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Glaucoma is an eye disease that takes many forms. In fact, there are at least 50 different types of glaucoma. In general, glaucoma has a number of associated characteristics. The one main characteristic is damage to the optic nerve. When light hits the retina it is the optic nerve that transmits the signal to the visual part of the brain. The optic nerve is like a very complicated bundle cable containing approximately 1.2 million connections in each eye. Glaucoma causes damage to this nerve by reducing the number of connections to the brain. In early stages of glaucoma a person may lose as many as 50% of these connections before they are aware of any vision loss and even then they may only feel like they are having a minimal problem. But much damage has been done at that point and additional loss or nerve connections will be increasingly noticeable. Well before all connections are lost very sever and profound vision loss may be experienced. Due to the intricate design of the optic nerve, as nerve connections are lost, it is typically peripheral vision that is lost first. Then with progression of the disease vision loss occurring closer to central vision is experienced. In the end stage of glaucoma total loss of vision wherein no light is perceived in one or both eyes is experienced. Any vision loss is permanent and the damage is not reversible.
Glaucoma treatment is almost entirely treated with reducing the pressure in the eye. The eye must have some pressure to keep it inflated and all of the internal parts at the proper distances from each other. But too much pressure causes damage to the nerve. By reducing the pressure in the eye it increases the blood flow into and within the optic nerve. The pressure may be reduced by one or a combination of medications such as drops, oral medication or surgical interventions such as laser or others. Typically, in most cases, once medication treatment is started it is a lifelong process.
Typically in mild to mild-moderate conditions of glaucoma standard glasses with an updated prescription may be all that is needed. In cases of vision loss that causes decreased ability to see it is visual acuity decrease or decreased contrast sensitivity or both that are impaired. In these cases hand held magnifiers work well. If you want a hands-free option higher powered eye glasses or even high powered telescopic eyeglasses may help. Some people may have almost normal ability to see the chart in the eye doctor’s office but experience difficulty seeing things in their work or home. This is sometimes experienced due to low contrast sensitivity. Contrast sensitivity is often decreased with glaucoma. Contrast sensitivity is a measure of how much contrast the eye (visual system) requires in order to perceive what is being looked at. For example black print on white background is high contrast. Gray print on a blue background is very low contrast. By increasing ambient lighting or magnification difficulties in seeing due to low contrast sensitivity may be overcome.
Here at the Low Vision and Binocular Vision Clinic the doctor will be working with (not in place of) your doctor treating the glaucoma. Our low vision doctor will not be dealing with the glaucoma but will be determining what vision you have and what can be done to make it better. This is done in an exam that takes an hour to an hour and a half but by the end of the exam you will know exactly what can be done for you to see better. In most cases the doctor can make your vision two to three times better than it is.
In more severe cases we will prescribe vision rehabilitation in the office or in the home to help with your activities of daily living. This is done with an occupational therapist that is trained in vision rehabilitation. This occupational therapist (OT) can come to your home to help with improving lighting, check for potential causes of falls, mark things such as thermostats, oven dials etc. to make it easier for you to see them. In the end what we want is to keep you as independent and safe as possible. In most cases OT, when prescribed, will be a covered benefit by your medical insurance.
For more information on how we can help manage your Glaucoma, call us at 727-463-2579 !