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Common Glaucoma Q & A’s

What is the normal intraocular pressure?

The normal intraocular pressure is in the range of 11 ~ 21mmHg. Due to the deference of tolerance of each person’s optic nerve, in some cases, the intraocular pressure is higher than normal with no visual field defect and optic damage, known as ocular hypertension, which will not develop into glaucoma; in other cases, there is glaucomatous optic nerve damage and visual field defects, but the intraocular pressure is still within normal range known as normal tension glaucoma or low tension glaucoma. Therefore, high intraocular pressure is not necessarily glaucoma and normal intraocular pressure can not rule out glaucoma.

What are the acute attack symptoms of glaucoma?

An acute attack of glaucoma is usually found in angle-closure glaucoma patients in middle-age and older. Age of onset is more frequent in patients over 40 years old, especially in those 50 to 70 years old. This occurs in women 24 times more often than men. It affects both eyes, but often one eye is onset first. The symptoms include: eye dispending pain, sudden loss of vision, steep decline in visual acuity and ipsilateral migraine headache, even nausea, vomiting, increased body temperature, pulse acceleration, bulbar conjunctival congestion, corneal edema, very shallow anterior chamber, dilated pupil, lens opacification, high intraocular pressure, and eye tissue as hard as stone. Particular attention should be paid to those who have high eye pressure but without any symptoms. The consequences are more serious for those patients. Some patients are not found to have glaucoma until they are almost blind or blind, when the treatment is too late.

How to prevent glaucoma?

Glaucoma is a common group of eye disorders and the second leading cause of blindness in the United States. More than 2.3 million Americans are affected and another 2 million do not know they have the disease. Because the incidence of glaucoma is due to a variety of factors, such as anatomy of the eyes, the neural-vascular system disorders, genetic factors, environmental factors, and so on, to avoid the attack of glaucoma, early diagnosis and early treatment is the key to prevention and treatment of glaucoma.

People with high-risk of glaucoma should avoid these risk factors as far as possible:

1. Don’t be emotional, don’t worry, and don’t lose your temper.

2. Don't stay up late. Get enough sleep.

3. Avoid prolonged stays in a darkroom. Don’t watch movies in the cinema.

4. Avoid drinking or drink less strong tea and coffee.

5. Avoid having constipation and ensure having a bowel movement everyday.

How to find glaucoma in its early stage?

Many glaucoma patients, with open-angle glaucoma in the early stage, especially without obvious symptoms, can easily be misdiagnosed and fail to find out they are at risk and miss the early treatment that often can help to slow down the development of the disease and protect the eyes against serious vision loss and blindness.

Therefore in the following circumstances, the patient should consider going to their ophthalmologist to have an eye check up so they can find the glaucoma in the early stage and to get timely treatment:

1. When there is a family history of glaucoma, every family member should be carefully examined and, if necessary, have a long-term observation on a regular basis.

2. When the common symptoms of glaucoma appear: eye pain with distension sensation, headache, rainbow vision, decreased vision.

3. When the diagnosis of glaucoma has been made in one eye, the other eye should be on high alert and get checked as soon as possible.

4. People who suffer from glaucoma-related systemic diseases, such as diabetes, high blood pressure, and low blood pressure, etc. or suffer from systemic diseases that may lead to secondary glaucoma, such as embolism of cavernous sinus which blocks the venous return of the eye, and thyroid dysfunction

5. People suffer from glaucoma-related other eye diseases, such as high myopia, hyperopia, central retinal vein occlusion, eye injuries, cataract, eye inflammation, and eye tumors, etc.

When knowing the risks of glaucoma, what attention should you pay to it?

After knowing the risks in patients of glaucoma, some believe that they have no symptoms and don’t need to take medication; others only take pain killers when there is an eye pain and withdraw them by themselves after the pain is relieved. Some experience anxiety, fear and don’t what to do with it. All those reactions are no help for the treatment of glaucoma. The patients should neither underestimate the severity of their illnesses, nor be over-stressed. The right thing to do is:

1. First, learning as much as possible about glaucoma can help patient in dealing with physical and emotional problems in the process of treatment.

2. Try to avoid the predisposing factors of glaucoma.

3. Actively work with your doctor, and use drugs with strict rules. Don’t deviate from the treatment program without your doctor’s permission.

4. Go back to your doctor’s office to get reviewed on a regular basis.

5. Immediately go to your doctor’s office for an examination when you experience rainbow vision, eye pain, vision loss and other symptoms as discussed in this report.

Can glaucoma be cured?

In general, glaucoma can not be cured, but can be controlled. Once diagnosed, the glaucoma patient needs regular, lifelong care. The patient should actively work with doctors, use medications with strict rules or have surgery to protect the optic nerve and the visual function. However, there are a few early acute angle-closure glaucoma cases, which, after proper treatments are no longer at risk, and achieve healing. In addition, for secondary glaucoma, as long as the pathogenic factors are removed, and the intraocular pressure is decreased, the development of glaucoma can be controlled.

It is worth mentioning that, despite the intraocular pressure being under control, the patient should regularly visit their doctor for an examination to find problems early and get treatment promptly.

When the pain and distension of the eye disappear after using the drugs or having eye surgery, does it mean the glaucoma is cured?

Some glaucoma patients no longer have eye pain after medication or surgery and think the glaucoma is treated well and they stop taking medication, and do not go to visit doctor to get reexaminations anymore, which is very dangerous for the following reasons:

First, many glaucoma patients have hidden onsets, slow progresses, and no eye pain even under high intraocular pressure.

Second, in most patients, there are no more eye pain symptoms with increased intraocular pressure after trabeculectomy.

Third, some acute closed-angle glaucoma cases transfer into chronic phase after a period of time of acute attack and the patients build up tolerance to the pain gradually without any symptoms or obvious symptoms. Therefore we should not depend on whether there is an eye pain to judge the condition of good or bad.

In addition, glaucoma is a lifelong disease. Even though the condition can be under control and the progression of development can be delayed, it is not able to be totally healed. Even if the intraocular pressure becomes normal under the treatment of medication and surgery, the internal and external factors can also cause fluctuations in intraocular pressure. If we do not receive examinations and treatments regularly, there is a high probability that eventually irreversible damage to the visual function will go unnoticed until it’s too late to do effective treatment.

What causes blindness in glaucoma patients?

Glaucoma is one of the most common causes of blindness. It brings patients the pain of blindness due to various causes. Common causes are as follows:

1. Open angle glaucoma and some chronic angle-closure glaucoma have no symptoms in the early stage, so the patient does not know his eyes are sick. Once it is found, it is already at an advanced stage or the patient has already become blind.

2. Some patients do not listen to doctors’ medical advice, do not trust doctors, and do not want to do any examinations, as a result, the best timing for treatment is missed.

3. Some patients are lack of awareness of the dangers of glaucoma and are indifferent to their diseases. Some people just work hard and never see a doctor until they notice the contraction of visual field, but it is often too late and vision may have already been lost in at lease on eye.

4. The patients do not take medication on time, or they fail to follow the doctors’ instructions once symptoms are no longer obvious, and may not follow up with proper eye exams. The irregular applying of medication may result in reducing the effectiveness of the treatment.

5. Some patients do not have any symptoms after surgery. They think their glaucoma has been completely cured and ignore follow-up examinations and regular monitoring, which may cause them to lose their vision and become blind after surgery.

6. After surgery some patients only pay attention to the intraocular pressure, without checking the change of vision field. Some patients may have hemodynamic abnormalities, such as cardiovascular disease, low blood pressure and increased whole blood concentrations. Due to the interaction of these factors, the optic system is in a long-term state of chronic insufficient blood supply resulting in progressive narrow vision field, even blindness.

Due to the above reasons, it is recommended that glaucoma patients must follow the doctors’ advice and actively seek early and effective treatment to minimize the damage of visual function.