Dr. Anthony Realini and Dr. Ike Ahmed discuss the importance of promptly diagnosing, managing, and treating glaucoma for better outcomes.
Anthony Realini, M.D., M.P.H.
Professor, Vice Chair for Clinical Research, West Virginia University Health Sciences Center
What is glaucoma, and how important is early detection?
Glaucoma is a very common eye condition that leads to degeneration of the optic nerve. The optic nerve is what connects the eye to the brain and tells you what you’re looking at. So, when it deteriorates, you begin to lose your vision. The vision loss starts in the periphery and gradually moves centrally until you go blind. Glaucoma is the leading cause of irreversible blindness in the world. Unfortunately, glaucoma has no symptoms until the very late stages of the disease. It’s called the “silent thief of sight” because people don’t know they have it. The only way to diagnose glaucoma in the early stages when it is not affecting your visual function is through routine eye exams. The American Academy of Ophthalmology recommends every American should have an annual eye exam beginning at age 50.
What are some of the primary treatments available for managing glaucoma?
Many patients with glaucoma have higher than normal eye pressure, and all of the treatments that we have currently available for glaucoma are focused on lowering the eye pressure. We can lower pressure using eye drop medications, laser procedures, or surgical procedures. The past 20 years have seen significant development in each of these three methods. The historical approach to treating glaucoma has always been to start with eye drops. However, over the past decade, there has been a shift occurring where laser procedures are the first approach for glaucoma treatment. This is typically a 5-minute procedure that is not painful, and the vast majority of people don’t need to use eye drops after the procedure. Many studies show very poor adherence rates with eye drops for glaucoma therapy, leading to the future progression of the disease. So, laser procedures have become the preferred approach to combat glaucoma at the time of diagnosis.
Are there any precautions that patients can take to help reduce the risk of the disease?
We don’t understand enough about the underlying cause of glaucoma to effectively recommend any risk reduction strategies at this point. There’s an incredible amount of work being done in the glaucoma genetics space to better understand what the underlying risks and causes are.
Where do you see the future of glaucoma care in the next decade?
The Holy Grail of glaucoma would be to develop strategies that protect the optic nerve from damage and to restore and regenerate the optic nerve that has been damaged. The biggest change we’re going to see in the next 10 years or so is the ongoing paradigm shift away from topical eye drop medications. I think the future will be a drop-free lifetime for our patients by optimizing how we do laser treatments. I am currently running a multimillion-dollar NIH-funded study to clarify the best way to use SLT laser therapy. There are also new medication options being developed that are physician-administered procedural pharmaceuticals. They are put in and around the eye. Patients should be able to enjoy control of their eye pressure without ever having the responsibility of putting an eye drop in.
What advice would you give to someone newly diagnosed with glaucoma to help them navigate their healthcare journey?
The first thing I would say is that blindness from glaucoma is extraordinarily rare in people who regularly engage with their healthcare provider and stay on top of their own personal health. Under those conditions, if the treatment that they’re receiving isn’t working, the doctor will pick up on that through routine monitoring and adjust their therapy. Most of the people who go blind from glaucoma are those who don’t know they have the disease. The biggest challenge healthcare practitioners face is convincing people that they have glaucoma in the early stages. The other thing I would say is don’t hesitate to get a second opinion if you are concerned about the diagnosis. Once the diagnosis is confirmed, you must take it seriously and start treatment immediately.
Ike Ahmed, M.D., FRCSC
Director, Alan S. Crandall Center for Glaucoma Innovation, University of Utah School of Medicine
What is glaucoma, and how important is early detection?
Glaucoma is a silent disease, even when eye pressure may be high. Although the disease is slow to progress, if it’s left untreated, it will cause vision loss and, ultimately, blindness. It’s generally a good idea for patients over the age of 40 to annually get an eye examination.
What are the current methods used to diagnose glaucoma?
To adequately diagnose glaucoma requires a visit to an ophthalmologist to do a proper exam of the eye. There are some tests we do to measure the pressure in the eye including a scan of the optic nerve, which is where glaucoma occurs. It really boils down to getting a regular check-up by an ICAP professional who can help assess the presence of glaucoma.
What are some of the primary treatments available for managing glaucoma?
The main treatment for glaucoma is to lower the eye pressure to a safer level. Taking certain eye drops daily has been shown to reduce the progression of glaucoma. New laser treatment has come through that really treats the disease at the source, which is in the drainage part of the eye. We’re also now able to use very small, microscopic stents in the eye to open the drainage channels. This is called MIGS, or Microinvasive Glaucoma Surgery. We can place the drug into the eye with an injectable implant that can release the drug over several months to years, depending on the platform. Lastly, there’s major surgery, which involves creating a bypass to drain the fluid outside the eye, which we usually reserve for more advanced cases.
Are there any precautions that patients can take to help reduce the risk of the disease?
The best way is to get examined regularly by an eye health professional. Some patients may still get worse, so it’s important to have that regular check-up to make sure their eye pressure is good. If you have a family history of eye issues, health issues such as diabetes, or a previous eye surgery, I encourage you to be vigilant and get an annual eye exam. Things like excessive stress, smoking, obesity, and poor diet all play an indirect role in glaucoma.
Where do you see the future of glaucoma care in the next decade?
I’m excited about the ability to use at-home diagnostics or virtual diagnostics to detect early changes in the eye. Additionally, using gene therapy to change the way your genes are expressed in your eye to lower pressure and protect your nerve is critical. We also have molecules being developed that may protect the eye from high pressure by preventing the nerve layer of the eye from degenerating. This practice is called neuroprotection, and in the future, we hope that we’re going to be able to use this mechanism.
What advice would you give to someone newly diagnosed with glaucoma to help them navigate their healthcare journey?
Education and the understanding of the disease are critical. Lifestyle choices, therapy, and having a good patient-doctor relationship also all play a key role. Having good family support to help you stay on top of medication and treatment is also very important because it’s very much an individual approach; it’s not one size fits all.
