Let’s Talk: Glaucoma

Growing old is no fun task but there are ways we can age healthily and happily. In our latest ‘Let’s Talk’ health series we talk with Dr Nigel Best, Clinical Spokesperson and Optometrist at Specsavers, and Poonam Patel, Eye Health Information Officer at RNIB, about the facts of glaucoma and how we can ensure better eye health and protect one of our greatest assets.

What is glaucoma?

Glaucoma is a group of eye conditions where your optic nerve (which carries information from your eye to your brain) is damaged by your eye pressure. Often, the damage occurs because your eye pressure is too high. Damage to the optic nerve can cause permanent changes to your sight and lead to blindness if left untreated.

Coined the ‘silent thief of sight’ due to its slow and gradual onset, glaucoma can be symptomless in its early stages meaning that only a health professional can test for it and detect it.

There are five main types of glaucoma:

• Primary open angle glaucoma: Also known as chronic glaucoma, this is the most common form. It is a slowly-developing condition in which the eye pressure rises causing damage to the optic nerve
• Normal tension glaucoma: Is a type of glaucoma where your optic nerve is damaged, even though you have an eye pressure within normal limits.
• Primary angle closure (acute) glaucoma: This often painful condition occurs when fluid builds up very quickly inside the eye  resulting in very high pressures. Damage results in a very short space of time. Treatment is required right away.
• Secondary glaucoma: This form of glaucoma occurs as a result of another health problem within the eye or due to the effects of medication, for example diabetic retinal disease.
• Developmental (congenital) glaucoma: Developmental glaucoma impacts children or babies in the early years of their life – it is virtually always due to raised pressure in the eye

The sooner an optician is able to detect the signs of glaucoma and advise on suitable treatments, the greater the chance of minimising its effects. Regular eye examinations with an optometrist play a fundamental role in ensuring early detection is possible.

How common is glaucoma?

There are approximately 600,000 people living with glaucoma in the UK and 64 million people worldwide [1] making it the leading cause of irreversible blindness globally [2] . Primary open angle glaucoma, the most common form, affects around 2 in 100 people over 40 years old, and almost 10 in 100 people aged over 75.

According to a recent study men are at greater risk of losing their sight than women because they ignore warning signs and do not seek medical attention. The independent research which focussed on the eye condition glaucoma, was carried out by City University London and showed that men are 16% more likely than women to have suffered advanced vision loss on diagnosis of the condition. The reason for this is because men have a tendency not seek medical treatment as readily as women.

Causes of glaucoma and the hereditary factor

People of Black African and Caribbean descent are up to eight times more likely to develop open angle glaucoma, 10 to 15 years earlier than people of other ethnicities and at a more severe rate. Being of East Asian origin can increase your risk of closed angle glaucoma.

Family history is also important. According to the International Glaucoma Association, people are at least four times more likely to develop glaucoma if they have a close blood relative with the condition (mother, father, brother, sister). That’s why it’s extremely important to tell your relatives if you have developed it so they are able to ensure they get tested. Likewise, if you know a family member has the condition, it’s important to have a full eye examination with an optometrist in order to help protect your own sight.

Glaucoma is also much more present in older generations – the number of people with the condition rises from about two per cent of people over the age of 40 to more than five per cent for those over the age of 80.

People suffering with other health and sight conditions, such as diabetes, low blood pressure and long or short sightedness also have an increased chance of developing the condition.

Symptoms and when to seek medical advice/help

The most common type of glaucoma has no symptoms. You can’t ‘feel’ primary open angle glaucoma, it doesn’t cause any symptoms and the eye pressure doesn’t cause any pain. There’s no warning that something is happening.

You may not notice any difference in your vision because glaucoma affects peripheral vision – also known as your side vision – first. As your peripheral vision is not as sensitive as your central vision it’s difficult to notice any early changes to your vision, even though your sight is being permanently damaged.

As you may not notice a problem until your glaucoma is more advanced, it’s important to have regular eye tests as this is the only way to know if you have it. The earlier glaucoma is diagnosed and treated, the more your sight can be protected.

Because in its early stages most types of glaucoma are virtually symptomless, it often means that most people only realise they have it when it is in more advanced stages. However, there are certain symptoms that can be warning signs – including:

• gradual loss of peripheral vision
• blurred vision
• seeing halos or ‘rainbow-like’ rings around lights
• eye pain
• red eyes
• headaches
• tenderness around the eyes

Should you start to suffer from any of these symptoms, it’s vital to seek the advice of an eye health professional as quickly as possible.

How is glaucoma diagnosed?

While there are no known ways of preventing glaucoma, ensuring you have regular eye tests is one of the best ways you can help detect the condition and limit its impact.

Glaucoma can usually be picked up by a routine eye test with an optometrist (also known as an optician). Your optometrist usually tests your eye pressure using the “puff of air” test. They also examine the inside of your eye, in particular where your optic nerve leaves the eye, and they can test your visual fields. If your eyes have higher pressure than normal, or there are changes to the appearance of your optic nerve, or loss of visual field, your optometrist may refer you to an ophthalmologist (an hospital eye doctor) to have more tests. If you are diagnosed with glaucoma, your ophthalmologist will start you on treatment to stop the glaucoma causing further damage to your sight.

Can glaucoma be treated?

The treatment available for glaucoma can only prevent further sight loss, it can’t bring back sight which has already been damaged.

Different types of glaucoma are treated differently. The most common type is treated with eye drops, which lowers the eye pressure so it doesn’t damage the optic nerve. For most people, treatment with drops will keep their eye pressure controlled and prevent sight loss. However, laser treatment, surgery, or medication can also be used if the eye drops are not effective enough in controlling your eye pressure.

Can glaucoma damage the eye permanently, if so, how?

Unfortunately the damage that glaucoma does to the optic nerve is permanent and although treatments can prevent damage in the first place, they can’t reverse it. Diagnosing glaucoma as early as possible before permanent damage is done is extremely important.

How we can reduce the risk

Research from Specsavers and RNIB’s (The Royal National Institute of Blind People) State of the Nation report[3] revealed that almost 14 million people in the UK are not having their eyes tested every two years as recommended, meaning a significant amount of easily preventable and manageable vision-related issues, such as glaucoma, are being left unaddressed. The damage caused by glaucoma cannot be reversed so it’s vital to have regular sight test to detect it early. If you fit into any of the higher risk groups then you should talk to your optometrist about how often you should be tested. Eye tests are free for people over 40 who have a direct blood relative diagnosed with glaucoma.

Find out more

Every 15 minutes, someone in the UK begins to lose their sight. The Royal National Institute of Blind People (RNIB) support everyone affected by sight loss – that’s over 2 million people in the UK. If you, or someone you know, has a sight problem, RNIB can help. For more information call the RNIB Helpline on 0303 123 9999 or visit www.rnib.org.uk and please visit: https://www.rnib.org.uk/eye-health-eye-conditions-z-eye-conditions/glaucoma.

[1] Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040 : A Systematic Review and Meta-Analysis Yih-Chung Tham, BSc Hons, Xiang Li, BSc, Tien Y. Wong, FRCS, PhD, Harry A. Quigley,MD, Tin Aung, FRCS (Ed), PhD, Ching-Yu Cheng, MD, PhD
[2] http://www.iapb.org/vision-2020/what-is-avoidable-blindness/glaucoma

[3]https://www.rnib.org.uk/sites/default/files/RNIB%20State%20of%20the%20Nation%20Report%202016%20pdf.pdf