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Glaucoma is the second leading cause of blindness in the United States, and half of the people who have glaucoma don’t know that they have the disease and are not aware that they are going blind.

Glaucoma is a disease of the optic nerve.  The optic nerve connects the eye to the brain.  It is like an electrical wire with one million strands – Each strand carrying unique information.  If you have Glaucoma, you are loosing or have lost a number of those strands or, Optic Nerve fibers.  When you lose Optic Nerve fibers, you lose a piece of the picture of the world as you see it.  The brain attempts to cover up the defect by filling in the gap with an image similar to the surround.  Because the brain is so good at doing this, the visual field defect is hard for the patient to detect.  One of the greatest risks for developing glaucoma is elevated fluid pressure inside of the eye, elevated intraocular pressure.  Without intraocular pressure (IOP), the eye would collapse and fail.  The pressure is created by the formation of aqueous humor inside the eye.  The acqueous is produced twenty-four hours per day – It never stops.  Therefore it must drain from the eye back into the veins of the eye.  The drain cannot be wide open or there would be no pressure and the eye would collapse, so the drain must offer some resistance to outflow.  Miraculously, the drain is similar to a sponge.  The aqueous can move through the gaps in the sponge, but the fibers of the sponge impede its progress just enough to keep the pressure in a narrow safe zone, usually.  In some people, the outflow is not sufficient to maintain normal pressure and the pressure increases.  This condition is known as ocular hypertension.  The greatest risk for developing glaucoma is ocular hypertension.  If it is determined that the intraocular pressure is too high to maintain a healthy optic nerve, treatment must be initiated to prevent damage.

At this time, the only effective treatment options we have are those that result in lowering the intraocular pressure.  This is accomplished through the use of drugs, usually in the form of eye drops or surgery.  Eye drops work by slowing the production of aqueous and/or by increasing its outflow.  Surgery  may consist of anything from a common extraocular laser procedure to complicated intraocular surgery where sophisticated stents or shunts are implanted in the eye in order to improve damage of the aqueous humor from the eye.

In many cases, treatment is begun before measurable optic nerve damage has occurred.  But as in virtually all medical treatments, there is a downside.  So the decision to initiate treatment is not taken lightly, even if it means something as seemingly minor as using eye drops once per day.  In the event that the first mode of treatment fails to lower IOP, a new treatment plan will be initiated.

Regardless of the mode of treatment, it is imperative that the patient follow the plan.  The success of any treatment plan hinges substantially on the ability of the patient to adhere to the plan.

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