Thursday , November 26 2020

Glaucoma: More Than Eye Pressure

By Dr. Latif Hamed MD, FAAO, MBA
Glaucoma: More Than Eye PressureFor many people, Glaucoma means high eye pressure.  This is only partially true. Glaucoma is a disease of the optic nerve that leads to gradual loss of its nerve fibers that is often but not always associated with high pressure.  The eye, like a football or a tire has a recommended pressure and if the eye pressure for a particular person exceeds that number then it may cause optic nerve damage.  What is that recommended pressure? Well, that is where the plot thickens.
It turns out that the optic nerve’s ability to withstand pressure differs from one person to another.  A pressure that may be high and damaging to one person may be entirely safe for another.  Some optic nerves are rugged and strong and can withstand higher pressure than other weaker more fragile nerves.  Therefore, although on average an eye pressure in the mid-teens may be safe to most, it may be too high for some patients with particularly fragile nerves, and lowering the pressure to single digits in such patients may be required.
The optic nerve is a bundle of about 1.2 million fibers that connect the eye to the brain.  Glaucoma entails losing a few fibers at a time and therefore the disease is gradual and surreptitious (Sneaky) in the sense that the typical patient is unaware of the problem until the disease is advanced.  This is particularly so since we have a lot of spare, redundant nerve fibers.
Up to this point we have talked about the eye pressure and the optic nerve structural strength and wherewithal as two important factors in the genesis of glaucoma. If only things were this simple!  The plot thickens even further as you delve deeper into potential systemic, genetic and environmental factors.  However, our approach to treatment thus far largely revolves around those two factors: eye pressure and nerve strength.
First and foremost are treatments that aim to lower the eye pressure, either by instilling eye drops or performing surgery.  If you know someone with serious glaucoma, then you may know that they need to take multiple eye drops daily of different types.  Why so many different eyedrops for glaucoma? To answer this, you should know that there is a fluid circulation that occurs inside the eye wherein fresh fluid loaded with oxygen and nutrients is secreted into the eye and that fluid then drains out through a drain or a sink as fresh fluid replaces it.  Therefore, to reduce the amount of fluid inside the eye and reduce the eye pressure we have two basic types of eye drops: The first reduces the amount of fluid secreted into the eye and the second increases the amount of fluid that drains out of the eye.  Some patients can be managed with just one type or the other while others require a combination of drops to get their eye pressure low and safe enough.
The surgical procedures aim to do the same as the drops: either reducing the amount of fluid going into the eye or, more commonly, increasing the fluid coming out by creating a new drain or sink or outlet for the trapped fluid to get out of the eye to bypass the natural drain that is not working properly.  These surgical procedures range from relatively brief laser procedures, to synthetic tubes and drains that are either implanted within the eye or bridge the inside and outside of the eye, to more involved surgical procedures that portend to fashion a new outlet for the fluid inside the eye to bypass the clogged natural drain.
Our discussion thus far has centered on what the medical profession has devised to help patients with glaucoma.  This brings up an issue that I am passionate about, no matter what the ailment: The first question we as doctors and patients need to address is whether there are behavior modifications we can undertake besides medications and surgeries that can improve or cure the ailment under consideration before you embark on the pharmaceutical or surgical options.  For instance, one of the risk factors for glaucoma is diabetes, and most patients with diabetes develop it due to being overweight and then are ensnared in a web of medications that may lead to further weight gain and need of more medications, an unfortunate circuitous route that I see so often.  We know that diabetes and hypertension are a risk factors for glaucoma and that both are better controlled with proper diet and exercise, so it is the duty of health care professionals to help spark patients’ interest along those lines, and it is the intelligent thing to do from the patients’ perspective to not solely rely on the medical and pharmaceutical industry to safe guard their health.
The treatments we have for glaucoma now are far from ideal. Patients are prescribed daily drops and sometimes multiple kinds and multiple daily drops.  That is admittedly inconvenient. These drops also have side effects such as burning and stinging, redness, blurred vision, and sometimes serious complications if given to the wrong patient.  For instance, patients with heart failure or asthma may develop severe problems if given eye drops that are of the beta blocker variety.
Until that ideal treatment arrives wherein we have a cure for the glaucoma or devise a drop with minimal side effects that can control glaucoma with one drop, say, per month, it is important to work together, doctors and patients, to comply with the best treatments available to protect the optic nerves that connect our eyes to the brain.  The disease is silent, so routine annual checkups are recommended.  Any nerve fiber loss is permanent so prevention is key.
Dr. Latif Hamed. Florida Eye Specialist Institute, is Board Certified by the American Board of Ophthalmology and is also an examiner for that Board.
He specializes in advanced laser, surgical and medical eye care. Dr. Hamed is a former professor and Chief of Division at UF Shands. He has been recognized multiple times by his peers in “Best Doctors of America” and is voted “Best of the Best” by the Ocala STAR Banner.
Dr. Hamed’s office at 3230 SW 33rd Road in Ocala. is equipped with the most advanced diagnostic equipment and newest procedures, allowing him to offer his patients the newest way to reduce or eliminate glasses. New patients are welcome. Most insurance plans arc accepted and filed for you.
Florida Eye Specialist Institute

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