Primary Open Angle Glaucoma

Glaucoma is is one of the leading causes of irreversable blindness in America
and effects one in every hundred people.  It is a disease where the optic nerve
is damaged which results in loss of vision.  If untreated, it often leads to
blindness, but in the majority of cases, treatment can be effective in stopping
the progression of vision loss.

Unfortunately, in most cases, we cannot restore vision that has been lost, but
we are relatively effective with both medical and surgical techniques in
preventing further visual loss.

Glaucoma occurs in all races of people.  However it is much more common in
African Americans than in whites.   Primary open angle glaucoma is unusual in
people under 40 years of age but the risk increases with increasing years.  At
40 - 50 years the risk is about one in one hundred increasing to about one in
ten by age 80.  It is also more common in diabetics, hypertensives, the near
sighted and those who have had trauma to their eyes (often forgotten because
the trauma may have occurred many years before onset).  A family history of
glaucoma increases the risk fourfold.

The eye is a closed system where a nutritional fluid (known as aquous humor)
is made by the eye.  There is also a drain, called the trabecular meshwork
which allows the fluid to exit.  In glaucoma, as one gets older or due to some
other causes, the drain of the eye does not work as it should, the fluid backs
up and the pressure in the eye rises.  If one considers the eye to be like a ball,
as the pressure rises, increased pressure is placed on the wall of the eye. 
There is only one weak spot in the wall where the optic nerve is located.  The
optic nerve is like a bundle of wires originating in the retina going to the brain. 
In order to exit the eye, there has to be a weak spot in the wall and this is the
sight of damage due to increased eye pressure from glaucoma.  As in a ball
with a weak spot, it bulges.   When this bulge occurs, there is a kinking of
these "wires" that compress the optic nerve.  This causes them to be damaged. 
For both good and bad, the damage tends to affect your peripheral vision first. 
This damage usually does not occur very rapidly, and often it is not noticed by
the patient.  That is the reason we need to do specific tests to see if any
damage has occurred to the peripheral vision.  If the pressure remains
elevated, continued damage will occur until finally the center of vision (which
contains the ability to read) is finally affected.  The eye pressure at which this
damage occurs is different in all people, but in general the more damage that
has occurred, like a snowball rolling down a hill, the easier it is for more
damage to occur and lower pressures are necessary.  If untreated, glaucoma
does lead to blindness.

If you have any questions please call Dr Feldman at 212 439-6882.