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Glaucoma

Glaucoma is a vision-threatening disorder characterized by slow loss of optic nerve fibers. Susceptibility to this disease depends on a variety of factors including the level of pressure in the eye, a genetic tendency and older age. Glaucoma sometimes is caused by an abnormal buildup of a clear fluid called aqueous humor inside the eyeball. Normally drained away and replaced by the eye, the fluid is critical for bringing nutrients to the lens and cornea and removing waste material. When drainage channels become blocked, the increased pressure in the eye can damage the optic nerve. Glaucoma often develops slowly and painlessly (open-angle), or occasionally, suddenly and painfully (closed-angle). Open-angle glaucoma strikes two percent of older Caucasians and eight percent of older African Americans. People who have a family history of glaucoma have a higher-than-normal risk of disease. Although open-angle glaucoma cannot be prevented, early diagnosis gives physicians a valuable advantage in treatment to reduce the chance of blindness.

Diagnosis:

The Wilmer Eye Institute is a leader in the development of new diagnostic techniques. These led Wilmer scientists to discover that early stages of glaucoma can damage nerve cells without causing noticeable symptoms. Two valuable testing procedures were developed at Wilmer and are generally unavailable elsewhere in the Baltimore area: photographic quantitation of the nerve fiber layer, which indicates the health of the eye; and the very latest visual field testing devices and computerized techniques for early diagnosis. The self-tonometer, a device invented by a Wilmer scientist that measures pressure in the eye and is designed for use at home, has been used successfully by patients on an investigational basis to measure their own intraocular pressure. The results of the study show that the amount of daily fluctuation in pressure can predict the likelihood of vision loss. The device is at least as reliable as standard measurements done during routine office visits. Such tests can lead to early treatment before obvious vision problems materialize.

Treatment:

Treatment for glaucoma may include eye drops to decrease production of the fluid aqueous humor. Eye drops also may promote outflow from the front part of the eye into small drainage canals, thereby lowering pressure. Glaucoma that is resistant to drug treatment can be treated with argon laser trabeculoplasty, an outpatient procedure using a laser beam. A surgical technique called trabeculectomy also may be performed to lower eye pressure.

> Treated by the Glaucoma Center of Excellence

The Future:

Wilmer Eye Institute is recognized as a center for national research studies. Here, glaucoma specialists continue to pioneer new surgical and drug-treatment options that are available on an investigational basis, even before FDA approval.

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