#GlaucomaAwarenessMonth – Early detection & treatment is critical to prevent permanent vision loss

January is recognised as Glaucoma Awareness Month. An age-related eye disease, glaucoma impacts the lives of over three million Americans, primarily over the age of 40. The COVID-19 pandemic has thrown up additional challenges given the vulnerabilities of the elderly. This makes awareness especially critical.

Glaucoma is one of the leading causes of vision loss and blindness worldwide. It’s a group of eye disorders that can cause damage to the optic nerve which connects the eyes to the brain. This damage is often due to abnormally high pressure from the build-up of the fluid inside the eye.

January, marked every year as National Glaucoma Awareness Month, is an opportunity to create awareness about the importance of regular eye check-ups. This is critical given that prevalence of glaucoma in the United States are rising.

January is Glaucoma Awareness Month

“Rates of glaucoma in the U.S. are increasing, from 2.2 million in 2000, to 2.7 million in 2010, and they are forecast to be 4.3 million by 2030. Currently more than three million people in the U.S. have glaucoma”, says Dr Jullia A. Rosdahl, MD PhD. Dr Rosdahl is a board-certified and fellowship-trained glaucoma specialist at the Duke Eye Center in Durham, North Carolina. She is also the chair of the Patient Engagement Subcommittee of the Patient Care Committee of the American Glaucoma Society (AGS) and serves as the Chair, Planning Group of the National Eye Health Education Program.

This year due to the COVID-19 pandemic, the AGS is reaching out to members and followers through an online messaging campaign through January.

Early detection of the disease, ideally before any symptoms or vision loss has occurred, can help prevent irreversible vision loss. It appears that the main reason for the increasing numbers of people with glaucoma is our ageing population. Glaucoma is more common in older people. – Dr Jullia A. Rosdahl, Glaucoma Specialist, Duke Eye Center

Types of glaucoma

There are two major types of glaucoma. The most common is primary open angle glaucoma. “This type is usually painless as the build-up of pressure occurs gradually. and causes no vision changes at first”, says Dr Amy Zhang, MD, Assistant Professor at the University of Michigan’s Kellogg Eye Center. Among her many interests are her work in minimally invasive glaucoma surgery and novel drug delivery methods.

The second common form of glaucoma is angle closure glaucoma. “This occurs when the structures in the eye causes the drainage angle to be very narrow and at risk for closure”, explains Dr Zhang. “When the drainage angle gets completely closed this leads to a sudden increase in eye pressure known as an acute attack. This requires immediate attention and can lead to blindness if not treated in a timely fashion”.

Regular eye exams are critical, emphasises Dr Zhang. “There is a tendency for the drainage mechanism of the eye to be less effective as we age”.

Treatment & lifestyle changes

Oxidative stress has been shown to be a factor in some patients. Lifestyle changes can help them.

“I recommend leafy green vegetables, and a “heart-healthy” diet for overall good health – lots of fruits and vegetables, lean proteins, and whole grains”, says Dr Rosdahl. “Getting enough sleep, having supportive relationships, and getting some exercise are good, too”.

Certain yoga positions are best avoided. “I ask about any head down yoga positions and inquire if they play any wind instruments as both can cause increased eye pressure”, says Dr Tania Lamba, a glaucoma specialist at the DC Veterans Affair Medical Center and a Clinical Assistant Professor at the George Washington University.

“Usually, glaucoma occurs in both eyes and is fairly symmetrical, but sometimes one eye can be much worse”, says Dr Lamba, who performs the latest glaucoma laser and surgical procedures. Sleeping on the same side can be a factor. In such cases, she asks patients to switch sleep positions. She also encourages patients to wear protective eyeglasses especially during direct contact sports and high-risk occupations to avoid any injury to the eye.

Eye drops to reduce eye pressure are usually the first line of treatment for glaucoma patients. “If the angle of the eye is narrow, then a laser treatment is used to open up the angle”, says Dr Lamba. “For patients with open angle glaucoma there is a laser treatment available that can help stimulate the drainage of fluid to lower eye pressure”.

Today there are many advanced surgical interventions available as well that are not invasive and promise quicker recovery. “These are called Minimally Invasive Glaucoma Surgery (MIGS) and include the iStent inject, Hydrus microstent, Kahook dual blade goniotomy, Xen gel stent, GATT and micropulse cyclophotocoagulation to name a few”, adds Dr Lamba.

Given the age factor, treating patients with glaucoma has become especially challenging during the pandemic.

“There was a specific algorithm designed at our institution to help identify the patients that were at most risk for vision loss to make sure they still came for their visits”, says Dr Zhang. Telemedicine was implemented with a drive through screening component where the eye pressure of patients was tested in the parking lot. “Then a video/phone visit would be performed to discuss plan and treatment”.

At the Duke Eye Center, all surgical patients are tested for COVID. “If a patient is COVID-positive and the surgery is elective, then it is delayed”, says Dr Rosdahl. “If the surgery is urgent, then we have a special COVID operating room that has been fitted out with all of the systems needed to keep the staff safe”.

The prevalence of glaucoma in the U.S. may reach as high as 5.5 million by 2050. Awareness is critical but so is greater support and empathy for people with the disorder. You can start by reaching out to those closest to you. Encourage family members and friends to get regular eye checks especially if they feel pressure on their eyes, are losing vision, or have a family history of glaucoma. Early detection and proper treatment can go a long way in preserving a person’s vision.

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