Understanding the facts and debunking common glaucoma myths is crucial to ensure you get the information you need to help save your sight. Read on to learn about some common misconceptions about glaucoma.
Myth #1: Surgery can reverse vision loss caused by glaucoma
Unfortunately, this is a common myth associated with glaucoma as any optic nerve damage and hence visual field loss is irreversible. The purpose of any treatment or surgery is to minimise or prevent further damage to the optic nerve to preserve the sight that remains.
Early detection is critical for people with glaucoma and in many cases, a combination of treatments may be recommended by your eye specialist including medicated eye drops, laser treatments, insertion of a stent, and additional drainage surgeries.
Myth #2: I have good vision so I can’t have glaucoma
The danger of glaucoma, also called the “silent thief of sight”, is that it is a painless condition that can cause damage to your optic nerve and progressively impact your peripheral vision.
In the early stages, you may not experience any symptoms but as the condition progresses you may notice blurriness, or darkening of your peripheral vision. By the time a patient notices worsening peripheral vision, disease is usually already very advanced, and can preclude their ability to drive permanently.
Over time left untreated, tunnel vision and complete blindness can occur.
Early diagnosis and treatment by an eye specialist are critical for glaucoma patients as any vision lost due to optic nerve damage is irreversible.
Myth #3: You need a family history of glaucoma to get it
Many patients develop glaucoma without a family history of the condition. A family history of glaucoma is significant as it increases your risk, but it is not the only risk factor.
Factors that increases your risk of glaucoma include: high eye pressure*, over 50, African or Asian descent, diabetes (especially poorly managed blood sugar levels), high myopia, prolonged course of cortisone (steroid) medication, experiences regular migraines, previous eye operations or serious eye injury, history of high or low blood pressure, and/or experience obstructive sleep apnoea.
*In most cases, damage to the optic nerve is caused by raised intraocular pressure (IOP) due to an imbalance between the production and drainage of aqueous humour (fluid). However, some people may experience glaucoma despite having a normal eye pressure if there is an underlying weakness in the optic nerve, known as normal tension glaucoma.
Myth #4: There is no point in treatment as vision loss from glaucoma is irreversible
A glaucoma diagnosis does not mean that you will go blind, and there are various management options available to help minimise vision loss.
Early diagnosis and treatment of glaucoma are critical as the irreversible optic nerve damage and vision loss can have life-changing impacts in reducing your independence, and potentially stopping visually significant activities, including driving.
In the early stages, people often go undiagnosed as there are no obvious symptoms. Only an Optometrist or an Ophthalmologist performing a comprehensive eye examination can determine your likelihood for glaucoma and the need to commence treatment.
Myth #5: Testing for glaucoma is painful
Many tests for glaucoma are done as part of a comprehensive eye examination, and other than minimal discomfort, does not result in painful eyes. Topical anaesthesia is utilised for procedures involving corneal contact. Some tests such as visual fields or OCT scans may need to be repeated for follow-up appointments.
These are 6 common tests your eye specialist will likely need to conduct:
Pupil dilating drops will be used to enable a full examination of the drainage angle, optic nerve, retinal and macula and provide a risk assessment and baseline measurements.
Tests your intraocular pressure as one of the main risk factors for glaucoma.
Measures the thickness of the cornea, which affects the actual intraocular pressure.
Automated tests for which can detect early peripheral vision loss and monitor progression.
A comparative scan of your optic nerve against a normal database to aid diagnosis of glaucoma and allow monitoring of progressive optic nerve damage.
A specialised mirror contact lens will be used to examine your eye’s drainage angles to determine if there is a closure or blockage, or a secondary cause of glaucoma.
Myth #6: There’s no treatment for glaucoma
It is true that vision loss from glaucoma is irreversible, however there are many treatments available to minimise or prevent further damage. Early detection remains crucial to preserving your sight as the sooner you are diagnosed, the sooner you can receive treatment.
In many cases, your eye specialist will recommend a combination of treatments to minimise or prevent further damage to the optic nerve, including:
Reduce the amount of fluid produced in the eye or increase outflow through the drainage system. It needs to be taken once, twice or three times a day, every day. These drops are generally well-tolerated with few side effects, which will be discussed by your prescribing specialist.
Often used to treat chronic open angle glaucoma, and pigment dispersion. The targeted laser treatment causes remodelling of the drainage angle to improve fluid outflow. There are only a few side effects, and the effect can last many years and can be safely repeated over time.
Involves placement of one or more ‘stents’ into the drainage angle of the eye to allow aqueous fluid to flow out of the eye. Some MIGS procedures can be performed at the same time as cataract surgery and can help to reduce the reliance on medicated eye drops.
A permanent shunting procedure used to effectively reduce IOP by creating an alternate outflow for the aqueous fluid in the eye to the subconjunctival space. This requires referral to a glaucoma surgery specialist.
A permanent procedure resulting in reduction of aqueous humour production from the ciliary body. This requires referral to a glaucoma surgery specialist.
Myth #7: The symptoms of glaucoma are obvious
In the early stages of glaucoma, you may not experience any symptoms and the condition usually cannot be self-detected.
As the condition progresses you may experience blurriness, loss, or darkening of your side or peripheral vision.
Over time and as the condition advances, tunnel vision, and even full blindness can occur if treatment is not sought.
- No obvious symptoms in the early stages but as the condition progresses you may notice:
- Patchy blind spots in your side (peripheral) or central vision
- Tunnel vision
- Watery eyes
- Blurred vision
- Haloes around lights
- Glare sensitivity
Eye pain, redness, and acute loss of vision
Nausea and vomiting
Severe headache
Note that these symptoms can be similar to a bad migraine or tension headache.
Any severe headaches with loss of vision should be reviewed by a medical professional promptly.
The following image gives an impression of the type of vision loss for someone with glaucoma.
Myth #8: You have to be over 50 to get glaucoma
The risk of developing glaucoma does increase as we get older, however this is a condition that can affect people of all ages. There are many types of glaucoma, including:
Primary Open-Angle Glaucoma is the most common form, accounting for approximately 90% of glaucoma cases in Australia.
Angle-Closure Glaucoma can be a medical emergency and immediate treatment is required.
Normal Tension Glaucoma is when there is optic nerve damage despite apparently normal intraocular pressures.
Secondary Glaucoma is optic nerve damage related to previous surgery, intraocular infections, ischaemic (poor blood supply) or inflammation conditions
Congenital Glaucoma is an uncommon type of glaucoma, present in newborns. It usually presents with watery eyes, enlarged eyes (buphthalmos) and hazy corneas.
Early detection is the key to preserving your sight from glaucoma, and we recommend being screened around the age of 40. Your attending optometrist or ophthalmologist can recommend follow-up intervals if needed. Additional precautions should be taken by those with a family history of glaucoma.
Myth #9: If you have glaucoma, you can’t have cataract surgery
In time, most people will need cataract surgery to restore their vision, this includes patients with glaucoma.
Cataract surgery is generally considered safe for patients with glaucoma but these patients may require extra attention to monitor for changes in intraocular pressure during and after the operation.
Procedures such as selective laser trabeculotomy (SLT) can be done before or after glaucoma surgery. Some patients with glaucoma may benefit from combined cataract and insertion of glaucoma stents at the same time, with benefits to vision and reduction in intraocular pressure.
Other glaucoma surgeries such as glaucoma tube surgery, trabeculectomy, cyclodiode are often performed after cataract surgery.
Where can I get help and advice?
Organisations that may provide additional support if you have been diagnosed with glaucoma include:
Glaucoma Australia: https://glaucoma.org.au/
Guide Dogs Qld: https://qld.guidedogs.com.au/
Guide Dogs NSW: https://nsw.guidedogs.com.au/
Vision Australia: https://www.visionaustralia.org/