providing personalized, expert care to patients with glaucoma.

EyeHealth uses the most advanced, up-to-date diagnostic technologies to detect and diagnose glaucoma at its early stages.

Our comprehensive eye health care enables our doctors to monitor the progress and treatment of established patients. Overall, physicians use the latest medications and surgical techniques to preserve vision while minimizing the impact of glaucoma therapy on the patient's lifestyle. A fellowship-trained glaucoma specialist, J. Kevin McKinney, MD is also available for consultation, second opinions and on-going care. Among glaucoma doctors in Portland, Dr. McKinney is the only glaucoma specialist practicing on the East Side.

For more information, or to schedule an appointment for a Glaucoma evaluation, contact us: MyEyeHealth

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The “silent thief of sight”    Glaucoma affects over 3 million Americans (65 million people worldwide). This is alarming since half of these people do not know they have the disease and may not learn of their problem until permanent vision loss has occurred. Because early glaucoma often has no warning symptoms and the vision loss “sneaks up” from your side vision, it has been called the "silent thief of sight".

The Disease

Glaucoma is a disease involving damage to the optic nerve. The most common cause of glaucoma is a higher-than-normal eye pressure.

The optic nerve is made up of a million tiny nerve fibers that carry information from the eye to the brain where images are formed of what our eyes see. The system functions like a video camera (the eye), connected by a cable (the optic nerve) to a television (the brain). When exposed to high intraocular pressures for prolonged periods of time, the optic nerve fibers begin to die and consequently cannot relay visual information from the eye to the brain. This can also occur at normal pressures if you inherited a particularly weak optic nerve or have episodes of very low blood pressure.

The Effects

If untreated, vision loss or blindness will occur. Loss of optic nerve fibers causes blind spots to develop, usually in the peripheral (side) vision. This early loss often begins near your nose (which we tend to ignore) so it is rarely noticed by the patient. With continued high pressures, irreversible damage to the optic nerve causes loss of reading (central) vision & eventual blindness.

Fortunately, blindness is uncommon with early detection and regular treatment, like the care and expertise provided at EyeHealth Northwest. Patients participating in routine prevention and quality treatment regimens, significantly decrease their risk of vision loss & blindness.

Unfortunately, those who do not know that they have glaucoma and those who have been diagnosed but fail to keep regular follow-up visits are at the greatest risk of blindness. The vision loss caused by glaucoma is permanent since the optic nerve cannot be replaced or repaired, not even at the best eye centers around the world. Because of this,
Glaucoma is the second leading cause of blindness in the US and the first cause of preventable blindness.

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Glaucoma can affect anyone, regardless of his/her race, gender or family history. Because of this, everyone should be concerned with the potential damage Glaucoma could cause to their vision and life.

Regular eye examinations by a qualified eye provider, like the doctors at EyeHealth Northwest, are the only way to detect glaucoma in its early stages. Early detection could save your vision.

The following factors increase your risk of glaucoma:

• Increased eye pressure
• Family history of glaucoma (especially parents or siblings)
• African-American, Hispanic or Asian Descent
• Older than 45 years of age
• Severe Nearsightedness
• History of eye injury causing bleeding inside the eye
• Systemic health problems, including diabetes, migraine headaches, and poor circulation.
• Chronic use of medications containing steroids - especially eye drops/ointments, nasal sprays, inhalers or pills taken by mouth (examples include cortisone, prednisone).

African-Americans

African Americans are much more likely to go blind from glaucoma than Caucasians of the same age. The Glaucoma Research Foundation recommends that African-Americans should have a thorough eye exam every 1-2 years starting at age 35.

Asian Descent

Angle closure glaucoma is much more common in those of Asian descent, as well as persons of Eskimo and Inuit descent. Early and regular eye examinations are recommended and must include Gonioscopy (a technique to determine if the anterior chamber angle is open or closed).

Hispanic Descent

Recent research in large Hispanic populations has shown an increased risk of glaucoma similar to that already demonstrated for African-Americans. More information is needed in this area, but persons of Hispanic descent should have eye exams earlier and more frequently.

How often should I be checked for glaucoma?

Regular eye exams are the only way to find glaucoma before it causes severe vision loss. The physicians and surgeons at EyeHealth Northwest recommend the following guidelines, but you should be seen more frequently if you have any of the risk factors discussed above (at least once a year).

• Age 40 and under: Once every three years
• Age 40 - 65: Once every two years
• Age 65 and over: Annually

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The normal eye maintains its spherical shape (like an inflated balloon) by means of a watery fluid, called the aqueous humor, which is constantly secreted within the eye. As this fluid slowly drains out of the eye and into the blood stream through small channels in the wall of the eye, the eye pressure is maintained at a constant, normal level. In contrast, tears are produced by glands around the eye and are totally different than the aqueous humor inside the eye.

If the aqueous drainage channels are blocked so that aqueous fluid is trapped inside the eye, then the pressure may build up to dangerous levels. Because the eye is a closed structure, this elevated eye pressure will push and damage the weakest part of the eye where the optic nerve fibers leave the eye at the optic disc. Loss of these nerve fibers causes "cupping" of the optic nerve. Cupping is one of the earliest signs of glaucoma.

Glaucoma is not just one disease, but a group of diseases that all involve optic nerve damage. Most of these types of glaucoma involve high eye pressure and are classified by the underlying problem that blocks the drainage channels.

Types of Glaucoma

Open Angle Glaucoma

In the US, Europe and Africa, open angle glaucoma is most common. The aqueous channels appear normal but fail to allow the aqueous fluid to pass through (similar to a clogged filter) so that the eye pressure builds up. Research suggests that a genetic defect is responsible for this malfunction of the aqueous channels in most patients with Primary Open Angle Glaucoma.

Up to one third of patients with open angle glaucoma have eye pressures that are in the “normal” range (10-21) but they still get glaucoma damage. This condition is called Low Tension Glaucoma or Normal Pressure Glaucoma.

Some of these patients have a very thin cornea (clear window at the front of the eye) that makes their eye pressure measure lower than it actually is. Others may have a weak optic nerve that can be damaged even at normal eye pressures. Still others may have episodes of very low blood pressure that cause damage to the optic nerve indistinguishable from glaucoma.

Angle Closure Glaucoma

In contrast, angle closure glaucoma is more common in Asia than in the U.S.A. Here the front part of the eye is small and the iris (the brown or blue part of the eye) covers the channels of drainage (like a sheet of paper covering the bathtub drain). This can happen suddenly with pain and immediate loss of vision, or more commonly develop slowly without pain or noticeable changes in sight.

The tendency to develop both kinds of blocked channels is often inherited and may affect several members in one family. In most patients, this blockage and high pressure is not caused by the blood pressure or anything one eats or drinks, although physical inactivity, obesity and smoking can make established glaucoma worse, as can poorly controlled high blood pressure and diabetes.

Infants and children may also develop glaucoma. Any infant or child with unusually large eyes, cloudy eyes or who cannot open his eyes (light sensitivity with excessive tearing) needs to have immediate evaluation by an ophthalmologist.

Medications affecting your eye pressure

Some medications can cause or worsen glaucoma. Use of steroids (like prednisone, cortisone, or dexamethasone) for more than a few weeks can cause high eye pressures in 30-40% of normal people. This occurs more frequently if you have family members with glaucoma (a “family history” of glaucoma) and even more frequently if you have glaucoma. While this is most common with topical eye drops and ointments, it can occur with steroids taken by any method (by mouth, skin cream, nasal spray, inhalers and joint injections).

A number of medications are labeled with a warning such as “Do Not take if you have Glaucoma”. This includes many over-the-counter medications like cold remedies, antihistamines, and decongestants, but also many prescription medications. This warning is somewhat misleading because it does not refer to persons with Open Angle Glaucoma (the majority of patients in the US). This universal labeling is a general warning for persons with an untreated Narrow Angle or Angle Closure Glaucoma . Once this has been diagnosed and treated, many of these persons may safely take these medications.

YOU SHOULD ALWAYS ASK YOUR OPHTHALMOLOGIST if you do not know what kind of glaucoma you have, or if it is safe for you to take these medications.

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Symptoms

Unfortunately, the common types of glaucoma have no early symptoms.

Once loss of vision is noticed, the damage is usually severe and irreversible. Despite what most people think, people cannot "feel" an elevated pressure inside their eyes unless the pressure is very high or has risen suddenly.

Symptoms of intermittent pain, blurring of vision or seeing colored haloes (“rainbow rings”) around lights may indicate a glaucoma attack and should be evaluated by an ophthalmologist as soon as possible. Any sudden, severe eye pain or loss of vision should prompt an immediate visit to an ophthalmologist.

Prevention of Vision Loss.

All adults over the age of 30 years should have eye examinations every 2-3 years to make sure they do not have early glaucoma.

Regular eye examinations by a qualified eye care provider, like the doctors at EyeHealth Northwest, are the only way to catch glaucoma in its early stages. Proactive prevention and early detection are critical to preserve your vision. Visit: Glaucoma Exam to learn more, or contact us for an appointment.

Physicians and surgeons at EyeHealth Northwest recommend the following guidelines for detection, However, if you are at higher risk, more frequent exams are recommeded.

• Age 40 and under: Once every 2 to 3 years
• Age 40 - 65: Once every two years
• Age 65 and over: Annually.

Unfortunately, vision lost to glaucoma damage CANNOT be restored. General ophthalmologists and glaucoma specialists endeavor to preserve what vision a glaucoma patient still has. Medicine and surgery for glaucoma can prevent further loss of vision, but cannot improve vision. Persons with glaucoma who fail to seek or follow the advice of an ophthalmologist may slowly lose their remaining vision until they become blind.

Even with current technology, it is not possible to perform an eye transplant or optic nerve transplant. In addition, the nerve fibers damaged by glaucoma cannot be replaced or re-grown. Retinal implants are being evaluated for patients with retinitis pigmentosa and macular degeneration, but are unlikely to help glaucoma patients

Treatment for Glaucoma

The common goal of all glaucoma treatment is to lower the eye pressure to a safe range. This can be achieved with eye drops, medications, laser treatment or surgery.

Eye Drops and medications

Eye drops usually work well for most cases, but they only work if taken regularly. If the medications are forgotten, used incorrectly or taken less often than prescribed, progressive glaucoma damage may occur.

Taking these medications more often than prescribed is also a bad idea - it may increase side effects and even cause acute illness.

Similar to diabetes, high blood pressure and arthritis, glaucoma is a chronic disease that cannot be "cured", so treatment is usually life-long. Multiple medications are often required and these medications may need to be adjusted over the course of several visits until the most effective combination is found. Even after the pressure is controlled, clinic visits are necessary several times a year to make sure that the pressure remains controlled.

Laser Surgery

Glaucoma that cannot be controlled with medications may respond to Glaucoma laser therapy. These procedures either seek or attempt to:

• create an artificial drainage pathway for the aqueous fluid to leave the eye ("an escape valve") or
• decrease the amount of aqueous produced inside the eye (“turning off the tap”). Unlike adults, children with glaucoma are usually treated surgically.

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Most patients can learn to administer their own glaucoma drops. Our physicians and ophthalmic technicians at EyeHealth Northwest would be pleased to demonstrate the technique to you and help you learn to successfully administer your own drops.

Eye Drop Technique

1. First, wash your hands and have a clean tissue available.
   
2. Pick up your drop bottle, confirm that it is the correct medication and then remove the cap (do not let the bottle tip touch anything). For a right-handed person, hold the bottle in your right hand.
   
3. Use the forefinger of your left hand to pull down the lower eyelid (creating a “pocket” between the lid and eyeball).
   
4. Place the wrist of the right hand on the knuckles of your left hand. The bottle is now positioned over the “pocket”.
   
5. Look up and gently squeeze the bottle until a drop falls into your eye. Only one drop is required (the eye can only hold 10% of one drop so you will always have excess medication to wipe away – this does not necessarily mean you missed your eye). Extra drops may increase your risk of side effects.
6. Close your eye for at least one minute.

Some patients find this process easier if they recline back in an easy-chair or lie on their bed. If you cannot feel the drop hit your eye, you may want to keep your drops in the refrigerator. It will be much easier to feel the cold drop hit your eye. If you use more than one kind of eye drop, always wait at least 5 minutes between the different drops (so they don’t wash each other out and decrease the desired effect).

Reducing Side Effects

Glaucoma drops contain medication that can affect other parts of the body. Closing the eye (without blinking) for 1-2 minutes will increase the beneficial effect and will decrease the amount of medicine that goes into the bloodstream via the nose, thus decreasing bodily side effects. Blinking pumps drops into your nose, increasing side effects. Pressing with a finger near the corner of the eye (“punctual occlusion”) may also be helpful, but must be properly performed (ask your glaucoma doctor to demonstrate). Like all medications, these drops should never be shared with anyone else.

Eye Drop Storage

Most eye drops should be kept in a cool place and protected from intense heat or sunlight. They should never be left in a parked car. These medications should not be stopped without consulting the ophthalmologist (unless severe illness or allergy occurs). Glaucoma medications should be used regularly, especially on the day of an office visit, so that the treating physician can accurately assess how well the medication is working. Otherwise, the time of the patient and the physician will have been wasted. It is also important to bring all of one's medications to every clinic visit to help the physician determine if each medication is being taken correctly.

Do not store eye drops with any other drop bottles (like superglue, nail polish, ear drops). Many patients have accidentally put toxic liquids in their eye because they stored them with their eye drops. Eye drops have color-coded caps to help in identification, but the caps can get mixed up!

Learn the name and cap color of your medications so you avoid mixing up the caps and taking your medications incorrectly. If you do not see well enough to tell your drops apart, please discuss this with your doctor and staff.

Reminders

Successful glaucoma patients develop a support system to help them take their drops at the right times. This often involves taking medication at natural transition times such as waking up, at meal times and at bedtime. An alarm clock or watch can be very helpful to remind you of drop times (watches and clocks that can be programmed to ring daily at several times are available for this specific purpose). Some patients have friends or family members call them for reminders. A written chart of your daily drops and dose times is critical to keeping track of when and if you take your drops (this can be kept on your refrigerator or bathroom mirror).

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Early in the disease, there are minimal restrictions on lifestyle other than taking medications and keeping follow up visits. Specific activities that can worsen glaucoma in some patients include:

• prolonged body inversion (turning upside down such as with yoga or gravity boots)
• heavy weight lifting (associated with holding one’s breath while lifting)
• drinking large volumes of fluids.

Later in the disease, the vision may be affected to the point that some activities become dangerous. These include driving and operating hazardous machinery. You should consult your eye doctor regarding specific restrictions based on your level of vision.

With modern medicines and surgical techniques many glaucoma patients can retain good vision for their lifetime. However, treatment is of greatest benefit when started early in the course of the disease.

Because glaucoma is a "silent" thief of sight, all persons should have an eye exam to exclude its presence and re-examination every few years. These repeat exams must be more frequent for those with a family history of glaucoma, with advancing age and with black or Hispanic heritage. Only by catching glaucoma early can the tragedy of irreversible visual loss be prevented.

It is common to feel depressed or fearful when you are diagnosed with a chronic condition like glaucoma. Fortunately, most patients with glaucoma experience very little change in their lifestyle and ability to work, drive and enjoy leisure activities. Should you feel like you are losing hope or are overcome with fear, please discuss this with us – the physicians and staff at Eye Health Northwest have decades of experience in the treatment and management of glaucoma and are dedicated to helping our patients live and cope with this condition.

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Researched by J. Kevin McKinney, MD

Additional information regarding glaucoma can be found at the following websites. These sites contain patient education about glaucoma and glaucoma treatment.

• Facts About Glaucoma

Excellent one page overview of Glaucoma for family and friends from the National Eye Institute of the National Institutes of Health

• A Patient's Guide to Glaucoma

This free online resource by the Glaucoma Faculty at the University of Iowa is highly recommended for those desiring in-depth information with excellent photos and diagrams about many aspects of glaucoma. It is also available for purchase in printed form (to avoid the online advertisements). EyeHealth Northwest and its staff/physicians have no financial interest in this product.

• Digital Journal of Ophthalmology

This website has excellent information regarding laser and surgery for glaucoma (the picture links are currently not working, but the text is good).

• American Glaucoma Society

This website answers commonly asked questions about glaucoma. The mission of the American Glaucoma Society is to promote excellence in the care of patients with glaucoma and preserve or enhance vision by supporting glaucoma specialists and scientists through the advancement of education and research.

• Glaucoma Research Foundation

The Glaucoma Research Foundation is a non-profit organization that works to prevent vision loss from glaucoma by investing in innovative research, education, and support with the ultimate goal of finding a cure. This website has excellent resources on living with glaucoma. You can also request free glaucoma literature and sign up for "Gleams", a patient-oriented newsletter with helpful news and tips.

• The Glaucoma Foundation
  

The Glaucoma Foundation is a not-for-profit organization committed to leading the fight against glaucoma and to identifying new treatments and cures.

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