Glaucoma

Glaucoma is a common eye condition that can cause permanent vision loss if left untreated.  

Preserving your vision is our ophthalmology consultants’ priority. We have a thorough understanding of glaucoma and use modern diagnostic tools to provide you with a comprehensive assessment and treatment plan through our ophthalmology services.  

What is glaucoma? 

Glaucoma is where damage occurs to your optic nerve, which connects your eye to your brain. It typically impacts your peripheral vision, although, in advanced cases, it can also threaten your colour vision and central vision. Although glaucoma can affect people of any age, it’s much more common in those over 70, or younger if you have a positive family history. This condition can affect 1 or both eyes and occur slowly or rapidly. 

Most of the time, glaucoma has no symptoms, and damage occurs to your optic nerve silently. Glaucoma tends to develop gradually and you may not notice any vision changes until it becomes more advanced. It’s essential to attend regular eye check-ups, as the earlier glaucoma is detected, the more effective treatment can be and the less vision loss you are likely to experience. 

If you have a family history of glaucoma and are aged over 40, you are entitled to free eye tests with your optician to detect any increase in eye pressure early. 

Types of glaucoma and their symptoms 

There are different types of glaucoma, and each has various symptoms depending on the stage of your condition.  

The main types of glaucoma are:  

• primary open-angle glaucoma – the most common type, which develops slowly over time
• angle-closure glaucoma – a rare type of glaucoma that can develop slowly (chronic) or suddenly (acute)
• secondary glaucoma – occurs because of an eye injury or another eye condition like uveitis (inflammation in the eye) 

The symptoms of each type of glaucoma can vary and they may not become noticeable until your condition has advanced. 

Primary open-angle glaucoma symptoms

Symptoms of primary open-angle glaucoma do not usually occur in the early stages, but they may include:  

• reduction in your peripheral vision (often without any symptoms) 
• changes to your central vision as it becomes more advanced
• migraines, cold hands, and cold feet as a result of poor circulation, including poor circulation to the optic nerve (this occurs in normal-pressure glaucoma, a type of open-angle glaucoma) 

Angle-closure glaucoma symptoms

Symptoms of angle-closure glaucoma may include:  

• headaches 
• eye pain 
• nausea or vomiting 
• blurry vision 
• halos around lights 
• redness of the eyes 

Secondary glaucoma symptoms

Symptoms of secondary glaucoma do not usually appear in the early stages but, as it develops, they may include:  

• loss of peripheral vision 
• changes to your central vision 
• cloudy or blurry vision 

What causes glaucoma? 

The cause of glaucoma will depend on the type you have. However, the leading reason is a build-up of pressure in your eye when fluid cannot drain properly. This fluid is different to tears or watery eyes. When the pressure within the eye increases, damage occurs to your optic nerve, leading to glaucoma.  

Primary open-angle glaucoma develops when parts of the drainage system in your eye do not function correctly. It leads to a gradual increase in eye pressure (intraocular pressure).  

Angle-closure glaucoma occurs when your iris (the coloured part of your eye) bulges and blocks your drainage system, causing increased pressure. It can occur rapidly or gradually.  

Secondary glaucoma is often caused by an eye injury, another eye condition that causes inflammation, or certain medications that elevate eye pressure, such as steroids.  

Risk factors for glaucoma 

Some people may have a higher risk of developing glaucoma.  

Risk factors for glaucoma can include:  

• your age – it’s much more common in older people 
• your ethnicity – people of African, Caribbean or Asian descent may have a higher risk of developing particular types of glaucoma 
• family history – if a close family member has glaucoma, you can be more likely to develop it 
• certain medical conditions – diabetes, uveitis, inflammation and steroid use can increase your risk of elevated eye pressure 
• pigment (brown deposits) or exfoliation (dandruff-like deposits) in your iris – these deposits can block drainage channels within the eye, leading to an increase in pressure 

Glaucoma can be prevented with regular eye check-ups, early detection and suitable treatments. 

How is glaucoma diagnosed? 

Glaucoma can be diagnosed by carrying out a range of tests during an eye test. 

Some of the tests you might undergo are:  

• tonometry to measure the pressure in your eye 
• dilating your pupils (the black part of your eyes) to check for optic nerve damage 
• visual field tests to check the extent of your vision loss 
• inspecting the drainage system in your eye through gonioscopy (a specific lens is placed over the eye for the ophthalmologist to look through) 
• optical coherence tomography to scan the back of your eye and optic nerve at high resolution (this checks for early undetectable damage) 

Glaucoma treatment 

Treating glaucoma as soon as possible is vital as nothing can reverse the damage caused to your optic nerve after it has occurred. The main aim of glaucoma treatment is to lower the pressure in your eyes, and there are many ways to do this, with treatment options varying depending on how advanced your glaucoma is.

Early glaucoma treatment 

Your ophthalmologist may prescribe eye drops to decrease eye pressure and improve fluid drainage. Depending on the type of glaucoma you have, they may also recommend some specialist laser treatments, such as selective laser trabeculoplasty (for open angle glaucoma) or laser iridotomy (for angle closure glaucoma). In some cases, minimally invasive glaucoma surgery can be combined with cataract surgery, if both conditions are present together. 

The main treatment for most patients with glaucoma is eye drops which are used 1-3 times a day. These contain medications called prostaglandin analogues, beta-blockers, or carbonic anhydrase inhibitors which lower your eye pressure. Using these regularly is the most effective way to treat early glaucoma and reduce the likelihood of potential damage occurring, and your consultant ophthalmologist will advise which eye drops are your best option. 

If these first lines of treatment do not work, you may need surgery to control your eye pressure. Laser treatments are often used instead of eye drops to lower eye pressure in the early stages of glaucoma.  

Advanced glaucoma treatment 

The standard operation for advanced glaucoma is a trabeculectomy. During this procedure, the surgeon creates a drainage reservoir to divert fluid from inside the eye into a bleb (a small blister created inside the eye), which bypasses the eye’s blocked drainage system and reduces pressure. The bleb is typically made underneath your eyelid, so you won’t notice it. 

The procedure usually takes less than an hour to complete and is generally carried out under local anaesthetic, so you are awake for the procedure but will feel no pain. If the surgery is more complex, general anaesthetic may be recommended, but your ophthalmologist will keep you informed of all options to help you make the best decision for you. 

After a trabeculectomy, you will usually visit your ophthalmologist weekly to monitor your healing progress and check that your eye pressure has decreased as expected. 

Our team also offers alternative procedures for advanced glaucoma treatment, including PreserFlo microshunt and tube implant surgery. Your ophthalmologist can provide you with further information should you require it. 

Stable glaucoma 

Once glaucoma is stable, meaning your eye pressure readings are regularly below the target pressure, your specialist will monitor for changes in your visual field test, or OCT scan, to detect the earliest signs of deterioration.  

As glaucoma is a long-term condition, you may also develop cataracts due to natural aging of the lens in the eye, and can have some glaucoma intervention at the time of your cataract surgery.