Yorkshire Eye Hospital

Glaucoma

Glaucoma is a condition that leads to the progressive loss of nerve fibres in the optic nerve. If left untreated this can lead to loss of peripheral vision.

What is glaucoma?

Glaucoma is a condition that leads to the progressive loss of nerve fibres in the optic nerve.

If left untreated, this can lead to loss of peripheral vision (i.e. what can be seen at the sides of the visual field, rather than in the centre). If glaucoma progresses, it can affect all peripheral vision, then impair central vision, and, very rarely, may lead to very significant central visual impairment.

Treatments for glaucoma are aimed at bringing down the pressure in the eye to a level that is low enough to prevent harm to the optic nerve. Once the optic nerve is affected by glaucoma, lowering the pressure in the eye prevents further damage to the nerve. Damage already done to the optic nerve cannot be reversed.

Visual field loss when plotted out is represented as dark spots on a visual field test. In reality, even though peripheral vision may be substantially lost in some areas, this may not be perceived as lost vision - because the brain is very clever at 'filling in the gaps'. This means that smaller areas of blank spots (or "scotoma") will not be noticed. Clearly it is important to be aware of this, particularly when driving a car.

Acute Angle Closure

Acute angle  closure  is the sudden onset of severe eye pain  due to very high eye pressure. This is caused by a blockage in the normal fluid circulation in the front of the eye. It affects  about one in a thousand people but is most prevalent in the over 70s. It is more common in people who  are long-sighted because they have smaller eyes and are more likely to get  the blockage. Hospital treatment may be required with eye drops and  laser treatment to make a tiny hole in the iris of the eye to bypass the  blockage.

Glaucoma Surgery

Glaucoma surgery  is usually performed in people with chronic glaucoma that continues to get  worse despite treatment with eye drops. The operation takes about 40 mins  under local anaesthetic and patients do not need to stay in hospital. A  chronic leak from the front chamber of the eye is created so fluid can pass  under the coverings of the eye back into the eye socket. This produces a  little raised blister on the surface of the eye under the upper lid. Sometimes the leak seals up due to the normal healing process but if not, it can be  reopened easily or the operation can be repeated.

Laser Treatment

Lasers are used for a wide variety of glaucoma problems. In angle closure where there is a block in the normal circulation of fluid in the front chamber of the eye a laser is used to make a tiny relieving hole in the iris of the eye. In chronic open angle glaucoma a different type of laser is used in multiple tiny spots to increase the drainage through the normal filter in the angle of the eye between the iris and cornea. In more unusual or difficult forms of glaucoma yet another type of laser is used to treat the ciliary body, which makes the fluid for the front part of the eye, to lower the production and thus reduce the pressure in the eye.