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KOL ' MD

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http://www.eyecancerinfo.com/index.htm
" http://www.eyecancerinfo.com/Pages/faqs.htm

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MayoClinic, :
"Glaucoma is sometimes called the silent thief because it can slowly steal your sight before you realize anything's wrong. The most common form of glaucoma, primary open-angle glaucoma, develops gradually, giving no warning signs. Many people aren't even aware they have an eye problem until their vision is extensively compromised Primary open-angle glaucoma progresses with few or no symptoms until the condition reaches an advanced stage. As increased eye pressure continues to damage your optic nerve, you lose more and more of your peripheral vision. If glaucoma is left untreated you can develop tunnel vision, and eventually lose all sight. Open-angle glaucoma usually affects both eyes, although at first you may have vision loss in just one eye."
Signs and symptoms ,Causes ,Risk factors , When to seek medical advice, Screening and diagnosis ,Treatment ,Prevention -Self care .

Patient UK, :
"Primary open angle glaucoma (also called chronic glaucoma) is the most common type. This develops slowly so that any damage to the nerve and loss of sight is gradual. The term ''open angle'' refers to the angle between the iris and sclera which is normal

What happens in primary open angle glaucoma?
In primary open angle glaucoma (just called ''glaucoma'' from now on) there is a partial blockage within the trabecular meshwork. This restricts the drainage of aqueous humour. The reason why the trabecular meshwork becomes blocked and does not drain well is not fully understood. The pressure of the aqueous humour builds up if the drainage is faulty. But, this also increases the pressure on the back of the eye.
The increased pressure in the eye can damage the optic nerve (the main nerve of sight) and the nerve fibres running towards it from the retina. The retina contains the ''seeing'' cells at the back of the eye. The damaged parts of the nerve and retina lead to permanent patches of vision loss. In some cases this can eventually lead to total blindness.

Who gets primary open angle glaucoma?
In the UK, about 1 in 50 people over 40 have glaucoma. It is unusual in people under the age of 35. It becomes more common with increasing age. Glaucoma can affect anyone, but it is more common if you:
Have a family history of glaucoma.
Have very short sight.
Have diabetes.
Are from African or Afro-Caribbean origin.

What are the symptoms of primary open angle glaucoma?
At first there are usually no symptoms. There is no pain or redness in the eye. Most people with glaucoma do not notice problems until quite a bit of visual loss has occurred. This is because the first part of the vision to ''go'' is the outer (peripheral) field of vision. Central vision, used to focus on an object such as when we read, is spared until relatively late in the disease. Also, although glaucoma usually affects both eyes, it may not affect them equally. The better eye may ''fill in'' for a while if the other eye starts to lose patches of visual field.
Some elderly people with glaucoma put their gradual failing vision down to ''just getting old''. They might not have had their eyes checked for many years and may needlessly lose their sight. Untreated glaucoma is one of the world's leading causes of blindness.
But, blindness can be prevented if glaucoma is diagnosed and treated early enough.

What is the treatment for primary open angle glaucoma?
The aim of treatment is to lower the eye pressure. If the eye pressure is lowered, further damage to the optic nerve is likely to be prevented or delayed. The eye pressure to ''aim for'' varies from case to case. It partly depends on how high the original pressure is. Your eye specialist will advise. Eye pressure can be lowered in various ways

Eye drops
A variety of eye drop can lower eye pressure. They work either to:
Reduce the amount of aqueous humour that you make
Increase the drainage of aqueous humour.
Your eye specialist will advise. Some drops work better in some people than in others. Some drops are not suitable if you have asthma. Also, the possible side-effects vary between the different types of drops. So, if the first does not work so well, or does not suit, another may work fine. In some cases, two different types of drops are needed to keep the eye pressure low.
It is vital to use your drops exactly as instructed. If you are unsure that you are using your drops correctly, ask for advice from your doctor or practice nurse. An eye specialist will keep a regular check on your eye pressures, optic nerves, and field of vision.

Tablets
These are sometimes used. They work by reducing the amount of aqueous humour that you make.

Surgery
An operation called trabeculectomy is an option. This involves creating a channel between just inside of the eye to just under the conjunctiva. So, the aqueous humour can bypass the blocked trabecular meshwork. In effect, it is like forming a small ''safety-valve'' for the aqueous humour.
Surgery may be advised if a trial of eye drops has failed to achieve target eye pressures, especially in younger people, or if you have very high eye pressures.
Like with all operations, there is a small risk of complications. Also the operation may have to be repeated in some cases. This is usually because some scar tissue forms at the site of the channel and prevents it working to drain the aqueous humour.

Laser treatments
A laser can ''burn'' the trabecular meshwork which improves the drainage of the aqueous humour. Another technique is to destroy parts of the ciliary body which reduces the amount of aqueous humour that is made. However, the reduction in eye pressure after laser treatments often only lasts a short time. So, laser treatments are not commonly done. "
, - International Glaucoma Association
: 108c Warner Road, London, SE5 9HQ
: 0207 737 3265
": www.iga.org.uk

eMedicine, eyeMDlink -Review of Optometry.

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MayoClininc Glaucoma

Patient UK Glaucoma (Primary Open Angle)

eMedicine Glaucoma, Primary Open Angle Article by Jerald A Bell, MD

eyeMDlink Eye Condition Primary Open Angle Glaucoma

Review of Optometry Handbook of Ocular Disease Management Primary Open Angle Glaucoma (POAG)

KOL

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