Experts Shed Light on Glaucoma
Picture this. At the back of our eyes, there are millions of retinal nerve fibers bundled together – called the optic nerve – that carry impulses from the retina in the eye to the brain. These impulses are then interpreted by the brain as images. Now, imagine what will happen if these optic nerves were damaged: no more impulses, no more images. And depending on the optic nerve damage, your vision may be lost forever.
Glaucoma, dubbed as the “silent thief of sight,” is one of the eye diseases that can cause damage to the optic nerve. It is considered one of the most serious among eye diseases as it can impair your vision gradually and stealthily that you may not notice anything amiss until it’s too late, and the disease is at an advanced stage.
March 12th to 17th was World Glaucoma Week. And just like the disease itself, the event happened silently. Most people didn’t even know there was such a thing as Glaucoma Week, or that there is an eye disease called Glaucoma, for that matter. For something that is ranked the second leading cause of blindness in the world by the World Health Organization, awareness of glaucoma is relatively low.
In support of the World Glaucoma Week, Ezyhealth & Beauty has partnered with LF Asia Pharmaceutical – one of the leading distributors of healthcare products in Singapore – to bring together not two, but four eye experts to shed light on this serious, incurable eye disease.
A Glimpse on Glaucoma
Dr Richard FT Fan
Consultant, Ophthalmic Surgeon
Mt Elizabeth Medical Centre
Ezyhealth & Beauty (EHB): What is Glaucoma?
Dr Fan: Glaucoma is a relatively common eye disease that causes damage to the optic nerve as a result of an abnormally high pressure of the eye. This will lead to the loss of peripheral vision and, over time, progress to severe blindness.
There are two kinds of glaucoma: open angle glaucoma and acute or close angle glaucoma. Open angle glaucoma is painless, but it is more dangerous because people usually don’t know they have it as it has no symptoms until at a
late stage of the disease. Acute or close angle glaucoma, on the other hand, is painful and immediate. The patient feels severe pain in the affected eye; they consult a doctor who refers him to a specialist. The ophthalmologist will treat the patient on an urgent basis to lower the IOP to prevent severe optic nerve damage.
EHB: How common is glaucoma in Singapore?
Dr Fan: Glaucoma is a leading cause of irreversible blindness and often undiagnosed in nine out of 10 affected people until severe impairment of vision occurs.
Acute angle closure glaucoma is more common in Asians than in Caucasians. Open angle glaucoma is common in Caucasians.
EHB: Is it true that women have a higher risk of developing glaucoma than men? Why?
Dr Fan: Older women have a higher risk of developing acute angle closure glaucoma than older men because of the shape of a woman’s eye. The anterior chamber which is in front of the iris is shallower in women and therefore the risk of blocking aqueous fluid from draining out of the eye is higher, thus causing pressure to build up. This is acute congestive angle closure glaucoma and presents with ocular pain, headache, inflammation and redness of the eye and severe and rapid loss of vision. This is an ocular emergency and requires immediate attention and treatment.
I have patients with elevated intraocular pressure (IOP) in both eyes and were started with tafluprost. A review a month later showed significant and desirable reduction in IOP in both eyes, indicating the efficacy of tafluprost as a glaucoma drug.
– Dr Richard Fan, Mt Elizabeth
Treatments and Medication
Dr Hoh Sek Tien
Specialist in Ophthalmology
Ophthalmic Consultants Pte Ltd
Gleneagles Medical Centre
EHB: What are the symptoms of glaucoma and when should we seek medical attention for it?
Dr Hoh: Glaucoma can either present acutely or chronically. In acute glaucoma, the patient may present with headache, eye pain, blurring of vision, and sometimes nausea and vomiting. For chronic glaucoma, there may not be early symptoms. In the beginning, central vision remains normal. The patient loses peripheral vision in the early stages while central vision remains normal. This loss gradually encroaches onto the central vision. That’s when the patient starts to experience vision loss.
Unlike acute glaucoma where the symptoms are characteristic, in chronic glaucoma, by the time the patient realizes that he has vision loss, the disease is usually in its advanced stages. Early tell-tale signs are lacking. What one can do is go for periodic eye check. This is especially important for those patients with a family history of glaucoma.
EHB: How often should they go for a check-up?
Dr Hoh: It depends on the age. If the patients are 40 years old and above, they should see a doctor every two to four years. At 60 years old, they should visit every one to two years. And by the time they are 65, they should go every year. These are only general recommendations. Of course, if there are other risk factors such as positive family history, previous trauma to the eye, taking medications such as steroids, diabetes, or hypertension, the timing and frequency may vary. For younger patients, less than 40 years of age, the general recommendation is have an eye examination if there are symptoms, e.g. pain, blurring of vision, flashes and floaters or eye injury. The message is regular eye exam.
EHB: Can glaucoma be cured or treated?
Dr Hoh: Glaucoma can certainly be treated. But curing glaucoma totally is not possible because whatever damage it has done is irreversible. Treatment is aimed at either preserving whatever vision the patient has left, or slowing down the damage. Medical treatments include eye drops, while surgical treatment is done by either laser or surgery.
EHB: What are the latest treatments available for glaucoma, and what sets these new treatments apart from the older ones?
Dr Hoh: There are constant improvements to the various forms of treatments. These improvements make the treatment either more effective or safer. In surgery, for example, the latest treatments are geared towards improving the safety profile of the surgery. For diagnosis, there are newer imaging techniques to detect the progression of glaucoma. Detecting progression or worsening of the disease is important because it will help the surgeon decide when to intervene.
For eye drops, traditionally, beta blockers have been the main drug for treatment. However, over the last few years, prostaglandin analogues have become first line treatment, especially for open angle glaucoma. There have been several types of prostaglandin analogues which have been available, such as latanoprost, travoprost and bimatoprost. The newest treatment in this category is tafluprost. These are all prostaglandin analogues that are given at convenient once-a-day doses. This group of medication has been shown to be effective in lowering eye pressure. It has become one of the first line therapies for glaucoma, particularly, open angle glaucoma.
Managing Dry Eye in Glaucoma
Dr Au Eong Kah Guan
Medical Director and
Eye Cataract Retina Centre
Singapore International Eye Cataract Retina Centre
EHB: Why is dry eye syndrome among the key concerns for glaucoma patients?
Dr Au Eong: Dry eye syndrome affects millions of people worldwide. It is also one of the most common ocular surface diseases in glaucoma patients. Although glaucoma is not the main cause of dry eye, studies have shown that about 59% of patients with open-angle glaucoma and ocular hypertension reported symptoms of dry eye in at least one eye.
While glaucoma medications are prescribed to prevent vision loss, the preservatives in some of these eye drops can unfortunately give rise to dry eye symptoms such as foreign body sensation, tearing, redness and fluctuation of vision. Conversely, irregular tear films in dry eye patients may also make glaucoma medications more irritating to the eyes.
Dry eye is therefore becoming a key concern among eye doctors who prescribe glaucoma medications because apart from selecting the best regimen that will effectively reduce
eye pressure, eye doctors now have to ensure that the medication-associated onset or aggravation of dry eye symptoms can be avoided to reduce patient non-compliance with glaucoma treatment. As treatment for glaucoma is generally lifelong, patient’s compliance plays a major role in achieving the maximum benefits that can be provided by the prescribed medications.
EHB: Any tips to manage dry eye in glaucoma?
Dr Au Eong: In managing dry eye in glaucoma patients, the first line management option may simply be switching patients to either preservative-free glaucoma medications or to medications that contain a different preservative. Combination eye drops that pair medications from different classes expose patients to a lower preservative load, hence reducing the risk of developing dry eye symptoms.
Some eye doctors advise their patients to instill preservative-free artificial tears five minutes after using glaucoma medications to help restore a smooth layer of tear film and wash away any residual preservative that may remain on the surface of the eye. In this case, artificial tears that contain hyaluronic acid may be a good option as it enhances the healing process of corneal erosions that may occur when one is exposed to certain types of preservatives in the eye drops.
EHB: Can dry eye that develops when using glaucoma medications be treated and what treatment will you recommend?
Ms Fifiana: While continuing the use of glaucoma medications, mild dry eye symptoms that develop can be treated with preservative-free artificial tears for temporary relief of the symptoms. Gels or ointments may be used for overnight lubrication of the eyes and nutritional supplements such as omega-3 fatty acids may also be used to optimise the health of the surface of the eyes. Co-existing eyelid diseases such as blepharitis should be addressed and treated with warm compress and eyelid scrub to improve eyelid hygiene as this condition may contribute to tear film instability, hence giving rise to dry eye symptoms.
In severe cases, patients may be referred back to their eye doctors for possible modification to their glaucoma medications or for topical cyclosporine treatment to improve their tear production.
EHB: Can glaucoma be prevented with certain changes to our diet or lifestyle?
Ms Fifiana: The risk factors of glaucoma include older age, family history, high myopia (short-sightedness), diabetes, hypertension and use of steroids. Although there is no scientific evidence to suggest that a healthy diet and lifestyle may directly prevent glaucoma or slow down its progression, there is no doubt that certain changes in diet and lifestyle improve one’s general health and reduce the risk of developing systemic illnesses such as diabetes and hypertension. This may in turn lowers one’s risk of developing glaucoma.
This article was sponsored by LF Asia Pharmaceutical in support of International Glaucoma Week.
By Maripet L. Poso