Doctors answer the most frequently asked questions:
Excluding borderline glaucoma (glaucoma suspect) and childhood glaucoma, there are two main forms of glaucoma: open-angle glaucoma and angle-closure glaucoma. There are generally no symptoms in either of these forms of the disease. There is no pain, no loss of vision (except in the advanced stage of the disease) and the eye looks normal. Left undiagnosed, glaucoma may continue to progress for years without the patient’s knowledge, causing the destruction of optic nerve fibre and an irreversible loss of sight. Symptoms appear only in case of an acute angle-closure glaucoma attack, which occurs suddenly and causes severe pain, vision loss and sometimes nausea and vomiting. An acute angle-closure glaucoma attack is an ophthalmological emergency. Fortunately, such attacks are very rare.
Glaucoma affects one to three percent of the population of the Western world age 40 and over. An estimated 400,000 Canadians have glaucoma. According to the World Health Organization, glaucoma is the second leading cause of blindness in the world, after cataracts. The incidence of glaucoma increases with age, rising from two percent in people over age 40, to five percent in those over 65 and ten percent in people over 80.
As glaucoma is an asymptomatic disease, the importance of regular eye examinations by an optometrist cannot be overemphasized, especially if you are over 40 and have one or more risk factors. The Canadian Ophthalmological Society recommends that anyone at risk of glaucoma (with a family history of glaucoma, for example) have an eye examination at least every three years over age 40, at least every two years over age 50 and at least every year over age 65.
As the name suggests, a glaucoma suspect is a patient who may be at risk of developing glaucoma because he or she shows signs of glaucoma or has one or more glaucoma risk factors. Only a doctor can determine if you are a glaucoma suspect.
The genes and mechanisms responsible for glaucoma have not all been identified. As a result, we do not yet know the exact causes of glaucoma. However, several risk factors (elevated eye pressure being the most common) whose presence promotes the onset of glaucoma have been identified.
Glaucoma is not caused by an infection, so there is no risk that you might catch it from someone else. However, several people in the same family may have glaucoma due to a family predisposition to the disease.
Glaucoma that is not treated, no matter what the form of the disease, may end in blindness. It is only a matter of time (several years) before eyesight is lost if glaucoma is left untreated. An acute angle-closure glaucoma attack can cause loss of sight within days. Such attacks are an ophthalmological emergency and are fortunately rare.
Not all cases of glaucoma are accompanied by elevated intraocular pressure (IOP). There are people who have elevated intraocular pressure for many years yet never develop glaucoma. Conversely, there are people with normal or even low intraocular pressure who have glaucoma. In other words, intraocular pressure is not the only factor in the development of glaucoma.
Yes. There are secondary glaucomas that are caused by trauma to the eye. Also, some diseases, and their treatments, can cause glaucoma, mainly joint inflammation disorders that cause intraocular pressure to rise.
No. Glaucoma is not caused by reading for long periods of time, working at a computer, watching television or precision activities requiring intense use of the eyes.
No. High blood pressure can cause a slight increase in intraocular pressure, but not enough to provoke glaucoma.
The only type of glaucoma that can be prevented is acute angle-closure glaucoma attack. An iridotomy (microscopic hole in the iris) can be performed as a preventive measure. For all other types of glaucoma, there is no preventive therapy.
No. At present, glaucoma cannot be cured. Even after an iridotomy (laser procedure), regular follow-up by an ophthalmologist or an optometrist is required, because angle-closure glaucoma can turn into open-angle glaucoma if elevated intraocular pressure persists. In addition, damage to the optic nerve caused by glaucoma is irreversible. However, if diagnosed and treated sufficiently early, glaucoma can be kept under good control in most cases.
Yes. There are very effective treatments available that can slow the progression of glaucoma. A variety of surgical procedures can be used to drain the aqueous humour from the eye and lower intraocular pressure. Trabeculectomy is the most common type of surgery. There are also a number of laser procedures that can be used in different types of glaucomas, notably iridotomy in the treatment of angle-closure glaucoma.
Unless instructed otherwise, it is dangerous to stop using your eye drops for any extended length of time. When the treatment is discontinued, intraocular pressure rises and vision gradually deteriorates. You must tell your attending care team of any side effects you experience. Often there are other medical or surgical solutions for reducing intraocular pressure.
Anyone who has glaucoma must be followed by an ophthalmologist. Your ophthalmologist will tell you what treatment you require and how often you need to see him or her based on the type and stage of your glaucoma.
Most of the time, both eyes are affected, though not necessarily to the same degree. Some types of glaucoma, however, can affect only one eye, particularly angle-closure glaucoma, exfoliative glaucoma and post-traumatic glaucoma.
Yes. Taking certain drugs increases the risk of glaucoma. Use of cortisone can reveal or trigger open-angle glaucoma in people predisposed to it. Angle-closure glaucoma suspects should also avoid certain drugs that can dilate the pupil and trigger an acute angle-closure glaucoma attack. Such an attack is an ophthalmological emergency and can very quickly lead to blindness. However, it is recommended that you consult your doctor before discontinuing any treatment.
No. The damage to the visual field caused by glaucoma is irreversible. No eyeglasses can compensate for the vision loss nor can it be restored by any treatment. Compliance with the treatment prescribed by your doctor is thus crucial, even when no symptoms are felt, to avoid permanent damage.
Yes. Most people with glaucoma can keep their driver’s licence for a very long time, as their vision is not affected. Driving only becomes difficult and dangerous in very advanced glaucoma. If the damage to the optic nerve and the visual field loss are substantial, the ophthalmologist and the licensing authority may decide that the patient is unable to drive safely and will have to give up his or her driver’s licence permanently.
Wearing contact lenses is not a problem for most people with glaucoma. Exceptions are those who have had certain types of surgery after which the wearing of contact lenses is not advisable. However, interactions with certain eye drops are possible, so you must ask your ophthalmologist what is recommended in your case.
Yes. There is no danger in taking a plane or using any other form of transportation, and practicing sports is recommended as it causes intraocular pressure to drop. However, sports that require excessive exertion (such as weight lifting) or exercise that demands postures with the head down (yoga) are to be avoided, especially in advanced glaucoma, as they can cause intraocular pressure to rise. Vigorous physical activity is also not advisable in cases of pigmentary glaucoma.
No. Stress, sexual relations and activities requiring intense use of the eyes are not risk factors in glaucoma and have no impact on the disease. People with glaucoma can, as a result, lead a completely normal life.
No. Glaucoma does not cause cataracts. However, it is not uncommon for someone with glaucoma to develop a cataract as well, as both diseases mainly affect people age 40 or older. Cataract surgery is usually not dangerous in people with glaucoma and may in fact lower intraocular pressure slightly.
Though it has not been established beyond any doubt that smoking is a risk factor in glaucoma, several recent studies have shown an association between glaucoma and smoking. It is thus best not to smoke.