Glaucoma Awareness Month Shines Light on Eye Condition Known as the Silent Thief

Experts from Duke Eye Center, NYU Langone Health, and the Kellogg Eye Center at University of Michigan Health spoke with The American Journal of Managed Care^® about how patients can identify their glaucoma, what treatment methods are available to use, and what the future of glaucoma looks like as part of AJMC’s coverage of Glaucoma Awareness Month, which concludes on January 31.

This transcript has been lightly edited for clarity; captions are auto-generated.

Transcript

Jullia Rosdahl, MD, PhD: Glaucoma is a disease of the optic nerve. The optic nerve is the cable that connects the eye to the brain, and glaucoma is when the head of that optic nerve that we can see when we look through the pupil into the eye, when that center part of the head of the optic nerve gets kind of scooped out or has a cupped appearance. That happens when nerve tissue dies off. Glaucoma is a disease where that nerve tissue is dying off slowly. One of the sneaky things about glaucoma is that it is often slow and silent early on, and so the most common type of glaucoma is called open-angle glaucoma, and people often don't have any signs or symptoms early on. It's just when we look inside the eye and see that cupping of the nerve developing that we know that there's glaucoma. Early screening, getting eye exams on a regular basis, is really important for finding it.

Signs and symptoms later on, if the glaucoma is progressing, that might include more difficulty with contrast, losses of your peripheral vision, maybe even noticing some blind spots. But that is rather uncommon, especially early in the disease. Then there's another type of glaucoma that's called angle-closure glaucoma, and that glaucoma does have some really important signs and symptoms. That glaucoma, unlike open-angle glaucoma, which comes on slow, angle-closure glaucoma can come on really fast, and pressure can go up very quickly in the eye in a matter of hours to days. People will have eye pain, headache, often have some nausea, and that's an emergency. Patients need to get in right away to get that diagnosed and treated to prevent irreversible vision loss.

Ariana Levin, MD: We now have a huge range of treatments for glaucoma. Innovation in glaucoma has been huge in the past 5 years, 10 years, and 20 years; how we treat glaucoma now looks very different from how we treated glaucoma and what we even understood about it 20 years ago. We have eye drops, and many patients with glaucoma will be on eye drops, but we have a lot more procedures and interventional options now than we did before. These range from small, quick, low-risk lasers to a group of surgeries that we call minimally invasive glaucoma surgery, which tend to be shorter, lower-risk options. Then we have larger surgeries as well that maybe take a longer time to heal from but which become necessary in some stages of the disease. And we often start small and go bigger. I explain to patients, we may start with something small, short, low-risk, but if the glaucoma is uncontrolled, and that may be sooner or maybe 10 years down the line, we'll have larger options to move on to should we need them.

Manjool Shah, MD: The sort of journey right now, if we look at today and tomorrow basically, is continued innovation and advancement in these micro-invasive technologies, as well as pharmaceutical innovation. We have new mechanisms of action of some of our medications, and we're hoping to have new mechanisms of delivering these medications. There [are] a number of companies, there are a number of devices and molecules in the pipeline, as well as new technologies for these micro-invasive surgical solutions. The holy grail for glaucoma is some way to actually regenerate and protect the optic nerve. Right now, the best we can do is stop glaucoma from getting worse, but we can't make it better, right? And this is why it's so important to be screened if you're in the right category of folks who need to be screened, and adhere to a physician's recommendation in terms of how to go forward. But, yeah, the holy grail would be to stop glaucoma despite pressure and then eventually try to regenerate the damaged optic nerve. And there's a ton of energy in that space. Hopefully, in our lifetimes, we'll have the ability to undo the glaucoma damage that's occurred.