By MATTHEW K. ADAMS, MD, MBA
Imagine slowly losing your vision, bit by bit, so subtly you don’t notice until it’s too late. That’s the chilling reality of Glaucoma, one of the leading causes of irreversible blindness worldwide. The most unsettling part? It often gives no warning signs.
As an ophthalmologist, I’ve met countless patients who walk into my office saying, “I see 6. Why would I need an eye exam?” Only for me to discover they’ve been quietly losing vision for years. So, let’s shine some light on glaucoma: what it is, how we treat it, and how you can protect your vision.
What Is Glaucoma?
In the simplest terms, glaucoma is a disease that damages the optic nerve, the vital cable connecting your eye to your brain. Think of your optic nerve as a bundle of a million tiny electrical wires carrying visual information. When these wires are damaged, parts of your vision fade, usually beginning with your peripheral vision (the outer edges of your sight).
The main culprit behind this nerve damage is increased pressure inside the eye, called intraocular pressure. Normally, your eye produces and drains a fluid that aqueous humor to nourish its tissues. But if this fluid can’t drain properly because its natural pathways are blocked, pressure builds up. That pressure squeezes the optic nerve.
Types of Glaucoma
There are two broad categories:
• Open-angle glaucoma: The most common type, where the eye’s drainage system becomes clogged over time, causing gradual vision loss.
• Angle-closure glaucoma: A more sudden, severe form that happens when the drainage angle between the iris and cornea becomes blocked. This is an emergency and requires immediate treatment.
Regardless of the type, the end result is the same: optic nerve damage that can’t be reversed.
How You Treat Glaucoma
While we can’t cure glaucoma or restore lost vision, we can absolutely prevent it from getting worse. The cornerstone of glaucoma care is lowering eye pressure. We do this through:
• Medicated eye drops: These reduce how much fluid the eye makes or improve its drainage.
• Laser therapy: A quick, in-office procedure called trabeculoplasty improves fluid drainage and is often just as effective as eye drops.
• Minimally invasive glaucoma surgeries (MIGS): These are small implants or procedures that create new pathways for fluid to escape, lowering pressure more permanently.
Managing glaucoma is a marathon, not a sprint. Regular follow-up visits, pressure checks, and visual field & 1 testing are essential to track the disease’s progression. With modern treatments and patient diligence, most people with glaucoma retain useful vision for their entire life.
How Do I Know If I Have Glaucoma?
Unfortunately, you probably won’t. At least not until damage has already occurred. That’s why glaucoma is so dangerous—it’s often called the silent thief of sight.
Symptoms rarely appear early on. Most people aren’t diagnosed until they’ve already lost some vision. And once vision is gone, it cannot be restored.
That’s why comprehensive eye exams are so critical. A dilated exam allows your doctor to inspect the optic nerve for early signs of glaucoma, answer your questions, and catch any concerns long before they affect your daily life.
Your exam may include:
• Tonometry: Measures your eye pressure.
• Ophthalmoscopy: Lets your doctor look directly at your optic nerve for early changes.
• Visual Field Testing: Maps your peripheral vision.
• Optical Coherence Tomography: A high-tech scan that creates detailed images of the optic nerve.
Left untreated, glaucoma can, and would literally steal your sight.
Final Thoughts
Here’s the good news: With early diagnosis, most people with glaucoma can preserve their vision for life. But you must be proactive. If you’re over 40, have a family history of the disease, or are of African, Asian, or Hispanic descent, you may be at higher risk.
So, schedule that eye exam—even if your “I see 6” is still rock solid. The only thing worse than glaucoma is not learning you have it until its too late to put a fix in place.
