Parkland eye specialist warns about a silent threat: glaucoma

Parkland eye specialist warns about a silent threat: glaucoma

March is National Save Your Vision Month

Ronald Hunt, 65, of Dallas loves to spend time at home cooking for family and friends. But after years of preparing home-cooked meals and hosting family gatherings, Hunt had difficulty reading favorite recipes.

“When I noticed my vision was deteriorating I thought it was because I was growing older. I was going through life thinking it was normal,” Hunt said.

About 10 years ago, Hunt visited Parkland Health & Hospital System for treatment of a hernia. It was then he learned something was seriously wrong with his vision. “Since I had a hernia and kidney issues, doctors checked me from top to bottom. They came back and told me I had glaucoma,” Hunt said.

Hunt is one of 3 million Americans living with the disease that is the second leading cause of blindness worldwide. Because of its asymptomatic nature, only about half the people affected know they have glaucoma, according to data from the Centers for Disease Control and Prevention.

“Glaucoma is a condition characterized by progressive damage to the optic nerve, which sends signals from the eyes to the brain,” said Niraj Nathan, MD, glaucoma specialist at Parkland and assistant professor of ophthalmology at UT Southwestern Medical Center. “Glaucoma can be associated with elevated eye pressure, but does not have to be. It typically, but not always, manifests as peripheral vision loss that can progress to central vision loss,” he said.

While there is no known cause for the most common type of glaucoma, studies have shown strong associations with aging, family history of glaucoma, and African American and Hispanic ethnicity. In addition, individuals with uncontrolled diabetes are at risk for developing glaucoma if the diabetic changes in their eye become severe enough. While Hunt does not have a history of diabetes, he is of African American descent and glaucoma runs in his family.

Dr. Nathan said the major challenge when diagnosing and caring for glaucoma is that many patients have no symptoms.

“The vast majority of glaucoma, especially in the mild to moderate stages, tends to be completely asymptomatic, even though it has been potentially going on for several years or even decades,” he said.

That was the case with Hunt. “I had no headaches and no pain. I really just couldn’t see as well as I used to,” he said.

When glaucoma is detected, appropriate care and management can slow progression of the disease and save remaining vision, Dr. Nathan said. “The unfortunate reality is that even with treatment, glaucoma is typically not reversible and any existing vision loss from glaucoma cannot be significantly restored. Treatment is aimed toward slowing or halting progression. Essentially, treatment is to prevent any damage that’s there from getting worse,” he said.

Glaucoma can be treated with eye drops, pills, laser or traditional surgery or a combination of these methods. Hunt’s condition was treated with a combination of eye drops and traditional drainage implant surgery. During this procedure small prosthetic devices (tubes) are placed in the eye to help lower pressure and prevent further optic nerve damage.

As far as lifestyle interventions, nothing has reliably proven to reduce glaucoma risks, Dr. Nathan added. “The main tools for prevention are regular vision exams and screenings.”

A typical glaucoma exam consists of a vision test, measurement of eye pressure, a visual field test of peripheral vision and an exam of the optic nerve, which requires pupils to be dilated.

The American Academy of Ophthalmology recommends a baseline eye exam including dilation for everyone at the age of 40, but even younger if there is a family history of eye disease. If there is anything that needs monitoring, the follow-up should be dictated by the provider. If all is healthy, exams every 2-4 years are recommended. For those over 65 years old, exams should be every 1-2 years. Patients with diabetes should get a yearly dilated eye exam.

Although he wore glasses most of his life, Hunt said eye exams were never a top priority for him. “I’d go to the eye doctor every three or four years. I knew there were problems, but I kept delaying. For my left eye, it was too little too late. I’m working really hard to keep my right eye, otherwise I’ll have to walk around blind. I don’t like going to doctor’s appointments and I don’t accept help very often. This time I have and I’m grateful,” Hunt said.

March is National Save Your Vision Month and Dr. Nathan said it’s a great time to urge patients to take care of their vision before it’s too late. “A lot of vision loss from glaucoma is preventable and we have the resources at Parkland to help,” Dr. Nathan said.

Hunt had a procedure on his right eye recently. When the eye patch was removed on his birthday, he was able to see. “That was the best gift. I couldn’t wait to go home and cook some pork chops,” he laughed.

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