Do you remember the song "On A Clear Day You Can See Forever"? No matter the weather, your eyesight is the most precious of your five senses.
When was the last time you had your eyes checked for glaucoma?
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The American Glaucoma Society recommends yearly comprehensive eye exams for everyone older than 40. Glaucoma is a generally irreversible eye disease that injures the optic nerve and retinal ganglion cells that bring vision from the eyes to the brain.
More than one million Americans are diagnosed as having glaucoma, and another million are unaware they have the condition. It is estimated that nearly 120,000 U.S. citizens are legally blind in both eyes resulting from glaucoma, and about 1.5 million Americans have some loss of peripheral vision from glaucoma.
According to the AGS, glaucoma is the second leading cause of blindness in the United States and around the world.
Rarely, infants and children are susceptible to glaucoma. Childhood glaucoma, also referred to as congenital glaucoma, pediatric glaucoma or infantile glaucoma, occurs in babies and young children and is usually diagnosed by age one.
The Glaucoma Research Foundation advises parents to watch for these indicators in their children: unusually large eyes, cloudy eyes, excessive tearing, and light sensitivity.
As we age, we are at increased risk for developing glaucoma. People that have relatives with glaucoma are also at increased risk of developing the disease, but the genetic mechanism for inheriting glaucoma is poorly understood.
Other risk factors include diabetes, Latin and African-American heritage, hypertension (high blood pressure), and myopia. There are over 40 different types of glaucoma, but the most common is Open Angle Glaucoma.
The eye continuously manufactures fluid that drains out of the eye through a drainage meshwork and channel. The eye has pressure like an automobile tire has pressure. Glaucoma causes the pressure in the eyes to be elevated.
An eye physician detects the elevated eye pressure of open angle glaucoma at an early stage before the optic nerve is injured and then treats the condition to preserve the patient's vision.
Dr. Stuart Sondheimer, M.D., is an ophthalmologist and eye surgeon with offices in Deerfield, Park Ridge and Skokie. He has been treating patients for glaucoma and other eye-related illnesses for more than 30 years.
Irene Yarigin of Lincolnshire began seeing Sondheimer for symptoms of glaucoma two years ago. After an examination, the doctor prescribed Lumigan to help increase the flow of fluid from Yarigin's eyes, resulting in a reduction of eye pressure.
"The condition has stabilized and I am now seeing much better," said Yarigin.
In the United States, most patients with glaucoma enjoy excellent vision for their entire lives, but some have severe vision loss and blindness.
The eye physician can detect loss of vision, elevated eye pressure, and injury to the optic nerve and retina upon examination.
"A visual field test tells me if a patient is losing or is at risk of losing the ability to see clearly. If the test is positive, the patient's eye pressure must be lowered,' said Sondheimer.
"There are other conditions that mimic glaucoma such as brain tumors, interrupted blood flow to the eye or brain, and congenital abnormalities that must be ruled out," he added. "The Ocular Coherence Tomography test detects injury to the retina and optic nerve at an earlier stage than when the visual field test becomes abnormal."
Using eye drops that either reduce the production of fluid in the eye or increase the flow of fluid out of the eye will effectively treat most patients with open angle glaucoma.
However, if the patient doesn't take the eye drops as recommended, or if the medications don't work well, continued elevated eye pressure and damage to the optic nerve and retina may require laser or conventional surgery to lower the eye pressure, increase the flow of fluid from the eyes and stop the progression of glaucoma and vision loss.
Sondheimer notes that patients must be monitored carefully to make sure that the treatments are working.
Riverwoods resident and photographer Michael Dunn is one such example. After being successfully treated for Iritis, Sondheimer discovered that Dunn had the early symptoms of glaucoma. He prescribed Latanoprost, a medication in eye drops form used to reduce eye pressure by increasing the amount of fluid that drains from the eye.
Dunn uses the eye drops daily and sees the doctor every three months to closely monitor his condition.
Latanoprost and Lumigan (prostaglandins) are well-tolerated medications with minor, if any, side effects. The side effects may include itching and redness of the eyes, and pigmentation of the pupils.
Carter Black, a registered pharmacist and consultant with Keefer's Pharmacy in Mount Prospect and Petranek's Pharmacy in Libertyville, notes that prostaglandins are more effective and better tolerated than beta blockers which were more widely used years ago.
Latanoprost is a popular medication that is available as a lower cost generic. The only drawback is the tiny bottle size (2.5 ml) may be difficult to handle for some patients.
Unfortunately, Lumigan is not yet available as a generic so it is more expensive.
"When patients pick up their prescription, the pharmacist should instruct them on how to properly apply the eye drops. The pharmacist helps to make the medicine more effective," Black said.
Narrow Angle Glaucoma occurs when fluid in the eye is blocked from reaching the drainage meshwork. This is more common in farsighted eyes than in nearsighted eyes.
The lens grows thicker with age and eventually fluid can't easily escape the eye. Some patients have acute attacks where the vision drops, the eye becomes red and inflamed, and the pressure in the eye increases.
In most cases of narrow angle glaucoma, the attack of high pressure can be relieved with medications, and surgeries are rarely required to break the acute attacks.
What about future glaucoma preventatives?
A recent study of more than 500,000 older adults with high cholesterol levels indicated that those who were taking cholesterol-lowering statin drugs for a two-year period were 8 percent less likely to develop open-angle glaucoma.
Further research will determine if statin drugs could potentially be used to help treat glaucoma.
• Dr. Stuart Sondheimer, MD is an ophthalmologist and eye surgeon with offices in Park Ridge, Deerfield and Skokie. The advice contained in this article is for informational purposes only. Readers should consult with a physician to evaluate any illness or medical condition. For more, visit www.drsondheimer.com.