Glaucoma can be present without pain, blurriness

Q: My eye doctor prescribed an eyedrop for glaucoma a couple years ago, but they were expensive and I did not see or feel any better, so I stopped taking them. Recently, I went to the local health fair, they said my eye pressures were fine. I am confused about what to do.

A: Glaucoma is surely the most misunderstood eye disease we deal with for our patients. Fundamentally, we even define glaucoma differently now than 30 years ago. At that time, and still today for most of the public, glaucoma was considered a disease of too much pressure inside the eye(s). That can still be true. But much more commonly, we now know that glaucoma is a mismatch between the internal eye pressure and the blood pressure reaching the eye. This means that many people, like you, may have “normal” eye pressure numbers and yet may be incurring damage in the back of the eye(s).

We now define glaucoma as an “ischemic optic neuropathy,” meaning the optic nerve is starving for blood flow and oxygen. While the treatments have not changed much in 30 years — still eyedrops or surgeries to reduce eye pressures — the testing is now very different!

We still measure your eye pressure (and no need for that dreaded “air puff” anymore), but more importantly, diagnostics of the optic nerve are more important. Basically, if your optic nerves look odd to us when we examine the inside of your eyes, we can new assess how healthy it really is. We can scan the optic nerves to measure the thickness of nerve tissue, we can measure how well the optic nerve is functioning in several ways — so we can better decide if your optic nerves are odd-looking but healthy, versus beginning to incur damage that may eventually cause you to lose your sight.

Glaucoma is generally a totally painless disease, with no hurting or pain or discomfort at all. And it generally causes no change in your vision — no blur, no fuzziness — all looks just fine. While glaucoma can begin in childhood, and is much more serious then, most patients are diagnosed with glaucoma in their 50s and 60s. Family history is important, as is race, is determining how likely glaucoma is to occur and to progress.

Perhaps the biggest surprise to most patients is the fact that both sleep apnea and very low blood pressure both worsen glaucoma. Sleep apnea essentially means you stop breathing many times each night, which deprives your eyes of needed oxygen. If your blood pressure drops too low overnight, that also damages your optic nerves. We encourage all patients with glaucoma, or suspected beginnings, to take their blood pressure medications early in the day and not at night.

Finally, you may need a fresh and more comprehensive glaucoma evaluation. These new tests are totally painless and generally covered by your medical insurance (not vision plans), so schedule a full glaucoma exam soon. Glaucoma is not a fast process, but it can be relentless in silently stealing your eyesight over the years.

DR. THOMAS STOUT, OD, FAAO is an eye physician in private practice at Morgantown Eye Associates. Info: MorgantownEye.com.

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