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Hazy side vision, nausea and eye pain: Common glaucoma myths and treatment options
As glaucoma can affect almost anyone, early detection and effective management are key to preventing vision loss, says glaucoma specialist Owen Hee
When it comes to glaucoma, regular eye check-ups, early detection and effective treatment are crucial for preserving vision and quality of life. PHOTO: HESED EYE SPECIALISTS
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Research has shown that impaired vision severely impacts our quality of life and increases the risk of falls. Glaucoma is one such condition that can potentially impair vision in those over the age of 40.
The condition occurs when there is unhealthy pressure in the eyeball, which gradually damages the optic nerve, causing vision loss and blindness if left untreated. In its early stages, glaucoma largely shows no symptoms, earning it the nickname “the silent thief of sight”, according to Dr Owen Hee, glaucoma specialist at Hesed Eye Specialists.
Glaucoma also commonly affects the side vision or peripheral vision in the initial stages, so the central vision is not affected until much later. However, there is a subtype of glaucoma known as Acute Angle-Closure Glaucoma, which tends to occur more frequently in Chinese women and is associated with specific symptoms. These include seeing halos around lights, nausea or vomiting, and eye pain.
Three per cent of Singaporeans above the age of 50 live with glaucoma. The risk increases as we age, with 10 per cent of those over 70 affected by the disease.
Common misconceptions about glaucoma
A more accurate understanding of this condition is the first step to helping
prevent glaucoma from impacting you. One common misconception is that all glaucoma patients will eventually become completely blind.
prevent glaucoma from impacting you. One common misconception is that all glaucoma patients will eventually become completely blind.
Dr Hee dispels this myth: "While glaucoma is a leading cause of irreversible blindness, not all patients will lose their vision. Most patients who detect glaucoma early, attend regular follow-up appointments and adhere to their prescribed glaucoma medications have a good chance of preserving their sight."
Additional misconceptions include the belief that painful red eyes are a symptom of glaucoma or that only those with high eye pressure are susceptible to glaucoma.
Dr Hee says it's important to note that most glaucoma cases do not present with redness. He emphasises that glaucoma can remain silent for many years until it progresses to an advanced stage and starts to impact vision.
"It's also crucial to understand that eye pressure alone cannot definitively determine the presence of glaucoma," he adds. "Normal Tension Glaucoma, more prevalent in Asia and Singapore, can manifest even when eye pressures fall within the normal range."
The key takeaway is that regular eye examinations are essential to ensure proper eye health and early detection of glaucoma. These examinations should be done at least once a year, if not more frequently, for those at risk.
Detecting glaucoma involves a series of steps during a dilated eye examination:
- A detailed medical history is taken to determine if there are any risk factors for glaucoma, such as a family history of glaucoma and previous trauma to the eye.
- The patient’s vision is checked, and eye pressure is measured using an instrument called the Goldman Applanation Tonometer.
- The eye's front chamber is assessed with a microscope called a slit lamp biomicroscope and a contact lens called gonioscopy, to see if there is blockage of the eye's drainage system, which can lead to high eye pressure.
- The eye’s optic nerve is examined, and a specialised scan is performed to detect any thinning of the optic nerve.
- A visual field test is performed to assess if there is any loss of vision.
When glaucoma is discovered at an early stage, the appropriate treatment can significantly slow down or stop the progression of the disease and help preserve remaining vision.
Dr Hee adds: “The earlier we find and treat glaucoma, the better it is. There have been advances in glaucoma detection such as the Optical Coherence Tomography that allows sophisticated imaging of the optic nerve so that it is possible to detect glaucoma earlier than before.”
Treatment options for glaucoma
The primary focus of glaucoma treatment focuses on reducing eye pressure to slow or halt the progression of the condition. Treatment options include:
- Medicated eye drops: These drops must be applied daily, often for a lifetime, similar to managing high blood pressure with medication.
- Laser treatments: Various types of lasers are employed to treat different types and stages of glaucoma. One option is Selective Laser Trabeculoplasty, which has recently shown potential as an initial therapy for newly diagnosed glaucoma. It may reduce the dependency on eye drops and results in minimal discomfort, with patients often resuming their normal activities the day after treatment.
An increasingly popular choice for patients with mild-to-moderate glaucoma who are undergoing cataract surgery is Minimally Invasive Glaucoma Surgery (MIGS). Although more traditional glaucoma surgical procedures like trabeculectomy are needed for advanced cases, they entail more extensive incisions and come with increased risks.
"In some ways, MIGS can be likened to ‘keyhole’ surgery for abdominal procedures, featuring small incisions, faster recovery times, and reduced discomfort and risks compared with traditional surgical approaches,” says Dr Hee.
The introduction of MIGS is significant because it is a less invasive option and can be offered at an earlier stage of the disease.
Regardless of the procedure chosen, patients should pay close attention to their post-operative eye care. One important reminder is to avoid rubbing the eyes, as doing so could result in irritation and potential injury.
Additionally, it is important to limit activities that might strain the eyes, particularly during the immediate post-surgery period. Regular follow-up appointments are also necessary to monitor progress, address concerns, and ensure a successful recovery.
Early glaucoma intervention not only enhances quality of life and visual comfort but also plays a crucial role in preventing blindness. Timely treatment allows individuals to maintain daily activities and routines without significant interruptions.
For more information or to book an appointment, visit Hesed Eye Specialists.
