Community Health
Our understanding of glaucoma has increased dramatically over the years. Originally it was discovered as a very high pressure in the eye; that occurred with severe pain inside the eye, and redness on the surface. This led to blindness, unless the intra-ocular pressure (IOP) was reduced substantially.
Later it was discovered that blindness was occurring gradually in people with modestly high intraocular pressures. It was also noted that certain types of optic nerve changes were occurring along with the elevated IOP’s.
As visual field instruments were invented and automated, we started noticing a specific pattern to the loss of visual field, or expanse of vision; and thus could determine if the disease was getting worse. This, however, has been difficult to determine because it relies on patient input.
First the patient needs to be accurate and reliable in the data collected. Second as the disease progresses, it becomes more difficult to know if the target signal was actually seen or not.
Recently, it’s been discovered that as much as 65-plus percent of early glaucoma patients have optic nerve changes before any visual field loss is detected. It’s also been noted that 50-plus percent have optic nerve and visual field changes with IOPs in what was previously considered the normal range.
With this in mind eye doctors are changing how we detect and determine if glaucoma is present and/or progressing.
In early glaucoma there is no pain and the vision loss is very gradual. It’s often suspected when we notice an irregularity in the optic nerve. IOPs are often in the teens, versus 20s and 30s previously. Specific photos, fields, and other tests are taken to get a baseline with which to compare in the future. As such we can often catch it before any visual field loss occurs.
Once glaucoma is diagnosed, there are a variety of ways to treat it. Traditionally the most common way has been with specific IOP-lowering eye drops. When these lose effectiveness, due often to patient not remembering to put the drops in, or the drops not working as well as before, then surgery is often considered.
These surgeries have become more successful over time, but sometimes lose their effectiveness over time in reducing IOP. As such, a variety of factors must be considered when determining each patient’s treatment of choice.
Recently, a new thought pattern has emerged in detecting and treating glaucoma. It is that glaucoma may be more than just eye pressure.
If 50-plus percent of glaucoma patients show visual field loss and optic nerve changes when IOPs are normal, or even low, could there be a nutritional factor involved? One study with over 3,000 participants found a significant correlation with optic nerve changes and blood vessel tortuosity in the area of the optic nerve change.
Other studies have shown that blood vessel tortuosity is often correlated with cholesterol irregularities or other nutritional factors. As such, besides lowering IOP, nutrition might be considered in treating glaucoma. With more research, hopefully this disease can be better controlled and eventually cured.
Dr. Scott Borgholthaus is owner of Vision Haus Optometry in Cheney. He is a member of the Optometric Physicians of Washington and has been in private practice for over 28 years.
Dr. Borgholthaus would love to answer and/or include any questions or comments in future columns. Please send questions or comments to drb@cheneyvision.com.
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