Learning that you have glaucoma can feel overwhelming. If anxiety and uncertainty cloud your thoughts, consider carrying a notepad so you can jot down questions as they occur to you. These notes will help you stay organized and get the answers you need at your next ophthalmology appointment.
Remember, no question is too silly to ask your doctor. More likely than not, other patients have asked similar questions before you. Here are some of the most common answers that glaucoma specialist and Academy member J. Kevin McKinney, MD, gives newly diagnosed patients.
Yes, you really do have glaucoma – even if you feel perfectly fine
Most people don’t notice any changes in their eyes when they’re diagnosed with glaucoma, so it can be hard to believe the diagnosis is real. If you’re tempted to skip your medications, think twice: Following your treatment plan, even if the disease seems imaginary, can help keep those symptoms and vision loss at bay.
With proper treatment, most people with glaucoma won’t go blind
Good news: Patients who stick with their ophthalmology follow-up appointments and treatments have a very low risk of becoming legally blind, says Dr. McKinney. Patients who go undiagnosed or untreated are at the highest risk of losing vision. If you've been diagnosed and are receiving treatment, you’re already on the right track. Keep taking your medications as prescribed to protect your sight.
Most people with glaucoma have three treatment options
Patients with primary open angle glaucoma, the most common form of the disease in the United States, typically have three treatment options: eyedrops, laser or surgery.
Ophthalmologists usually start new patients on a daily eye drop medicine to lower eye pressure. You must use these eye drops exactly as instructed for them to work. This can be challenging at times because glaucoma eye drops sometimes produce unwanted side effects such as burning or blurry vision.
Some patients also undergo laser surgery (trabeculoplasty) at the doctor’s office. This helps fluid drain from your eye to reduce pressure. Laser treatment can be used by itself or in combination with eye drops.
If laser and eye drop therapy aren’t enough, your doctor may recommend traditional glaucoma surgery, such as trabeculectomy or tube shunt implant. These procedures, performed in an operating room, create a new drainage channel for fluid to leave the eye. Some patients are offered newer, minimally invasive glaucoma surgeries called MIGS. Your ophthalmologist will help you determine the best treatment option based on your individual disease progression, tolerance of eye drops and other factors.
You won't be able to feel whether a glaucoma treatment is working
Glaucoma has no symptoms early on and most patients don’t feel their eye pressure rising or notice their vision loss until later in the disease. The only way to know if a treatment is working is to attend all scheduled follow-up visits with your ophthalmologist – generally two to four times per year, though your doctor may want to see you more or less often. At these visits, your doctor will measure your eye pressure, test your side (peripheral) vision, check for damage to your optic nerve and make any necessary adjustments to your treatment plan. Side effects from eye drops such as burning and stinging don’t offer any clues about whether the treatment is working, so it’s important to stick with your treatment plan until your doctor tells you otherwise.
Most patients need multiple glaucoma treatments
Some patients can achieve long-lasting glaucoma control with only one eye drop medication or laser treatment. But most patients will require additional treatments over time, says Dr. McKinney. For people with glaucoma, eye pressure tends to worsen with age and will need to be monitored for life.
Severe glaucoma can cause blind spots to form in your side vision
If you stick with your treatments and attend all follow-up appointments, you may never notice vision loss even if it occurs. As the disease progresses, however, many patients will notice blind spots in their side vision.
“Affected patients tend to notice spots in their vision where information is missing or they may not see as well in the dark,” said Dr. McKinney. Patients with severe glaucoma may lose contrast sensitivity and experience diminished color vision. Advanced vision loss from glaucoma can make it difficult to read fine print and cause you to miss people or objects in your periphery or have tunnel vision. Blindness from untreated glaucoma typically occurs slowly over a 10- to 15-year period. For most patients, advanced vision damage can be avoided with consistent treatment and follow-up.
Glaucoma is usually caused by factors outside your control ...
Don’t fall into the trap of wondering what you could have done differently. There is no universal cause of glaucoma, but most glaucoma patients have inherited a combination of genes that put them at risk of eye damage from glaucoma. Long-term use of steroid medications, an eye injury, African, Hispanic or Asian ancestry or having high eye pressure, diabetes, migraines, high blood pressure, poor blood circulation or other health problems that affect the whole body can also increase your risk of developing glaucoma.
... but you can help control how quickly glaucoma progresses
A healthy, balanced lifestyle can stack the odds in your favor when it comes to preventing glaucoma progression. Avoid smoking, saturated fats and excess alcohol and caffeine. While it’s important to stay hydrated, keep in mind that consuming large volumes of liquid all at once can increase your eye pressure. Sleep hygiene is important: If you think you may have sleep apnea, make an appointment to get evaluated. Studies have shown that untreated sleep apnea may worsen glaucoma. Sleeping with an eye against a pillow or arm is also thought to worsen glaucoma.
Aerobic exercise is a good thing, but if you practice yoga or similar activities, be careful: Head down positions such as downward dog or inversions can increase blood pressure in the head and eye pressure. Doctors recommend that glaucoma patients wear safety glasses during sports and other risky activities to protect their eyes from injury.
Finally, ask your ophthalmologist before starting a steroid prescription. Steroids of any kind — oral, topical, inhaled or IV — can be a risk factor for progression of glaucoma.