One patient’s story of living with glaucoma eye disease
John spends a great deal of his time in his woodworking shop. He took up the craft after he and his wife, Anna, retired in 2019. He was enjoying carving chess pieces and ornamental birds — but he wanted to create something with more purpose.
He discussed it with Anna, and together, they decided they would start making wooden toys to give away to less fortunate children. That first Fall of 2019, they created and donated 80 handmade toys to the local toy drive group who distribute the unique gifts to needy children around Tampa Bay, Florida.
After volunteering at one of the group’s distribution locations, John and Anna were so moved by the excited squeals of children receiving their unique wooden racecars and dolls, and the tears of gratitude from thankful parents, the two retirees committed to producing and distributing toys year-round. The busy couple are now churning out 200+ creations each year to be donated to local children’s charities, school districts and homeless shelters.
This rewarding post-retirement lifestyle was threatened in the busy toy-making Fall of 2020, when John was diagnosed with glaucoma.
Anna had remarked to John that his eyes looked red and tired. John added that his vision had not been “quite right” the past few months. He’d been seeing strange rainbow halos around the shop lights and had an off-and-on dull headache for a few weeks.
After his vision almost caused a potentially dangerous mishap in the woodshop, John had to put his rewarding hobby on hold. He called and had his regular 2-year eye exam appointment moved up from January. It didn’t take long for his ophthalmologist, Craig Berger, MD, a Tampa, Florida eye doctor and surgeon, to suspect glaucoma. Dr. Berger’s practice, Bay Area Eye Institute, provides full-service ophthalmology and optometry, so John was immediately referred to the practice’s board-certified ophthalmologist and glaucoma specialist, Lisa Gamell, MD.
Dr. Gamell’s staff asked several detailed questions, including family history, and performed several eye tests on John. Using special lenses, Dr. Gamell examined his eyes through a slit lamp, a microscope for the eyes.
After studying the findings of the various tests and looking at John’s optic nerves, Dr. Gamell determined that John has open-angle glaucoma – a serious but manageable eye condition. Dr. Gamell prescribed medicated eyedrops to alleviate eye pressure that had been discovered in John’s eyes. She explained that there are many types of eyedrop medications that can be used for his condition but this type of drop would be the best one for his particular case. John learned that glaucoma is a lifelong condition and that he may need to use daily eyedrops forever. Dr. Gamell would know more after seeing how John’s eyes respond to the eyedrops.
In this post, we’ll take a look at what John has experienced and learned about his glaucoma in the almost two years since his diagnosis. We’ll also dive into what “could have been” and how John and his doctors avoided possible permanent vision loss by being proactive about his eye disease.
The good news is that glaucoma is treatable—but only if you catch it early enough to prevent blindness. So how can you tell if you have glaucoma? And what are some treatments for this condition? Let’s take a look at the basics!
What is Glaucoma?
Glaucoma is a group of diseases that damage the eye’s optic nerve and can lead to vision loss. It’s a leading cause of blindness worldwide. In most glaucoma cases, the pressure inside the eye is higher than normal and this increased intraocular pressure is what damages the optic nerve.
If you’re reading this post, it’s probably because, like John, you or a loved one have noticed some changes in vision. And if that’s the case, you’re not alone: Glaucoma is a common eye condition that affects about 2% of the population over the age of 40. While it can affect people of any age, it’s even more common in people older than 60. It’s also more common in African Americans, Hispanics and Asians than Caucasians.
Types of glaucoma
There are four main types of glaucoma: Open-angle glaucoma, Angle closure glaucoma, Congenital glaucoma, Secondary glaucoma.
John has the most common type of glaucoma — open angle glaucoma. This sneaky eye condition usually has no symptoms in its early stages, then significant vision loss can occur – usually painless peripheral (side) vision loss, followed by central vision loss. Open-angle glaucoma is more common and it occurs when fluid builds up inside the eye, causing pressure on the optic nerve and eventually damaging it.
Although open-angle glaucoma usually affects both eyes, often one eye will be affected more severely than the other or may be affected earlier than the other eye.
Angle closure glaucoma causes pressure on the optic nerve due to an abnormal narrowing of one or both angles in your eyes (the drainage space between the iris and cornea). As a result, fluid can’t circulate through the eye and intraocular pressure increases to damaging levels. Acute angle closure causes sudden very high pressures. Symptoms of acute closure are severe, and patients are usually in pain. This is an emergent acute attack — permanent damage to the optic nerve can happen quickly in this condition and the patient should be seen by an eye doctor as soon as possible. Angle closure glaucoma can also be chronic: pressure builds up slowly (silently), as with primary open angle glaucoma, but can be more aggressive.
Congenital glaucoma, also known as childhood, infantile or pediatric glaucoma, occurs in babies and young children. It is usually diagnosed within the first year of life. This rare condition may be inherited and is caused by incorrect development of the eye’s drainage system before birth, leading to increased intraocular pressure.
Secondary glaucoma is a glaucoma that occurs as a result of an acquired condition, like an injury to the eye, inflamed inner parts of the eye (like the iris), a damaged lens in the eye, diabetes, high blood pressure or using some medications. When treating secondary glaucoma, the underlying condition is usually addressed first.
Does glaucoma run in the family?
People with the highest risk are those with a family history of glaucoma, so if your parents or siblings have it, you might want to be tested. If you have diabetes, you’re also at higher risk for developing glaucoma as well.
What are the symptoms of glaucoma?
Glaucoma symptoms usually start slowly and gradually and worsen over time. They include painless blurring of vision, halos around lights, difficulty reading, and seeing double. Also, difficulty seeing at nighttime, discomfort in bright lights and eye redness are not uncommon. Glaucoma can be sneaky, often causing very subtle, or no noticeable symptoms until severe vision loss has occurred, so regular eye exams are very important for early detection. If not treated, glaucoma can result in permanent vision loss.
What causes glaucoma?
The exact cause of glaucoma is unknown but there are several factors that may contribute to its onset. These include elevated intraocular pressure (IOP), age-related changes in the trabecular meshwork, genetic predisposition, and other systemic diseases.
Your eye pressure is determined by how much fluid your eyes produce and how well that fluid drains. Found behind the iris, the ciliary body includes the ciliary processes that produce the aqueous fluid that fills the space between the cornea and the iris, called the anterior chamber. The fluid is responsible for providing oxygen, nutrients, and metabolic waste removal inside the eye.
Always moving and circulating, the fluid then drains through the trabecular meshwork – a spongy tissue located in the drainage angle between the iris and cornea. Aqueous fluid is then drained through the Canal of Schlemm.
Any disruption in any one of these fluid dynamics can cause glaucoma.
How is glaucoma diagnosed?
There are several ways to diagnose glaucoma. Early diagnosis and treatment can prevent vision loss from glaucoma. During your visit to the eye doctor, you’ll be given several eye tests by an ophthalmic technician. These tests will include a visual acuity check and intraocular pressure (IOP) test. A tonometer (tonometry) is a very important diagnostic test used to measure the pressure inside the eyes.
The visual field test is used to determine if you have glaucoma-related blind spots (called scotoma) in your vision and where they are. This test has been used in glaucoma diagnosis for many decades and is still a standard testing tool.
A modern test, called Optical Coherence Tomography (OCT) uses non-invasive light waves to scan the back of the eye and creates a topographical map of the optic nerve and measures the thickness of the nerve fiber layer, which is the portion of the optic nerve most vulnerable to eye pressure elevation. The nerve fiber layer thickness is then compared with the data of thousands of “normal” nerve fiber thicknesses within the age, race and gender of the patient. A nerve fiber that is “thinning” is indicative of glaucoma damage.
The technician uses an ultrasonic wave instrument called a pachymeter to measure the thickness of your cornea. Corneal thickness has been found to be an accurate predictor of glaucoma development.
The glaucoma eye exam
After dilating your pupils, the eye doctor uses a slit lamp microscope to exam the optic nerve, which sits in the back of your eye, and is made up of a dense network of tiny nerve fibers. When those smaller nerve fibers are damaged and die, the space they leave behind looks a bit like a cup. Doctors call this “optic nerve cupping.” Whether or not there is glaucoma present, all people have cup-to-disc ratio. Those with glaucoma damage tend to have a greater cup-to-disc ratio causing optic nerve cupping. Eye doctors measure cup-to-disc ratio in tenths — greater than six-tenths (0.6) is generally considered to be suspicious for glaucoma. Cupping of the optic nerve is a hallmark of glaucoma.
How is glaucoma treated?
There are several medical treatments for glaucoma, including prescription drop medications, laser treatment and microsurgery to improve the flow of fluid in your eyes. Doctors at Bay Area Eye Institute will customize treatment for each patient based on testing, treatment trials and observations.
Prescription eye drops that lower the pressure in the eye and prevent damage to the optic nerve are the most common glaucoma treatment. There are dozens of eyedrop medications on the market and each one is specifically formulated for certain types of glaucoma and specific ways of treating the mechanisms causing elevated intraocular pressure. Your doctor will make an educated recommendation and observe the results.
What glaucoma treatment helped John?
Eye drops have been a good solution for managing John’s glaucoma. Gone are the rainbows around lights, random blurry vision and headaches. And most importantly, his risks of permanent damage to his optic nerves has been eliminated. It is quite possible that if John had not been diligent in having his eyes checked, his glaucoma could have gone unnoticed and eventually resulted in irreparable damage to his optic nerves and vision. Instead, his eye drop regimen, prescribed by Dr. Gamell, has become part of a simple daily routine and has kept his eye pressures at non-threatening, stable levels. He has a yearly checkup with Bay Area Eye Institute and knows that if he ever needs a change in treatment, like a more aggressive laser treatment, they have the expertise and modern treatment technologies to help him.
John is thrilled to be living what he calls a “carefree” lifestyle. He no longer worries about woodshop accidents due to poor vision. Now he is able to focus his time and energy on doing what he loves – working with his wife in their home woodshop and putting a smile on needy children’s faces year round.
Bay Area Eye Institute
Craig Berger, MD opened the Bay Area Eye Institute in Tampa, Florida in 2007, a multi-subspecialty eye clinic, focusing on the treatment of glaucoma, corneal conditions, dry eye disease, cataract and cornea transplant surgery.
Along with Dr. Berger, Doctors Gamell, and Kerris, treat and manage a large spectrum of eye conditions and diseases at Bay Area Eye Institute. They accept most health insurances and will accommodate quick new-patient appointments.
The practice focuses on patient satisfaction. Their philosophy is to put the patient first, provide physical and emotional comfort, and strive for the highest care possible. Your time and comfort are paramount. They feel that patient education is an important aspect of treatment and will take the time to explain ocular conditions and treatment plans.
At Bay Area Eye Institute, they offer the most modern glaucoma management options. Their office employs state-of-the-art technology and careful testing is conducted to tailor your glaucoma treatment for your specific condition.
Bay Area Eye Institute is conveniently located in north Tampa and is easy to get to from all Tampa Bay area counties. They are open 8:00 a.m. to 5:00 p.m. on Monday-Thursday and 1:00 to 5:00 on Friday. Call them today and ask about setting up a cataract surgery evaluation with Dr. Berger.