UW Department of Ophthalmology: GLAUCOMA SERVICE

High eye pressure
Advanced age
African-American ancestry
Family history of glaucoma

MOST GLAUCOMA is due to high eye pressure, meaning eye pressure greater than 21 millimeters of mercury (mmHg, the unit of eye pressure measurement, same as blood pressure). The eye has normal pressure, just like your circulatory system has blood pressure. The eye constantly makes fluid and drains it; the fluid contains nutrients important to normal eye function. The drain of the eye is called the Trabecular Meshwork, located all around where the white Sclera meets the colored Iris and the clear Cornea, in a part of the eye called the Angle.

Usually the drain is open in people with glaucoma due to high eye pressure; this is called Open-angle Glaucoma [left]. Sometimes, access to the trabecular meshwork is blocked by the iris; this is called Closed-angle Glaucoma [below]. Up to one third of people with glaucoma never have a high eye pressure recorded; these people have "Normal Tension Glaucoma." Many other people have high eye pressure but never get glaucoma;

these people have "Ocular Hypertension." Still, we know that high eye pressure is definitely a strong risk factor for glaucoma, especially eye pressure greater than 30 mm Hg, so people with ocular hypertension must see their ophthalmologist regularly, to make sure they are not developing glaucoma.

Advanced age is an important risk factor, since glaucoma usually develops in those above age 50, especially above age 65. If you are above age 60 you should have your eyes examined by an ophthalmologist every year, even if you are not having any trouble seeing. However, there are less common types of glaucoma that affect infants and young people.

African-Americans are affected earlier (by as much as a decade on average) and more severely by glaucoma than are white people, in general. Glaucoma is the leading cause of blindness in people of African-American ancestry.

A family history of glaucoma (especially among brothers, sisters, parents, or children) puts a person at a higher risk to have glaucoma.

Other less-important risk factors include diabetes mellitus, myopia (nearsightedness), retinal vein occlusion, and chronic use of corticosteroid medications.

TREATMENT of glaucoma usually starts with eyedrops that lower eye pressure. If medicines don't work well, eye pressure may be lowered by laser surgery to improve access to the drain of the eye (Peripheral Iridotomy or Iridoplasty) or to improve drain function (Laser Trabeculoplasty). Incisional surgery must be done sometimes, to bypass the poorly-functioning drain of the eye (Trabeculectomy). In some cases a plastic tube that drains eye fluid to the back of the eye must be implanted (Glaucoma Drainage Device) to lower eye pressure. Often cataracts occur in people who have glaucoma, and these may be removed surgically if appropriate.

At the University of Washington Eye Center, glaucoma specialists Philip P. Chen, MD, Anuja Bhandari, MD, and Raghu Mudumbai, MD, see patients and perform surgery; please call (206) 598-4011 to schedule an appointment. Doctor Chen is also doing research on a wide variety of topics in glaucoma, including visual field testing using several different computerized perimeters; retinal nerve fiber layer measurement with the Nerve Fiber Analyzer; comparison of new eyedrops for glaucoma; effect of anti-scarring medicines on glaucoma surgery; and results of glaucoma surgery.

FOR FURTHER INFORMATION, click on the following links:

American Academy of Ophthalmology (to find an ophthalmologist, and for more information);

Glaucoma Research Foundation (for additional information);

National Eye Institute (NEI) (for national research projects involving glaucoma. Select Clinical Trials Database, then search the Table of Contents (by NEI-Disease Program Area)

				Patient Care Clinical Trials
	Glaucoma Service at the University of Washington GLAUCOMA is a leading cause of blindness in the U.S. and the world, and may be the greatest cause of irreversible but preventable blindness in the world. Glaucoma is a disease of the optic nerve. The optic nerve is like a cable that carries all the information from your eye to your brain; without the optic nerve, the brain cannot process what the eye sees. In glaucoma, the optic nerve is damaged. Usually, the damage reduces the peripheral vision of the eye (the kind of vision that allows you to notice things around you when you are not looking directly at them), and the central vision of the eye is not affected until the damage has gone on for a long time. Unfortunately, ophthalmologists cannot repair damage already done to the optic nerve, so treatment is best begun before noticeable peripheral visual field damage occurs. We measure peripheral vision using computerized machines called perimeters, that check the peripheral visual field in both eyes in about 15 minutes. This testing allows the ophthalmologist to see if the glaucoma damage is stable or changing. We often take photographs of the optic nerve to record its appearance for future reference. RISK FACTORS for glaucoma include: High eye pressure Advanced age African-American ancestry Family history of glaucoma MOST GLAUCOMA is due to high eye pressure, meaning eye pressure greater than 21 millimeters of mercury (mmHg, the unit of eye pressure measurement, same as blood pressure). The eye has normal pressure, just like your circulatory system has blood pressure. The eye constantly makes fluid and drains it; the fluid contains nutrients important to normal eye function. The drain of the eye is called the Trabecular Meshwork, located all around where the white Sclera meets the colored Iris and the clear Cornea, in a part of the eye called the Angle. Usually the drain is open in people with glaucoma due to high eye pressure; this is called Open-angle Glaucoma [left]. Sometimes, access to the trabecular meshwork is blocked by the iris; this is called Closed-angle Glaucoma [below]. Up to one third of people with glaucoma never have a high eye pressure recorded; these people have "Normal Tension Glaucoma." Many other people have high eye pressure but never get glaucoma; these people have "Ocular Hypertension." Still, we know that high eye pressure is definitely a strong risk factor for glaucoma, especially eye pressure greater than 30 mm Hg, so people with ocular hypertension must see their ophthalmologist regularly, to make sure they are not developing glaucoma. Advanced age is an important risk factor, since glaucoma usually develops in those above age 50, especially above age 65. If you are above age 60 you should have your eyes examined by an ophthalmologist every year, even if you are not having any trouble seeing. However, there are less common types of glaucoma that affect infants and young people. African-Americans are affected earlier (by as much as a decade on average) and more severely by glaucoma than are white people, in general. Glaucoma is the leading cause of blindness in people of African-American ancestry. A family history of glaucoma (especially among brothers, sisters, parents, or children) puts a person at a higher risk to have glaucoma. Other less-important risk factors include diabetes mellitus, myopia (nearsightedness), retinal vein occlusion, and chronic use of corticosteroid medications. TREATMENT of glaucoma usually starts with eyedrops that lower eye pressure. If medicines don't work well, eye pressure may be lowered by laser surgery to improve access to the drain of the eye (Peripheral Iridotomy or Iridoplasty) or to improve drain function (Laser Trabeculoplasty). Incisional surgery must be done sometimes, to bypass the poorly-functioning drain of the eye (Trabeculectomy). In some cases a plastic tube that drains eye fluid to the back of the eye must be implanted (Glaucoma Drainage Device) to lower eye pressure. Often cataracts occur in people who have glaucoma, and these may be removed surgically if appropriate. At the University of Washington Eye Center, glaucoma specialists Philip P. Chen, MD, Anuja Bhandari, MD, and Raghu Mudumbai, MD, see patients and perform surgery; please call (206) 598-4011 to schedule an appointment. Doctor Chen is also doing research on a wide variety of topics in glaucoma, including visual field testing using several different computerized perimeters; retinal nerve fiber layer measurement with the Nerve Fiber Analyzer; comparison of new eyedrops for glaucoma; effect of anti-scarring medicines on glaucoma surgery; and results of glaucoma surgery. FOR FURTHER INFORMATION, click on the following links: American Academy of Ophthalmology (to find an ophthalmologist, and for more information); Glaucoma Research Foundation (for additional information); National Eye Institute (NEI) (for national research projects involving glaucoma. Select Clinical Trials Database, then search the Table of Contents (by NEI-Disease Program Area)