 
Glaucoma is often referred to as the “sneak thief of sight” because in the vast majority of cases vision is lost to glaucoma with no pain, discomfort or noticeable change in vision. This is surprising to many people who feel that their routine eyeglass exam is sufficient to protect against the development of glaucoma. Unfortunately, with more than 2 dozen distinct types of glaucoma, each with its own subtle presentation, a complete medical evaluation is needed to detect this condition in its early, very treatable stages.
In order to see properly, the eyeball requires a certain internal pressure to maintain its round shape and to nourish the eye's internal structures. This pressure is maintained by a delicately balanced system of fluid pumps and drains which normally maintains the eye pressure within a very narrow range for a lifetime. However, if this pump and drain system is disturbed by any number of factors, the eye pressure can begin to build up and very gradually damage the optic nerve and slowly constrict vision until eventually all vision is permanently lost. This usually happens so gradually and painlessly that we notice no change in vision from month to month until substantial vision is permanently lost.
It is estimated that there are at least 3 million people in the US with established vision loss from glaucoma, but only 2 million have been diagnosed and are receiving treatment. This means that at least one million people are currently losing vision and are unaware of any problem. Most cases of glaucoma could be discovered and treated if those at risk could be screened annually.
There are many risk factors for the development of glaucoma: chief among them is age. Those over 40 have a significantly higher risk of glaucoma, and the risk increases with every decade achieved after that.
Family history is also significant; if a first-degree relative (mother, father, sister, brother or child) has glaucoma, the risk increases from about 2% for the general population to more than 30% for that individual in his or her lifetime.
Prior eye injuries, even in the distant past, can lead to the premature development of glaucoma later in life. Certain medications, primarily steroids such as Prednisone and Medrol, if given for more than a few weeks can lead to steroid-induced glaucoma and certain types of cataracts.
If we do our job and get the word out that those at risk of glaucoma should get routine screenings, we will be able to treat many of the million undiagnosed glaucoma sufferers and save a great deal of vision.
Current glaucoma therapy is much more effective and comfortable that the treatments in place when I began as an eye surgeon 21 years ago. At that time, there were only a few medications effective against glaucoma and they caused many distressing side effects, such as pain and blurring of vision. More recently developed eye drops are much more effective at lowering pressure with many fewer side effects.
A very exciting development in glaucoma treatment is the strides that have been made in the use of laser therapy to lower eye pressure. Many different lasers are used for many eye conditions, but the recent introduction of Selective Laser Trabeculoplasty or SLT, has allowed me to reduce many of my patients' dependency on drop therapy and in some cases eliminate drops entirely.
SLT is a convenient office procedure that takes a few minutes and is comfortable with few risks. For the most severe cases of glaucoma, an array of microsurgical techniques are available to save vision.
Again looking back over my career so far, I am impressed with the tremendous improvement in effectiveness of our most demanding glaucoma surgical procedures. 20 years ago, these procedures would succeed in controlling eye pressure only about 60% of the time. Today I can do a microsurgery that is more than 90% successful at controlling pressure, in many cases with few or no eyedrops required after the eye has healed.
This is clearly a very exciting time to be an eye surgeon, and I am grateful every day that I can play a part in preserving the vision of my fellow Southern Mainers!
Please click here for more information on SLT laser therapy.
- Rob Rice, M.D., Glaucoma Specialist
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Last modified:
October 1, 2007
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