Glaucoma | Mate pēhinga karu

Key points about glaucoma

  • Glaucoma (mate pēhinga karu) is a preventable eye disease in which progressive damage to your optic nerve can result in blindness if not treated in time.
  • More than 1 in 10 people over the age of 80 have glaucoma and often there are no symptoms, so get regular eye checks from the age of 45 years.
  • If you experience sudden vision changes or eye pain get help urgently. I
  • f you have glaucoma, treatments are available. With proper care, less than 2% of people with glaucoma will lose their vision.  
Woman getting an eye pressure test by optometrist
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Video: What is glaucoma?

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(EyeSmart, Academy of Ophthalmology, US, 2018)

Fluid is produced in the front of your eye and produces pressure within your eye. When the pressure is too high within your eye, the optic nerve becomes damaged, leading to loss of vision. In some people, damage can occur with pressure within the normal range and is largely thought of a problem in pressure sensitivity. The causes of glaucoma are largely unknown at present; however, there is strong evidence for a genetic cause. 

Vision is lost due to damage to the optic nerve, which is the ‘cable’ that connects your eye to your brain. This damage is irreversible, so glaucoma must be detected early to stop progressive damage leading to blindness. 

You are at an increased risk of glaucoma if you:

  • are older than 40 years
  • have a family history of glaucoma
  • are either short-sighted or long-sighted
  • have a history of migraine or Raynauds syndrome
  • use cortisone or steroids
  • have a previous eye injury.

If you fit into one of these risk groups, see an eye care professional (known as an optometrist or ophthalmologist) at least every 1 to 2 years for an eye check.

There are optometrists who have advanced training in glaucoma. Ophthalmologists are medical doctors who have completed training in managing eye conditions. Fellowship-trained glaucoma specialists are ophthalmologists who have conducted additional training in managing glaucoma and performing glaucoma surgery.

Take this test to see if you have an increased risk of glaucoma

  1. Are you older than 40?
  2. Do you have a family history of glaucoma?
  3. Do you have near-sightedness (myopia)?
  4. Do you have diabetes?
  5. Do you have high blood pressure?
  6. Do you have a history of migraines?
  7. Do you use cortisone or steroids? 
  8. Have you had a previous eye injury?


Image: Canva

If you answered yes to any of these questions, visit an eye care professional (known as an optometrist) for an eye check. They can also assess your risk more carefully and advise how often you should have your eyes tested. 

Source

Adapted from list of risk factors(external link) NZ Association of Optometrists

Glaucoma mainly has no symptoms, except in advanced glaucoma or in people with acute angle closure glaucoma. Contrary to previous assumptions, you do not develop a darkening of vision in your peripheral vision. Instead, you usually experience a ‘jack in a box’ perception of the sudden presence of objects missed from your peripheral vision.

When to seek urgent medical help

In cases of acute angle closure glaucoma and some other causes of glaucoma, you may develop rapid onset of these symptoms:

  • blurred vision
  • seeing coloured halos around lights
  • redness of your eye
  • nausea or vomiting
  • pain in your eye.

These are all serious symptoms and you should see a doctor immediately. 

Early detection through regular check-ups is the key to protecting your vision from damage caused by glaucoma. Glaucoma is easy to treat when found early.

  • If you are in any of the higher risk groups above, have an eye check at least every 1 to 2 years.
  • For everyone else, have a regular eye check from the age of 45 (see the 45 + 5 recommendations below).
  • If you are over 60 years of age, get your eyes checked every year.

The 45 + 5 eye examination

Glaucoma NZ(external link) recommends the 45 + 5 glaucoma eye examination.

  • From the age of 45 years, have an eye check examination – even if you haven’t had any eye problems.
  • If the examination is normal you can repeat it every 5 years.
  • If the examination shows any signs of glaucoma, your eye specialist will advise you on a course of treatment.

A complete eye exam will include several tests to detect glaucoma. Common tests include taking measurements of:

  • your vision
  • your inner eye pressure (intraocular pressure)
  • the appearance of the optic nerve
  • your field of vision (this indicates the function of the optic nerve)
  • the drainage angle (where fluid drains out of your eye)
  • the thickness of your cornea
  • the structure of your optic nerve and retina (OCT).

Although glaucoma cannot be cured, it can usually be stopped from getting worse. Things you can do to slow the progression of glaucoma include to:

  • stop smoking
  • exercise regularly
  • eat a balanced diet
  • see an optometrist or eye specialist regularly for advice and monitoring
  • apply your eye drops everyday as directed.

Eye drops

Medicated eye drops are the most commonly used treatment. They reduce the pressure in your eye by helping the fluid drain from your eye or by reducing the amount of fluid produced. Read more about eye drops for glaucoma.

Laser treatment

Another treatment option is laser surgery to make it easier for fluid to drain from your eye. The lasers used for glaucoma are quite different from the refractive surgery used to correct vision and are usually clinic-based procedures. The types of laser surgery for glaucoma include the following:

Complementary or alternative treatments are not usually recommended in the treatment of glaucoma due to a lack of quality evidence that they are effective. Examples of alternative therapies include vitamins, meditation and acupuncture. Read more about alternative glaucoma therapies(external link) and glaucoma and gingko biloba(external link)

Surgery

If you have progressive glaucoma despite medical and laser therapy, or have significant side effects from medical therapy, surgery may be the only form of treatment for controlling the pressure in your eyes.

Most surgeries are day procedures, which means you don't need to stay in hospital after the procedure. The procedures can range between 10–90 minutes and may be done in conjunction with cataract surgery. Most procedures are done under local anaesthetic and you do not need to fast (not eat) for them. This is similar to having your teeth filled by your dentist.

Surgical options include the following:

  • filtration surgery (trabeculectomy and deep sclerectomy)
  • drainage tube
  • cyclodiode laser
  • minimally invasive glaucoma surgery (MIGS)
  • XEN
  • iStent
  • Hydrus
  • micropulse laser.

Read about these surgical options in the tab below

Surgery

If you have progressive glaucoma despite medical and laser therapy, or have significant side effects from medical therapy, surgery may be the only form of treatment for controlling the pressure in your eyes. 

Most surgeries are day procedures, which means you don't need to stay in hospital after the procedure. The procedures can range between 10–90 minutes and may be done in conjunction with cataract surgery. Most procedures are done under local anaesthetic and you do not need to fast (not eat) for them. This is similar to having your teeth filled by your dentist. 

Surgical options include the following:

  • filtration surgery (trabeculectomy and deep sclerectomy)
  • drainage tube
  • cyclodiode laser
  • minimally invasive glaucoma surgery (MIGS)
  • XEN
  • iStent
  • Hydrus
  • micropulse laser.

Filtration surgery (trabeculectomy and deep sclerectomy)

This procedure is the traditional glaucoma operation that has been performed for 40+ years. It involves making a separate channel for the fluid to drain out of your eye and form a clear transparent ‘bleb’ on the outer wall of your eye.

Follow-up after glaucoma surgery is fairly frequent at first, and can include weekly reviews for the first 6 weeks. In these reviews, small manipulations are performed in clinic and may include injections. You may need to be off work for up to 2 weeks after your procedure, depending on your vision and how strenuous your work is. Potential risks of surgery include high or low eye pressure, damage to your cornea, inflammation, reduced vision and bleeding.

Drainage tube

This procedure involves placing a silicone tube into the front of your eye, which allows fluid to drain out onto a plastic plate that has been secured to the wall of the eye. This procedure is generally reserved for advanced glaucoma and refractory glaucoma (glaucoma that has failed with previous conventional surgery). The surgery is generally performed under general anaesthesia and typically takes up to 90 minutes to perform. Potential risks of surgery include damage to your cornea, cataract, exposure of the implant, high eye pressure, low eye pressure, double vision and reduced vision.

Cyclodiode laser

This procedure involves applying a special laser treatment though the coat of your eye, which targets reducing the production of aqueous. It is done typically with local anaesthetics, and takes approximately 15 minutes to perform. Potential risks include failure to sufficiently reduce eye pressure, inflammation and shrinking of your eye.

Minimally invasive glaucoma surgery (MIGS)

This refers to a group of glaucoma surgeries that are associated with smaller incisions and generally have a safer and quicker recovery. MIGS procedures don't provide any better treatment than standard treatment, but there are fewer side effects. Long-term results are not available for some MIGS procedures, as new devices are constantly being developed. MIGS procedures can be seen as operations that enhance existing glaucoma control or may allow a reduction in eye-drop treatment burden. The biggest disadvantage of MIGS procedures are the costs associated with these devices. 

MIGS procedures may be particularly beneficial if you:

  • can't tolerate eye drops because of side effects or allergy
  • can't use eye drops for other health reasons
  • are having a cataract operation and have mild to moderate glaucoma, and would like to decrease the number of drops you are using.

XEN

This is a 6mm porcine gelatin implant inserted through the wall of your eye and drains fluid onto the surface of your eye. The procedure is usually performed under local anaesthesia and takes generally 15 minutes. Potential risks of surgery include high or low eye pressure, inflammation, reduced vision and bleeding. 

iStent

This is a small titanium implant and is the smallest implant approved for use in the human body. The implant increases drainage of aqueous by bypassing the trabecular meshwork and is generally used in treating mild to moderate glaucoma. 

The implant is generally inserted at the time of cataract surgery and adds about 10 minutes to the time taken for a standard cataract surgery. Potential risks include failure to sufficiently reduce eye pressure and implant migration.

Hydrus

This is a metallic implant made from titanium and nickel which can also be implanted at the time of cataract surgery, and works by dilating the drain that aqueous drains into. This is generally used in treating mild to moderate glaucoma. 

The implant is generally inserted at the time of cataract surgery, and adds approximately 10 minutes to the time taken for a standard cataract surgery. Potential risks include failure to sufficiently reduce eye pressure, implant migration and scarring. 

Micropulse laser

This procedure involves applying a special laser treatment though the coat of your eye that targets reducing the production of aqueous and increasing the outflow of aqueous. 

It is done typically with local anaesthetics and takes about 15 minutes to perform. Potential risks include failure to sufficiently reduce eye pressure and inflammation.

Video: Glaucoma and Surgery – Dr Divya Perumal

Glaucoma specialist Dr Divya Perumal discusses the benefits and risks associated with the different types of glaucoma surgeries currently available and how they work. This video may take a few moments to load.


(Glaucoma, NZ, 2019)

Video: Understanding Glaucoma - Jean's story

Watch Jean tell her story and what living with sight loss means to her. This video may take a few moments to load.


(RNIB, UK, 2017)

Video: Amanda Eddy: My Glaucoma Story

Amanda Eddy is a jewelry designer who was born with glaucoma. This video may take a few moments to load.


(Glaucoma Research Foundation Videos, US, 2017)

Video: Maureen's story living with glaucoma | Fight for Sight

This video may take a few moments to load.

(Fight for Sight, UK, 2015)

Read more personal stories at Glaucoma NZ.(external link)

Need an eye check? Find an optometrist

Public hospital services

Private eye specialists

Glaucoma(external link) Best Health UK
Glaucoma section(external link)  NZ Association of Optometry Read more(external link) 
Best Health UK Minimally invasive glaucoma surgery(external link) 
International Glaucoma Association Glaucoma Australia(external link) Glaucoma and surgery – Dr Divya Perumal(external link) Glaucoma NZ

Resources

Glaucoma NZ Factsheets

Acute angle closure glaucoma(external link) 
Angle closure glaucoma(external link) 
Laser peripheral iridotomy(external link) 
Laser trabeculoplasty(external link) 
Normal tension (normal pressure) glaucoma(external link) 
Ocular hypertension(external link) 
Pigment dispersion syndrome(external link) 
Primary open angle glaucoma(external link) 
Pseudoexfoliation syndrome(external link) 
Trabeculectomy surgery(external link) 

Video: Glaucoma and Research – Professor Helen Danesh Meyer

Professor Helen Danesh-Meyer discusses what is known about glaucoma, what is not known, and where research may take glaucoma management into the future. This video may take a few moments to load.


(Glaucoma, NZ, 2019)

Video: Glaucoma and Lifestyle Factors – Dr Jim Stewart

Glaucoma specialist Dr Jim Stewart talks about the necessity of treatment compliance, and what the evidence says about lifestyle factors that may provide positive benefits alongside glaucoma medical treatment. This video may take a few moments to load.


(Glaucoma, NZ, 2019)

Video: Glaucoma and driving – Dr Hussain Patel

Glaucoma specialist Dr Hussain Patel provides valuable knowledge into how living with glaucoma affects driving and how different driving conditions can prove difficult and why. This video may take a few moments to load.


(Glaucoma, NZ, 2019)

Clinical guidelines

Glaucoma – who to refer for testing and how to manage their treatment(external link) BPAC, NZ, 2014
Glaucoma overview map(external link)  NICE, UK, 2013

Continuing professional development

Video: Common Eye Complaints Webinar - David Garland

This video may take a few moments to load.


(Mobile Health, NZ, 2020)

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Divya Perumal, Ophthalmologist, Auckland

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