By Dr Noor Ali for Blink Eye Clinic
What is glaucoma and why do we all need to know about it?
Glaucoma is a disease that causes slow damage to the nerve in the back of the eye - the optic nerve - that takes the messages to the brain. High pressure in the eye causes this damage to the optic nerve, in turn causing slow irreversible damage to the vision, starting with the peripheral vision, without people noticing.
Occasionally people with eye pressure in the higher end of the normal can also develop glaucoma. For this reason, glaucoma is called the silent thief of sight.
To protect yourself and your loved ones it is good to have an understanding of glaucoma and get regular check-ups with your optometrist or ophthalmologist.
Why is Glaucoma a public health issue?
It is estimated that two in 100 Australians will develop glaucoma in their lifetime, but this increases dramatically with age especially over 50. In, fact one in eight Australians over 80 will develop glaucoma.
As high pressure seldom causes symptoms, and peripheral visual changes are slow, 50 percent of people with glaucoma don't know they have it. This is why raising awareness is so important in our community. We are fortunate to be living longer here in Australia, and so it is crucial to get tested early because early detection allows early treatment and prevention of vision loss. In particular, it is important to prevent any significant loss of side vision, as this is a legal requirement for driving a car.
How do we pick up glaucoma early?
We recommend everyone over 50 years of age get a general eye test every two or three years. If there are any suspicious features your optometrist will refer you to an ophthalmologist for further investigations.
We know that certain people may be more likely to develop glaucoma, for example those with a family history, people with diabetes, short or long sightedness, long-term steroid medications, have high blood pressure or obstructive sleep apnoea. For these patients, yearly check-ups should start at an earlier age.
What can be done to treat glaucoma?
Fortunately, there are many treatments for glaucoma including laser, eye drops, keyhole surgery and the traditional open surgery. With our ageing population, I now plan the treatment for each patient as if they were going to live to a 100 and still drive.
In years gone past, we started treatment with eye drops, which although can be very effective, may cause side effects like redness and burning sensation, and must be taken every day. Recent research from London has shown laser treatment to be effective as a first line for glaucoma in three out of four people, and can last up to five years. This is certainly very exciting as I can tell my newly diagnosed patients we can use laser treatment as a drop-delaying therapy.
Secondly we also have access to preservative-free eye drops which are gentler on the eye. Finally, for patients who have cataracts, we can combine a small glaucoma procedure with their cataract surgery using the same microscopic incision; effectively keyhole surgery. These new and cutting edge procedures are called minimally invasive glaucoma surgeries (MIGS). They are suitable for patients with mild to moderate glaucoma.
Protecting yourself and your loved ones against glaucoma is as easy as 1-2-3:
- Get checked regularly
- If there is a suspicion of glaucoma at a check up, get it investigated further.
- If you have a cataract and glaucoma, talk to your ophthalmologist about MIGS.
Dr Ali joins Blink Eye Clinic
Dr Noor Ali will be working at Blink Eye Clinic in Canberra from September.
Dr Ali graduated from The University of Auckland Medical School, and completed her ophthalmology training in New Zealand, with fellowships from Sydney Eye Hospital, and Oxford Eye Hospital. Before leaving the UK during COVID, she also worked at Imperial College Hospitals Trust, focussing on new glaucoma procedures.
Keen to share knowledge among peers, students and others, she has published a number of scientific articles and taught a number of medical students and ophthalmology trainees.