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Glaucoma

What Causes Glaucoma?

Glaucoma is a group of eye diseases associated with high eye pressure. This is caused by an accumulation of fluid within the eye when the drainage system is not functioning properly, resulting in increased eye pressure and damage to the optic nerve. In the early stages, glaucoma does not exhibit symptoms. As the condition progresses, blind spots start to appear, and one starts to lose their peripheral vision.

The Different Types of Glaucoma Include:

Primary Open-Angle

The drainage angles in the eye are open. However, the drainage system is not functioning properly, resulting in an accumulation of fluid within the eye, leading to high intraocular pressure. In most cases, patients with primary open-angle glaucoma do not exhibit symptoms.

Primary Angle-Closure

The drainage angles in the eye are narrow or closed, and the fluid is unable to reach the drainage system, resulting in high eye pressure. This occurs due to the mechanical obstruction of the drainage angle and is associated with sudden high eye pressure and cause an attack of acute angle closure. Again, the cause for this can be primary (anatomically narrow angle) or secondary (for example diabetes, and previous inflammation).

Normal Tension

A type of glaucoma that occurs when the optic nerve is intrinsically weaker, and gets damaged even though the eye pressure is within a normal range.

Congenital Glaucoma

A type of glaucoma that occurs in childhood due to the drainage system not functioning properly.
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What Are the Risk Factors of Glaucoma?

Some risk factors of glaucoma include:
  • High eye pressure
  • Age over 55
  • Family history of glaucoma
  • Certain medical conditions, such as diabetes, migraines, high blood pressure and sickle cell anemia
  • Extreme near-sightedness or farsightedness
  • Eye injury
  • Being on long-term steroid medication i.e. inhaled or topical steroids for allergies, oral steroids for autoimmune disease, injectable steroids for arthritis
How is Glaucoma Diagnosed?
  • Visual acuity test: This test will be done to assess the sharpness of your vision.
  • Tonometry: To measure intraocular pressure
  • Optical coherence tomography (OCT): An OCT scan of your macula will be performed to measure thickness of the ganglion cell and retinal nerve fibre layers. An OCT scan of the anterior (front) segment of the eye is also captured to assess the angle width
  • Visual field test: To check for areas of vision loss
Currently there is no option to reverse any sustained damage to the optic nerve from glaucoma. It is recommended to detect glaucoma as early as possible to halt disease progression and initiate treatment before it causes any further vision loss.
Any damage that glaucoma causes to the optic nerve cannot be reversed. Any treatment provided is meant to halt the disease progression. There is a subtype of glaucoma that can be “cured”. For a select group of patients where the cause of glaucoma is a narrow drainage angle, the condition can be indefinitely reversed following surgery.
Glaucoma affects one’s peripheral vision. This means the outer parts of one’s vision are blurred or completely missing. This continues progressing and can leave the patient with only a central island of vision. If disease progression is not halted, glaucoma can potentially cause irreversible blindness.
Glaucoma is controlled by lowering the eye pressure. Non-surgical options include using prescription eye drops to maintain eye pressure at a healthy level. Treatment is individualised and regular monitoring is required after successful control of the eye pressure. Any damage done to the optic nerve cannot be improved or reversed with treatment hence it is important to have early eye screening to detect glaucoma and prevent continued damage to the optic nerves.
  • Minimally invasive glaucoma surgery (MIGS): MIGS can either improve fluid outflow using the eye’s inherent drainage system, shunting fluid to the outside of the eye, or decrease production of fluid within the eye. This decreases eye pressure.
  • Trabeculectomy: During the surgery, the surgeon creates a flap in the conjunctiva, the outermost layer covering the white part of the eye. Underneath this flap, a pathway in the sclera (i.e. white of the eye) is created to allow fluid to drain. The flap is then placed loosely back down against the sclera and stitched to protect the new drainage pathway.
  • Tube Implant surgery: During the surgery, the device is positioned on the outside of the eye under the conjunctiva. A small tube inserted into the front chamber of the eye, just in front of the iris (colored part of the eye). The fluid drains through the tube into the area around the back end of the implant, within a fibrous capsule. The fluid collects here and is reabsorbed by the surrounding blood vessels.
  • Peripheral Iridotomy Laser: This laser procedure opens the drainage angle and lowers the eye pressure.
  • Selective Laser Trabeculoplasty: This procedure can achieve desired reduction in eye pressure without the need for continuous medication. The effects of the procedure can last up to 5 years and the treatment can be repeated if required. Any side effects from the procedure are minimal and rare.
  • Cyclodiode laser: For patients where other types of treatment haven’t been successful, cyclodiode laser treatment can be used to control fluid production and reduce intraocular pressure. This will usually remove pain completely, making it useful for patients with painful symptoms, and remove the need for eye drops.

Glaucoma treatment is a highly personalised journey, tailored to each individual’s condition and vision goals.

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Why Choose Us?

DR ERROL CHAN

Specialised Experience in Retinal Care

Dr Chan is a triple-Fellowship trained and experienced Ophthalmologist. He has international clinical experience from McGill University and Moorfields Eye Hospital London, and has been awarded Ophthalmology accreditation from the UK, Canada & Singapore. He specialises in diagnosing, managing and treating vitreoretinal diseases, including complex and second opinion cases.
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Meet Dr Errol Chan

DR ERROL CHAN

Meticulous Approach

Our meticulous approach means that every detail is considered, from your medical history to your lifestyle needs, as we aim to provide you with the most optimal retinal care.
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Meet Dr Errol Chan

DR ERROL CHAN

Comprehensive Diagnostic Technologies

A comprehensive detection of retinal tears or detachment necessitates specialised imaging equipment that are available at Ascend Eye Clinic.
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Meet Dr Errol Chan

DR ERROL CHAN

Individualised Treatment

With the aim to optimally preserve your eye health as far as possible, we create personalised treatment plans that are tailored to your specific needs and vision goals.
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Meet Dr Errol Chan

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