Open-angle glaucoma is an eye condition which can lead to blindness
There are no symptoms during the early stages of this condition. You should get checked for glaucoma at around age 35 and again at age 40
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Open-angle glaucoma affects your freedom and daily tasks
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It is estimated that three million Americans have glaucoma, and half of them do not know it.
Glaucoma is a leading cause of irreversible blindness. 90% of glaucoma patients have open-angle glaucoma.
Symptoms of open-angle glaucoma
- In the early stages, there are no symptoms. There is no pain or outward sign of trouble.
- Mild aching in the eyes
- Gradual loss of peripheral vision (the top, sides and bottom areas of vision)
- Seeing halos around lights
- Reduced visual acuity (especially at night, that is not correctable with glasses)
- Tunnel vision with severe damage to the optic nerve
- Loss of vision
Who is at risk 
Glaucoma can occur in people of all races at any age. However, the likelihood of developing glaucoma increases if you:
- Are African American
- Have a relative with glaucoma
- Are diabetic
- Are very nearsighted
- Are over 35 years of age
The eye receives its nourishment from a clear fluid that circulates inside the eye. This fluid must be continuously returned to the bloodstream through the eye’s drainage canal, called the trabecular meshwork.
In the case of open-angle glaucoma, something has gone wrong with the drainage canal. When the fluid cannot drain fast enough, the pressure inside the eye begins to build. This excess fluid pressure pushes against the delicate optic nerve that connects the eye to the brain. If the pressure remains too high for too long, the nerve is damaged, and irreversible vision loss can occur.
Everyone should be checked for glaucoma at around age 35 and again at age 40. Those considered to be at higher risk, including those over the age of 60 should have their eye pressure checked every year or two.
Your doctor will use tonometry to check your eye pressure. After applying numbing drops, the doctor will gently press the tonometer against the eye to measure and record its resistance.
The doctor can use an ophthalmoscope to examine the shape and color of your optic nerve. The ophthalmoscope magnifies and lights up the inside of the eye. If the optic nerve appears to be cupped or is not a healthy pink color, the doctor will run additional tests.
Perimetry is a test that maps the field of vision to help diagnose and monitor glaucomatous vision loss. Looking straight ahead into a white, bowl-shaped area, you’ll indicate when you’re able to detect lights as they are brought into your field of vision.This map allows your doctor to see any pattern of visual changes caused by the early stages of glaucoma. We can map your visual fields yearly or more frequently if needed.
We can perform a gonioscopy exam to check whether the angle where the iris meets the cornea is open or closed. This helps your doctor determine if they are dealing with open-angle glaucoma or narrow-angle glaucoma.
We will take photographs of the optic nerve at periodic intervals to assess for enlargement of the inside of the optic nerve, which can indicate worsening.
While glaucoma cannot be cured, we can usually control it by decreasing the pressure within the eye with drops, lasers, or surgery. With early treatment, glaucomatous vision loss may be minimized or stopped.
To control glaucoma, your doctor will use one of three basic types of treatment: medicines, laser surgery, or filtration surgery. The goal of treatment is to lower the pressure in the eye.
Medicines come in pill and eye drop form. They work by either slowing the production of fluid within the eye or by improving the flow through the drainage meshwork. Most glaucoma medications must be taken between one to three times every day, without fail to be effective. Most of the eye drops are well tolerated and have minimal side effects. The doctor will choose the drop or drops that will be most effective. You should never stop taking these medicines without consulting your doctor, and you should notify all of your other doctors about the medications you are taking.
Argon Laser Trabeculoplasty and Selective Laser Trabeculoplasty surgery treat the drainage canal. Once we’ve numbed you eye with numbing eye drops, we apply the laser beam to the trabecular meshwork resulting in an improved rate of drainage. When laser surgery is successful, it may reduce or eliminate the need for daily medications.
Endoscopic CycloPhotocoagulation (ECP) is another type of laser procedure. Instead of treating the drainage canal, it treats the ciliary body. Treating the ciliary body reduces the amount of fluid production, thereby reducing the intraocular pressure.
ECP is most often performed along with cataract surgery but can be done on an outpatient basis when in the best interest of the patient. The majority of patients having ECP reduce or eliminate their need to take glaucoma medications.
Minimally invasive glaucoma surgery (MIGS) is a newer class of surgical procedure that all involve using microscopic-sized equipment and incisions to reduce some of the complications and healing time of traditional glaucoma procedures.
We perform filtration surgery when medicines and/or laser surgery are unsuccessful in controlling eye pressure. During this microscopic procedure, we create a new drainage channel to allow fluid to drain from the eye.
How long do I need to continue to take drops?
Most patients will need to continue drops forever to prevent vision loss
Will I go blind from glaucoma?
If you are diagnosed early and receive proper treatment, we can prevent blindness in the vast majority of patients
What is normal pressure of the eye, and is it related to my blood pressure?
Normal pressure inside the eye ranges from 12 – 21 mmHg and is independent of your blood pressure. While glaucoma is usually associated with elevated eye pressure, some patients with normal pressures may still develop glaucoma, especially if they have thin corneas
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Dr. Bennett Chotiner is the founder and medical director of Memorial Eye Institute. A noted innovator, in 1977 he established his clinical practice, the Pennsylvania Eye Associates. In 1984, he established the Pennsylvania Eye Surgery Center, Pennsylvania’s first …
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GENERAL OPHTHALMOLOGY, CATARACT & REFRACTIVE SURGERY, LASIK SURGERY
Erik Chotiner, M.D. diagnoses and treats a wide range of medical eye conditions. He is a Phi Beta Kappa graduate of Franklin and Marshall College. Dr. Chotiner attended Jefferson Medical College in Philadelphia where he received multiple awards including the Physiology Prize for …
