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\n\tAt a Glance:<\/strong><\/p>\n Things to know and remember:<\/p>\n What is a glaucoma?<\/strong><\/p>\n Glaucoma is commonly referred to as the silent thief of sight<\/em> and is one of the leading causes of preventable blindness worldwide. It affects over 3 million Americans and 70 million people around the world, most of whom don’t even know they have it.<\/p>\n Glaucoma is a group of eye diseases characterized by damage to the optic nerve, the nerve that transmits visual information from the eye to the brain. In most cases, this nerve damage is produced by increased fluid pressure within the eye. This elevated pressure is caused by a backup of fluid in the eye. Over time, it causes damage to the optic nerve. Through early detection, diagnosis and treatment, you and your doctor can help to preserve your vision and often protect your eyes against serious vision loss.<\/p>\n Think of your eye as a sink, in which the faucet is always running and the drain is always open. The aqueous humor is constantly circulating through the anterior chamber. It is produced by a tiny gland, called the ciliary body, situated behind the iris. It flows between the iris and the lens and, after nourishing the cornea and lens, flows out through a very tiny spongy tissue, only one-fiftieth of an inch wide, called the trabecular meshwork, which serves as the drain of the eye. The trabecular meshwork is situated in the angle where the iris and cornea meet. When this drain becomes clogged, aqueous cannot leave the eye as fast as it is produced, causing the fluid to back up. But since the eye is a closed compartment, your `sink\u00b4 doesn\u00b4t overflow; instead the backed up fluid causes increased pressure to build up within the eye. We call this open (wide) angle glaucoma.<\/p>\n To understand how this increased pressure affects the eye, also think of your eye as a balloon. When too much air is blown into the balloon, the pressure builds, causing it to pop. But the eye is too strong to pop. Instead, it gives at the weakest point, which is the site in the sclera at which the optic nerve leaves the eye.<\/p>\n The optic nerve is part of the central nervous system and carries visual information from the eye to the brain. This cranial nerve is made up of over one million nerve axons, which are nerve fiber extensions of the retinal ganglion cells. When the eye pressure is increased and\/or other inciting factors exist, the optic nerve becomes damaged and the retinal ganglion cells undergo a slow process of cell death termed “apoptosis.” The death of the retinal cells and degeneration of the nerve fibers results in permanent vision loss. Early diagnosis and treatment of glaucoma can help prevent blindness.<\/p>\n\t\t\tAre there different types of glaucoma?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t There are a variety of different types of glaucoma. The most common forms are:<\/p>\n Several large studies have shown that eye pressure is a major risk factor for optic nerve damage. In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid leaves the chamber at the open angle where the cornea and iris meet. (See diagram below.) When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye.<\/p>\n In open-angle glaucoma, even though the drainage angle is “open”, the fluid passes too slowly through the meshwork drain. Since the fluid builds up, the pressure inside the eye rises to a level that may damage the optic nerve. When the optic nerve is damaged from increased pressure, open-angle glaucoma-and vision loss-may result. That’s why controlling pressure inside the eye is important.<\/p>\n Another risk factor for optic nerve damage relates to blood pressure. Thus, it is important to also make sure that your blood pressure is at a proper level for your body by working with your medical doctor.<\/p>\n\t\t\tWho is at risk?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Everyone should be concerned about glaucoma and its effects. It is important for each of us, from infants to senior citizens, to have our eyes checked regularly, because early detection and treatment of glaucoma are the only way to prevent vision impairment and blindness.<\/p>\n There are a few factors related to this disease which tend to put some people at greater risk:<\/p>\n Additional risk factors include:<\/p>\n Everyone under age 40 should have a comprehensive eye examination every three to four years. Individuals under age 40 with one of the above risk factors should get tested every one and a half to two years. Everyone 40 years or older should have a comprehensive eye examination every one and a half to two years. If you are 40 and have an additional risk factor listed above, get tested annually. Anyone with high risk factors should be tested every year or two after 35.<\/p>\n\t\t\tWhat are the symptoms?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t At first, open-angle glaucoma has no symptoms. It causes no pain. Vision stays normal. Glaucoma can develop in one or both eyes.<\/p>\n Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. As glaucoma remains untreated, people may miss objects to the side and out of the corner of their eye. They seem to be looking through a tunnel. Over time, straight-ahead (central) vision may decrease until no vision remains.<\/p>\n\t\t\tHow can people with glaucoma protect their vision?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t There is no cure for glaucoma. And vision lost to glaucoma cannot be restored. However, early detection and treatment can reduce the risk of further vision loss and blindness. Because glaucoma often lacks early symptoms, early detection and treatment are key. That’s why regular eye exams are so important. (See “Who is at risk?” above.)<\/p>\n How glaucoma detected<\/strong>?<\/strong><\/p>\n Glaucoma is detected through a comprehensive eye exam and a series of tests that include:<\/p>\n Visual field testing has advanced greatly in recent years. While Humphrey (and Octopus) perimeters are the most widely used devices by optometrists and ophthalmologists, several newer strategies – some using these same machines, others use different devices – have been introduced which allow for earlier detection of field defects and easier monitoring of field changes. These new technologies work by testing different groups or types of the retinal ganglion cells that are destroyed in glaucoma. One is blue-yellow perimetry, also known as Short Wavelength Automated Perimetry (SWAP), which uses blue light as the stimulus and yellow light as the background illumination. Another is Frequency Doubling Technology (FDT), which measures a form of contrast sensitivity. This test is especially useful for patients who have blurred vision or cataracts.<\/p>\n\t\t\tDo the newest imaging devices add to glaucoma diagnosis?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Optical coherence tomography (OCT), first introduced in 1991, has become an invaluable tool in ophthalmic practice. With advances in imaging technology over the past years, ophthalmologists can now visualize the eye and ocular disorders in three-dimensional images generated at a speed and resolution not possible earlier. One of the more recent advances in imaging is spectral-domain optical coherence tomography (SD-OCT), introduced in 2005. SD-OCT, which measures the reflection of laser light much like an ultrasound measures the reflection of sound, can directly measure the thickness of the nerve fiber layer and create a three-dimensional representation of the optic nerve. Today we can use such high-tech equipment both in diagnosing and managing patients with glaucoma, more effectively monitoring subtle changes in both structure and function.<\/p>\n Because glaucoma damage is irreversible, it is critical to detect glaucoma and its progression as early as possible. This OCT technology displays a three-dimensional, cross-sectional view of the retina and not just the view of its surface provided by conventional imaging technologies. It enables layers of the retina to be seen and analyzed with respect to structural changes associated with glaucoma and other blinding eye diseases. OCT is becoming increasingly valuable as a means to measure these changes in relation to a patient’s own previous images. This technology can sometimes allow doctors to detect glaucoma-related changes in the eye in its earliest stages, before the visual field or optic disc appearance indicate that glaucoma damage is occurring.<\/p>\n\t\t\tAre there advanced testing techniques in the pipeline to diagnose and assess visual field damage earlier?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Visual evoked potential (VEP) technology has been a promising avenue as we look for better ways to help identify early glaucoma visual field loss. VEP monitors the brain’s electrical response to a stimulus using electrodes placed on the scalp. So it, bypasses some of the problems associated with subjective standard visual field tests that require the subject to respond to stimuli by pushing a button. All the patient has to do is look straight ahead, look at the test object, and just have the electrodes measure the recordings from their scalp.<\/p>\n The best-known version of this technology has been multifocal VEP. But the chief problem with mfVEP has been that it’s a time-consuming test; it can take even longer than a standard visual field test, making it potentially difficult for some patients.<\/p>\n We have been engaged in Phase II clinical trials of an alternative called isolated-check VEP. The premise is similar-monitoring brain waves to evaluate retinal function in glaucoma-but the way the stimuli are presented is completely different. A patient can lose 30 or 40 percent of his ganglion cells before he has a visual field abnormality. We’re hoping that icVEP will be able to provide earlier evidence that a person has developed glaucoma so treatment can begin before the loss becomes that extensive.<\/p>\n This is not intended to replace visual field testing; it’s meant to be a complement to it. We’re interested in seeing whether this technology can provide another data point to help determine whether glaucoma is present or whether a therapy is slowing progression.<\/p>\n\t\t\tWill I develop glaucoma if I have increased eye pressure?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Not necessarily. Not every person with increased eye pressure will develop glaucoma. Some people can tolerate higher levels of eye pressure better than others. Also, a certain level of eye pressure may be high for one person but normal for another.<\/p>\n Whether you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. This level is different for each person. That’s why a comprehensive dilated eye exam is very important. It can help your eye care professional determine what level of eye pressure is normal for you.<\/p>\n\t\t\tCan I develop glaucoma without an increase in my eye pressure?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Yes. Glaucoma can develop without increased eye pressure. This form of glaucoma is called low-tension or normal-tension glaucoma. It is a type of open-angle glaucoma.<\/p>\n\t\t\tWhat is the relationship of conditions like sleep apnea and Raynaud’s to glaucoma?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Recent studies suggest that certain types of glaucoma may result from insufficient blood supply to the optic nerve due either to increased intraocular pressure (IOP) or other risk factors. Sleep apnea, Raynaud’s syndrome, as well as migraine headaches and reduced nocturnal blood pressure are vascular factors that have been associated with glaucoma, particularly with normal-tension glaucoma,a form of glaucoma in which optic nerve damage and visual field loss progress despite seemingly normal IOP levels. Studies have shown that there is decreased ocular blood flow in sleep apnea, and that normal-tension glaucoma is more prevalent patients with sleep apnea than in patients without the disorder. Studies have also shown that the severity of sleep apnea correlates with the severity of glaucomatous damage.<\/p>\n Raynaud’s disease, characterized by abnormally cold hands and feet, may also be an indicator for normal-tension glaucoma, because decreased perfusion to the extremities could suggest a vascular disorder compromising blood flow to the optic nerve. Migraine headaches may also be associated with decreased blood flow to the optic nerve. And while not all patients with low blood pressure develop glaucoma, blood pressure is often significantly lower in patients with normal-tension glaucoma. In addition, patients who experience a decrease in blood pressure while sleeping may have a higher risk of glaucoma progression.<\/p>\n The subject of blood flow and glaucoma is currently an active field of scientific investigation. The impending results will be important in optimizing treatment to prevent development and\/or halt glaucomatous progression.<\/p>\n\t\t\tDo nutrition and exercise affect glaucoma?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t A healthy diet coupled with a daily routine of exercise is a good prescription for everyone interested in good health. But remember, every patient is different. Before making any drastic change in your diet, it is wise to communicate that intention to your doctor and discuss the pros and cons. The same advice is true for embarking on a new exercise program. While studies show that aerobic exercise can lower intraocular pressure, other forms of exercise can increase pressure. So, if you’re a glaucoma patient, it’s especially important to check with your doctor before making any lifestyle changes. Such changes could have an impact on the test results your doctor relies on to evaluate the success of your treatment plan.<\/p>\n\t\t\tCan caffeine affect intraocular pressure (IOP)?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t For years it was thought that caffeine had no affect on IOP, except in rare instances. Now, with the concept of non-pressure dependent factors such as constriction of the veins or arteries and ocular blood flow, the question is being debated again, since caffeine can affect blood flow. There is no conclusive answer, but too much caffeine is not recommended – especially if you have cardiovascular problems or migraines. As always, only a doctor who examines your eyes can determine the most appropriate treatment for you or answer questions about your specific condition. If you remain unsure or uncomfortable with your options, we recommend seeking a second opinion.<\/p>\n\t\t\tIs there a particular diet that prevents the development of glaucoma?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Glaucoma is an intraocular pressure related optic nerve disease and before answering this question, it is worth exploring whether nutritional deficiencies are implicated in optic nerve disease of any kind. Such a question is important because it demonstrates that proper nutrition can be tied to optic nerve health. In point of fact, it is well known that optic nerve atrophy is associated with deficiencies of B12 or folate deficiency. The question is whether associations between nutritional habits and glaucoma exist in developed countries where food is in abundant supply. That is a more difficult question to answer. First, frank nutritional deficiency is very uncommon in the developed world.<\/p>\n Furthermore there are no other clinical signs or panel of blood biomarkers that adequately reflect variation of typical dietary behavior in the setting where food is in abundant supply. Nothing short of performing an extensive dietary history that captures nutritional intake from all foods and supplements will accurately reflect a person’s dietary habits. In order to capture patterns of nutrient intake in this setting, repeated measures of dietary intake are needed using validated food frequency questionnaires. Also, in order to minimize recall bias, dietary intake data should be collected on large numbers of patients prior to the onset of glaucoma. The definition of glaucoma needs to be standardized and the ability to detect glaucoma must be similar in people who demonstrate a wide variety of dietary habits.<\/p>\n With that said, such studies have been performed and no consensus on dietary behavior associated with POAG for a wide range of nutrients including antioxidants and dietary fat currently exists. Yet, more nutritional epidemiology research in the field of glaucoma is needed and welcome. If such studies demonstrate that dietary habits consistent with overall good health are also associated with a reduced risk of glaucoma, then patients and their eye care providers would certainly embrace them as a way to prevent this disease.<\/p>\n Can glaucoma be cured?<\/strong><\/p>\n No. There is no cure for glaucoma. Vision lost from the disease cannot be restored.<\/p>\n\t\t\tHow is glaucoma treated?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Glaucoma can be treated with eye drops, medications, laser surgery, traditional surgery or a combination of these methods. The goal of any treatment is to prevent loss of vision, as vision loss from glaucoma is irreversible. The good news is that glaucoma can be managed if detected early, and that with medical and\/or surgical treatment, most people with glaucoma will not lose their sight.<\/p>\n Taking medications regularly, as prescribed, is crucial to preventing vision-threatening damage. That is why it is important for you to discuss side effects with your doctor. While every drug has some potential side effects, it is important to note that many patients experience no side effects at all. You and your doctor need to work as a team in the battle against glaucoma. Your doctor has many options. They include:<\/p>\n Eye Drops:<\/strong> It is important to take your medications regularly and exactly as prescribed if you are to control your eye pressure. Typically glaucoma eyedrops are dosed with one drop once or twice a day in the affected eye. Medications should be taken on a fixed schedule every day to achieve the best long term control of the disease. Since eye drops are absorbed into the bloodstream, tell your doctor about all medications you are currently taking. Ask your doctor and\/or pharmacist if the medications you are taking together are safe. Some drugs can be dangerous when mixed with other medications. To minimize absorption into the bloodstream and maximize the amount of drug absorbed in the eye, close your eye for one to two minutes after administering the drops and press your index finger lightly against the inferior nasal corner of your eyelid to close the tear duct which drains into the nose. While almost all eye drops may cause an uncomfortable burning or stinging sensation at first, the discomfort should last for only a few seconds.<\/p>\n Oral Medications:<\/strong> Sometimes, when eye drops don’t sufficiently control IOP, pills may be prescribed in addition to drops. These pills (ie. Acetazolamide or Methazolamide) have more systemic side effects than drops. They also serve to turn down the eye’s faucet and lessen the production of fluid. These medications are usually taken from two to four times daily. It is important to share this information with all your other doctors so they can prescribe medications for you that will not cause potentially dangerous interactions.<\/p>\n Surgical Procedures:<\/strong> When medications do not achieve the desired results, or have intolerable side effects, your ophthalmologist may suggest surgery.<\/p>\n Laser Surgery:<\/strong> Laser surgery has become increasingly popular as an initial treatment or an intermediate step between drugs and traditional surgery though the long-term success rates are variable. The most common type performed for open-angle glaucoma is called trabeculoplasty. This procedure takes between 2 and 5 minutes, is painless, and can be performed in either a doctor’s office or an outpatient facility. The laser beam (a high energy light beam) is focused upon the eye’s drain, called the Trabecular Meshwork. Contrary to what many people think, the laser does not burn a hole through the eye. Instead, the eye’s drainage system is changed in very subtle ways so that aqueous fluid is able to pass more easily out of the drain, thus lowering IOP.<\/p>\n You may go home and resume your normal activities following surgery. Your doctor will likely check your IOP one to two hours following laser surgery. After this procedure, many patients respond well enough to be able to avoid or delay surgery. While it may take a few weeks to see the full pressure-lowering effect of this procedure, during which time you may have to continue taking your medications, some patients are eventually able to discontinue some of their medications. This, however, is not true in all cases. Your doctor is the best judge of determining whether or not you will still need medication. Complications from laser are minimal, which is why this procedure has become increasingly popular and some centers are recommending the use of laser before drops in some patients.<\/p>\n Selective Laser Trabeculoplasty (SLT): <\/strong>Used for open-angle glaucoma, SLT is a laser that uses very low levels of energy to help stimulate the drainage network to drain more fluid out of the eye and into the bloodstream. It is termed “selective” since it specifically targets portions of the trabecular meshwork. Typically this procedure carries a 75-80% success rate as far as lowering intraocular pressure with very minimal risk. Additionally, SLT may be safely repeated if needed for further control later in life if the disease is noted to progress.<\/p>\n Laser Peripheral Iridotomy (LPI):<\/strong> Used for angle-closure glaucoma, this procedure is used to make an opening through the iris, allowing aqueous fluid to flow from behind the iris directly to the anterior chamber of the eye. This allows the fluid to bypass its normal route. LPI is the preferred method for managing a wide variety of angle-closure glaucomas that have some degree of pupillary blockage. This laser is most often used to treat an anatomically narrow angle and prevent both acute and chronic forms of angle-closure glaucoma.<\/p>\n Cycloablation:<\/strong> Two laser procedures for open-angle glaucoma involve reducing the amount of aqueous humor in the eye by destroying or suppressing part of the ciliary body, which produces the fluid.<\/p>\n Transscleral cyclophotocoagulation uses a laser to direct energy through the outer sclera of the eye to reach and destroy portions of the ciliary processes, without causing damage to the overlying tissues. There are two forms of transscleral cyclophotocoagulation- Micropulse or Diode technology. Both typically require some form of monitored anesthesia care to provide added comfort to the patient during treatments. Micropulse laser can be very effective in reducing intraocular pressure, but often times requires repeated efforts to maintain control of the disease. Diode laser is usually reserved for use in eyes that either have elevated IOP with limited visual potential or those in which incisional surgery is not possible or advisable due to the shape or other features of the eye.<\/p>\n Endoscopic cyclophotocoagulation (ECP) is another method where a probe is placed inside the eye through a surgical incision and laser energy is applied to the ciliary body tissue with direct visualization. The ciliary processes are suppressed by way of the laser to help reduce the amount of aqueous fluid produced by the eye and thus lower intraocular pressure.<\/p>\n Trabeculectomy:<\/strong> When medications and laser therapies do not adequately lower eye pressure, doctors may recommend conventional surgery. The most common of these operations is called a Trabeculectomy, which is used in both open-angle and closed-angle glaucoma’s. In this procedure, the surgeon creates a passage in the sclera (the white part of the eye) for draining excess eye fluid. A flap is created that allows fluid to escape, but which does not deflate the eyeball. A small bubble of fluid called a “bleb” often forms over the opening on the surface of the eye, which is a sign that fluid is draining out into the space between the sclera and conjunctiva. Occasionally, the surgically created drainage hole begins to close and the IOP rises again. This happens because the body tries to heal the new opening, as if it was an injury. Many surgeons perform Trabeculectomy with an anti-fibrotic agent that is placed on the eye during surgery and reduces such scarring during the healing period. The most common anti-fibrotic agent is Mitomycin-C. Another is 5-Fluorouracil, or 5-FU.<\/p>\n About 50 percent of patients no longer require glaucoma medications after surgery for a significant length of time. Thirty-five to 40 percent of those who still need medication have better control of their IOP. A Trabeculectomy is usually an outpatient procedure. The number of post-operative visits to the doctor varies, and some activities, such as driving, reading, bending and heavy lifting must be limited for two to four weeks after surgery.<\/p>\n Express Mini Glaucoma Shunt:<\/strong> This is another form of filtration surgery but avoids creation of a drainage hole, or sclerotomy. It is a stainless steel device that is inserted into the anterior chamber of the eye and placed under a scleral flap. It lowers IOP by diverting aqueous humor from the anterior chamber. The ExPress offers the glaucoma surgeon an alternative to Trabeculectomy or placing a more extensive silicone tube shunt in those patients whose IOP is higher than the optic nerve can tolerate. This procedure also requires a fair amount of close postoperative care to ensure adequate control of the disease.<\/p>\n Drainage Implant Surgery:<\/strong> Several different devices have been developed to aid the drainage of aqueous humor out of the anterior chamber and lower IOP. All of these drainage devices share a similar design, which consists of a small silicone tube that extends into the anterior chamber of the eye. The tube is connected to one or more plates, which are sutured to the surface of the eye, usually not visible. Fluid is collected on the plate and then absorbed by the tissues in the eye. This type of surgery is usually preferred in patients whose IOP cannot be controlled with traditional surgery or who have previous scarring.<\/p>\n <\/p>\n Surgical Alternatives: <\/u><\/strong>There are also a number of surgical alternatives for the treatment of glaucoma. Your glaucoma specialist can explain each, and together, you can decide which might be appropriate for you.<\/p>\n iStent:<\/strong> The iStent is a 1 millimeter titanium device that is directly inserted into the trabecular meshwork to help bypass outflow resistance and reduce intraocular pressure. It is a low risk, effective instrument that can help control open angle glaucoma with the potential of eliminating use of topical glaucoma medications when combined with cataract surgery. At this point in time, this device is approved for use and covered by insurances only at the same time of cataract surgery. Other similar devices, such as the Hydrus stent and CyPass shunt, will also be readily available in the coming years.<\/p>\n Trabectome:<\/strong> Trabectome is a technique involving a probe-like device that is inserted into the anterior chamber through the cornea. The procedure uses a small probe that opens the eye’s drainage system through a tiny incision and delivers thermal energy to the trabecular meshwork, reducing resistance to outflow of aqueous humor and, as a result, lowering IOP.<\/p>\n Canaloplasty:<\/strong> Canaloplasty is designed to improve the aqueous circulation through the trabecular outflow process, thereby reducing IOP. Unlike traditional Trabeculectomy, which creates a small hole in the eye to allow fluid to drain out, canaloplasty has been compared to an ocular version of angioplasty, in which the physician uses an extremely fine catheter to clear the drainage canal.<\/p>\n Xen Stent:<\/strong> The Xen Stent is one of the newest options available to surgically treat and control glaucoma. It is a collagen based flexible device that allows steady filtration of aqueous fluid from the anterior chamber to the subconjunctival space. It often requires use of antimetabolites to prevent scar tissue formation.<\/p>\n\t\t\tAre there over-the-counter medications that people with glaucoma should avoid?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t We have all read the labels on over-the-counter medications that say “do not take if you have glaucoma.” Many of these are cold and allergy medications containing a decongestant. These and other drugs prescribed for conditions as diverse as depression and systemic hypertension can dilate the pupil and provoke angle closure in people with narrow angles. They don’t seem to have an effect on people with open-angle glaucoma.<\/p>\n Patients should ask their doctor before taking any drug that has warnings about usage in people with glaucoma. Glaucoma is a group of different diseases. Only a doctor who examines your eyes can determine the most appropriate treatment for you and answer specific questions. You can also discuss possible drug interactions with your pharmacist.<\/p>\n\t\t\tAre alternative therapies being studied for their role in glaucoma?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Many available natural compounds used as non-pharmaceutical therapy have been reported to show beneficial effects on circulation, the immune system and neuroprotective activities. The mechanism of action of neuroprotection most common to natural compounds is antioxidant\/free radical scavenging activity. However, many other actions are present and some extracts, such as Ginkgo biloba and curcumin, have widespread activity on a number of enzyme systems. There has been a paucity of clinical trials examining neuroprotective effects of these compounds on ocular diseases. More are warranted.<\/p>\n Among natural compounds and extracts of great interest for glaucoma are curcumin, omega-3 fatty acids and Ginkgo biloba. Curcumin, a component of the commonly used spice, turmeric, is a potential neuroprotective candidate for glaucoma.Curcumin studies have increased greatly in recent years, with over 2000 papers published since 2000. Curcumin has shown possible beneficial effects in most of the mechanisms thought to be involved in the development and progression of glaucoma. A pilot study has shown that it slows disease progression. A clinical trial on patients with glaucoma is on the horizon.<\/p>\n Omega-3 fatty acids, found most notably in fish oil, play an important role in reducing oxidative damage in the retina, improving ocular blood flow and protecting against retinal ischemia (decrease in the blood supply) induced by increased IOP. While studies have not specifically addressed glaucoma, it has been suggested that fish oil may reduce IOP and be relevant to glaucoma because of its protective effect on the macula and its benefits for other eye problems.<\/p>\n Ginkgo biloba extract has been claimed effective in the treatment of a variety of disorders associated with aging. It appears to have many qualities applicable to the treatment of non-IOP-dependent risk factors for glaucomatous damage. It is believed to improve central and peripheral blood flow, reduce spasm of the blood vessels, and have protective effects against free radicals because of its antioxidant property. It has been shown to be effective in treating Raynaud’s disease, which is strongly associated with normal-tension glaucoma. These and other properties raise the possibility that this herb may be a potential antiglaucoma therapy.<\/p>\n How is an eye examination given to an infant or young child?<\/strong><\/p>\n If glaucoma is suspected in a child under the age of four, it is often necessary to perform an examination with the child under anesthesia. Under anesthesia, the doctor is best able to test the child’s intraocular pressure (tonometry) and evaluate the angles or dimensions of the eye (gonioscopy). Gonioscopy assists the doctor in determining whether the eye is functioning properly: producing, circulating, and draining the fluid or aqueous humor within the eye.<\/p>\n\t\t\tShould I allow my twelve year old participate in regular activities and sports, despite his glaucoma?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Your child’s participation level depends on his level of vision and the condition of his eyes. You should speak with your child’s ophthalmologist to determine what level of activity would be acceptable and what could be damaging. It is possible for a child to have a normal and active life if the glaucoma is under control and sight is good. If a child has had a corneal transplant, more caution is warranted and the child’s physical activity should not be strenuous or fast-paced.<\/p>\n\t\t\tIs there a surgery that can cure childhood glaucoma?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Congenital, or infantile, glaucoma can sometimes be “cured” through a goniotomy or trabeculotomy surgical procedure, although it may be necessary to have more than one operation. These procedures are invasive and intended to cut the trabecular meshwork (eye’s drain) in order to improve its drainage function. If these procedures are unsuccessful, it will become necessary to perform a trabeculectomy, a filtering surgery traditionally given to adults. If surgery is successful, it is sometimes considered a “cure” because the glaucoma may never become problematic or vision threatening, but it never really goes away. There is still a chance that conditions will surface years later, and that further treatment with medication and\/or surgery will be required.<\/p>\n Glaucoma Videos<\/p>\n\t\n
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