Glaucoma – Causes, Symptoms, Types, Prognosis, Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Glaucoma is a disease of the eye which damages your optic nerve. Optic nerve supplies visual information from your eyes to the brain.

It is caused due to abnormally increased pressure inside your eyes i.e. increased intraocular tension. But it may not be as a rule. This increased pressure tends to erode your optic nerve tissue. This eventually leads to loss of vision or blindness. The vision loss may be prevented if this condition is diagnosed and addressed at proper time.

It is one of the leading causes of blindness for people over the age of 60 years. It can occur at any age but is more common in older adults. Many forms of glaucoma manifest without warning signs. The effect is very gradual that you may not notice change in vision until in the advanced stages of the disease. Vision loss from glaucoma is irreversible. Glaucoma will need lifelong treatment.
Read – Trachoma – Causes, Symptoms, Prognosis, Treatment, Remedies

Symptoms of Glaucoma

Signs and symptoms vary depending on the type and stage of your condition.

Open angle glaucoma – is the commonest type of glaucoma. In this there is gradual vision loss and no signs and symptoms. You need to keep a check and monitor changes in your vision if any regularly. For this, once diagnosed, you need to see your ophthalmologist regularly to keep a track of your glaucoma.

Patchy blind spots may occur in your side or central vision, frequently in both eyes. Tunnel vision may be seen in advanced stages.

Acute angle closure glaucoma / Narrow angle glaucoma – This is a medical emergency. You need to quickly see your doctor in case you have the below mentioned symptoms –

• Severe eye pain
• Nausea
• Vomiting
• Redness in your eyes
• Sudden vision disturbances
• Seeing colored rings around lights
• Sudden blurring of vision (Read more)

Causes, Mechanism of formation

Aqueous humor is a clear fluid present at the back of your eye. This fluid is made continuously. It fills the front part of your eye as it is made. Then it leaves your eye through channels in your cornea and iris. If these channels are blocked or obstructed partially, the intraocular pressure (IOP) may increase. In the natural circumstances, IOP is the natural pressure in your eye. As the IOP increases it imparts pressure on your optic nerve. The nerve gradually may get damaged. With progressive damage you may lose your sight.

Though the exact causes of what causes the pressure in your eye to increase, the below mentioned factors are said to be contributive –

• Blocked / restricted drainage in your eye
• Eye dilating drops
• Medications like corticosteroids
• High blood pressure
• Poor / reduced blood flow to your optic nerve
  Read – Eye Diseases Causes, Pathogenesis, Symptoms, Treatment, Herbs

Types of Glaucoma

There are five main types of glaucoma. They are –

1. Open-Angle (Chronic) Glaucoma

It has no signs and symptoms. There is gradual loss of vision. The vision loss is slow but the vision can suffer damage in an irreparable way before the onset of any other signs. This is the most common type of glaucoma according to the National Eye Institute (NEI).

2. Angle-Closure (Acute) Glaucoma / Closed-Angle Glaucoma

This occurs when the iris bulges forward to narrow or block the drainage angle formed by cornea and iris. As a result the fluid cannot circulate through the eye and the pressure increases.

In this condition there is severe, quick and painful increase in pressure due to the sudden block of flow of aqueous humor subsequently leading to rapid buildup of fluid. It is an emergency situation. Symptoms like severe pain, nausea and blurred vision should prompt you to call your doctor immediately.

3. Congenital Glaucoma

Children who are born with congenital glaucoma have a defect in the angle of their eye. This slows down or prevents normal fluid drainage. It may run in families and presents with symptoms like cloudy eyes, excessive tearing or sensitivity to light.

4. Secondary Glaucoma

This often occurs as a side effect of injury or another eye disease such as cataract. Medicines like corticosteroids also may cause this condition. Sometimes eye surgeries can also cause secondary glaucoma.

5. Normal Tension Glaucoma

In few people the optic damage gets damaged even without increase in eye pressure. The cause of this is not known. Lack of blood supply to optic nerve or extreme sensitivity might be contributory.
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Other conditions

Pigmentary Glaucoma – Here, pigment granules from your iris build up in the drainage channels, slowing or blocking fluid exiting your eye. Activities like jogging cause intermittent pressure elevation.

Risk factors

Glaucoma is the second leading cause of blindness around the world according to WHO. The risk factors for glaucoma include –

• Having high internal eye pressure i.e. IOP is an independent risk factor.
• People over 60 years of age are at increased risk of glaucoma. The risk increases with each year of age.
• African-Americans or people of African descent are more prone than Caucasians. Asians are at higher risk of angle-closure glaucoma. Japanese have higher risk of developing low-tension glaucoma.
• Eye pressure can increase due to chronic inflammation of eye and thin corneas.
• It may also occur due to injury or trauma to the eyes and surgery of eyes.
• Some types of glaucoma run in families.
• People with diabetes, high blood pressure and heart disease and sickle cell anemia have an increased risk of developing glaucoma.
• Corticosteroids may increase the risk of developing secondary glaucoma if they are used for extended periods of time.
• Being extremely nearsighted or farsighted are also risk factors.
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Diagnosis

Eye specialist / ophthalmologist will perform a comprehensive eye examination to confirm glaucoma. One or more of the below mentioned tests and procedures may be used for diagnosis –

• Detailed medical history
• Tonometry – to measure the internal pressure of the eye
• Pachymetry test – to tell if the cornea is thinner than average
• Perimetry test / visual field test – to tell if glaucoma is affecting your vision
• Optic nerve monitoring – to know and compare gradual changes in your optic nerve from time to time
  Read – Classification of Eye Diseases As Per Ayurveda

Prevention

Glaucoma cannot be prevented. But it is important that it gets diagnosed at the earliest. This helps in taking prompt action and control the condition from getting worse. To catch up with glaucoma early one needs to have an annual preventive eye care appointment, regularly. Simple tests done during these routine eye checks may be able to detect damage from glaucoma before it advances and begins causing loss of vision.

Self care is important in prevention of glaucoma from progressing. Below mentioned are key strategies –

• Get regular dilated eye examinations – helps in detection of glaucoma in earlier stages. The American Academy of Ophthalmology recommends having a comprehensive eye exam every 5-10 years if you are less than 40 years of age, every 2-4 years if you are 40-54 years old and every 1-2 years if you are older than 65 years of age. If you are at risk of glaucoma you will need more frequent screening.
• Know your family’s eye health history
• Exercise safely – regular, moderate exercise may help prevent glaucoma by reducing eye pressure
• Take prescribed eye drops regularly – reduces the risk that high eye pressure will progress to glaucoma.
• Wear eye protection – serious eye injuries can cause glaucoma. Wear eye protection when using power tools or playing high speed racket sports in enclosed courts. (Read more)

Treatment

The goal of glaucoma treatment is to reduce IOP to stop any additional loss of eyesight.

The treatment begins with prescription of eye drops by your ophthalmologist. Medicines for reducing IOP are available in the form of eye drops or pills. Either of these or combination of both may be prescribed.

Surgery may be advised to make a drainage path for fluid or destroy tissues that are responsible for the increased fluid.

Angle-closure glaucoma needs immediate treatment to reduce eye pressure as quickly as possible. It may include combination of oral medicines and laser peripheral iridotomy.

If your increased IOP can be stopped and pressure returned to normal, the vision loss can be slowed or stopped. There is no cure for glaucoma. Therefore you will need treatment for the rest of your life to regulate IOP. Vision lost due to glaucoma cannot be restored.
Read – Ayurvedic Eye Health Tips, Diet, Yoga

Other interventions –

• Laser therapy
• Filtering surgery
• Drainage tubes
• Minimally invasive glaucoma surgery (MIGS)

Lifestyle, Natural treatments

Natural remedies for glaucoma are not alternative for glaucoma treatment. Vision loss from glaucoma cannot be reversed.

Home remedies may prove dangerous in glaucoma care if done without consent or knowledge. Below mentioned tips may help in controlling high eye pressure and promote eye health.

• Healthy diet – Including healthy diet will not prevent glaucoma from worsening but may help one to maintain health. Inclusion of vitamins and nutrients, zinc, copper, selenium and antioxidant vitamins C, E and A – are conducive for eye health. Carotenoids too are helpful. Studies suggest that eating food high in antioxidants can help patients with glaucoma. Antioxidants are found in foods like cranberries, pomegranates, flax seeds, black and green teas. You can add foods like dark, leafy greens and fish that is packed with omega 3 fatty acids. Peaches, carrots, beets, green beans and radish may also be included.
• Regular and safe exercise – This will reduce eye pressure. They keep blood flowing to the nerves in your eye.  Appropriate eye exercise program may be followed in consent of the doctor.
• Limit intake of caffeine is good for health. More caffeine may increase eye pressure. Watch out for your intake of coffee, tea or soda. According to a study just a cup of coffee can raise the pressure in your eye go up to significant amount for up to 90 minutes.
• Frequently sip fluids – Take moderate quantity of fluids. Drinking more liquids may temporarily increase eye pressure.
• Keep your head elevated when you sleep – Keep your head slightly elevated for about 20 degrees using a wedge pillow as you sleep. This has shown to reduce intraocular pressure while you sleep.
• Take prescribed medicines regularly – Taking the medicines and eye drops regularly, as prescribed will help in having the symptoms under control. Optic nerve damage could worsen when the eye drops are not used regularly.
• Keep away from stress – Stress might trigger an attack of acute angle closure glaucoma. Therefore one should cope with stress in every possible way. Meditation and other techniques might help.
• Keep away from smoking – Smoking raises eye inflammation and blood pressure. This will make your risk of diabetes and cataracts go up. Both are risk factors for glaucoma.
• Eye protection – While working in yard or playing contact sports make sure to protect your eyes. While swimming wear your goggles. Use non allergenic make-up brands and replace them often. Use sunglasses outside, especially in summer. Also use them around high glare surfaces like sand, snow and water. In glaucoma eyes may be highly sensitive to glare.
• Don’t rub your eyes
• Do yoga, but be cautious with certain poses – Some of the head-down poses of yoga wherein your heart is above your eye can raise your eye pressure. Therefore the poses which increase eye pressure shall be avoided. The poses to avoid are – Downward facing dog, Standing forward bend, Plow pose and Legs up the wall pose.
• Maintain healthy weight. High and low BMI can increase the risk of glaucoma.
• Meditation – research has shown that regular meditation may reduce eye pressure. It also relieves stress which tends to increase a person’s risk of high IOP.
• Dental hygiene – Some research has shown that gum disease is associated with an increased risk of primary open angle glaucoma. Therefore one should maintain dental hygiene.
• Screening – If you have a family history of glaucoma, get screened for the disease.
• Periodic eye checkups – should be particularly undertaken by those who have been diagnosed with glaucoma or those who are at risk of developing glaucoma. (Read more)

Herbs, important points, studies

• Ginkgo is shown to enhance ocular blood flow.
• Bilberry – has shown to decrease retinal ganglion cell damage in mice.
• Forskolin – might reduce intra-ocular pressure when applied topically.
• Cannabis / Medical marijuana – Studies suggest that it may lower IOP temporarily. It has also shown to cause dangerous side effects when used for prolonged periods of time.

These herbs have shown promise in studies. They are not clinically proven treatments. The prescribed medicines should not be replaced with these herbs. Do not take these without consulting with doctor. (Read more)

Yoga, Exercise

Avoid headstands and inverted poses since they tend to increase pressure in the eyes.

Avoid –

• Adhomukha Svanasana – Downward dog pose
• Uttanasana – Standing forward bend
• Sirsasana – head stand
• Viparita Karani – legs up the wall

According to a study, practicing the above said poses for 2 minutes each caused an increase in IOP in both healthy and glaucoma subjects.

Other poses to avoid are –

• Salamba Sarvangasana – shoulder stand
• Urdhwa Dhanurasana – wheel pose
• Matsyasana – fish pose

Useful Yoga poses in glaucoma

• Yoga Nidra
• Pranayama – deep Yogic breathing, Ujjayi, Viloma, Nadi Shodhana (Read more)

A study – ‘Evidence from various studies support that yoga based Tratak ocular exercise might lead to decrease in IOP and might halt further damage. This may also be useful in prevention of onset of glaucoma in high risk individuals’. (Read more here)

Aerobic Exercise – Dr Robert Ritch, MD, @ New York Eye and Ear Infirmary of Mount Sinai, New York City advocates 45 minutes of aerobic exercise 3-4 times a week. He tells ‘It’s simple, if it is good for your heart; it’s good for your glaucoma. If it’s good for your brain, it’s good for glaucoma’. (Read more)

According to Dr Ou, recent animal studies add to the evidence that physical activity protects against glaucoma damage.

Strength training – Relatively few studies have been conducted on the effect of weight training on IOP. The results too have been contradictory.

Ayurveda correlation of Glaucoma

A condition named as Adhimantha explained in the context of eye disorders in Ayurveda closely resembles Glaucoma.

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