Glaucoma

Here are the different types of glaucoma:

• Open angle glaucoma – this is the most common glaucoma type, which starts slowly and gradually damages the eye because the fluid within the eye does not drain away as it should

• Normal tension glaucoma – occurs even if eye pressure is normal, and is caused by a damaged or weak optic nerve

• Angle closure glaucoma – this sometimes happens really quickly, or can develop very slowly. If this type of glaucoma occurs quickly, urgent medical attention is needed because it can cause permanent blindness due a sudden pressure increase which puts the cornea and iris into contact

• Secondary glaucoma – this occurs as a result of other eye conditions. Read more about secondary glaucoma

• Baby/child glaucoma – sometimes babies can be born with glaucoma, which is rare, and some children develop glaucoma during childhood but this is often related to other health conditions. Read more about this type of congenital glaucoma.

Generally, glaucoma symptoms:

• Affect peripheral vision first

• Happen gradually and slowly – symptoms may come on then disappear again

• Include blurred or misty vision

• Cause an aching feeling in the eyes

• Can make you see a halo shape or ring around lights

• Can cause redness

• Can make you feel sick or induce vomiting – usually when the condition has progressed

• Cause pain in the eye – usually when the condition has progressed

Angle closure glaucoma symptoms may come on much more quickly and be more painful than open angle glaucoma; the pain is likely to be much more severe.

If you think you, or someone you know, may have any symptoms of glaucoma that are listed here, you should visit an ophthalmologist for a check-up and glaucoma testing. If you have never had your eyes checked for glaucoma, you should make an appointment and have a test every two years. If you have a relative with glaucoma or you are in a higher risk group, you should have more regular testing.

Glaucoma diagnosis is usually first picked up during a routine eye test by an optometrist (optician). The standard tests for glaucoma include:

• Tonometry test – measures eye pressure with a tonometer instrument, which may involve the instrument touching the eye, or can be done without contact using small puffs of air that blow into the eye

• Gonioscopy exam – the optometrist looks into the eye to see if fluid is draining effectively

• Visual field / perimetry test – assesses whether or not vision is affected by glaucoma damage by testing whether or not a person can see things around the edges of their vision

• Optic nerve test – optometrist visually assesses the optic nerve with a bright light microscope by looking into the eyes

If an optometrist suspects you have glaucoma, they will refer you to an ophthalmologist, which is a doctor that specialises in eyes. This is usually a hospital based appointment where you will have further tests and, if required, a plan of glaucoma treatment will be devised for you.

Read more about symptoms of glaucoma and diagnosis of glaucoma.

Living with a glaucoma diagnosis will affect each person differently. Early glaucoma diagnosis can make all the difference in how effective glaucoma treatments are, and to the quality of life a person has. Many people will find that glaucoma does not limit their life and they can still do most of the things they used to.

Glaucoma may mean more time spent on hospital and optometry appointments. You may have to get used to putting drops in your eyes every day, or having more advanced treatment options such as laser treatment or, in worst cases, surgery. The latter may take time to heal and recover from and this is likely to affect daily life in lots of ways.

Some people find that their glaucoma symptoms include some visual impairment, such as difficulty seeing when the light is low or, oppositely, when it is a very bright day. These problems can often be solved by good lighting around the home, avoiding driving or walking alone in the evenings, or wearing tinted glasses or sunglasses.

Some people with more advanced glaucoma may also find they have issues with their vision that make hobbies such as reading, painting, drawing, playing sports, and so on, more difficult.

In the most severe cases, some people will experience vision issues that make it difficult for them to get around safely. For example, they may bump into things more regularly, or be put at greater risk of having a fall inside or outside the home. A number of daily tasks, such as preparing food, doing household chores, eating a meal, making drinks, using the bathroom or using the telephone, may all become difficult if a person’s glaucoma causes vision loss.

NRS Healthcare are experts in daily living aids – these are products that are designed to make everyday tasks easier for people who have mobility difficulties, vision loss, hearing loss, or other health conditions.

Here, we list a variety of products that some people may find useful if they have vision loss as a result of glaucoma (or another eye condition).

• Bathroom aids – if a person is finding it difficult to navigate in the bathroom due to vision loss, the introduction of daily living aids that provide support may help to ensure a safer bathroom routine. Adding coloured aids to the room can also create contrast which makes items easier to see.

o Red bathroom step

o Red raised toilet seat

o Toilet frame and seat

o Bath lift

o Shower stool

o Grab Rail

• Mobility aids – some people living with glaucoma may have existing mobility problems, or they may develop mobility difficulties as part of another health condition. It’s possible they may also become less mobile as they grow older. Sometimes, glaucoma causes vision loss which may affect the way a person is able to get around, putting them more at risk of falls. These daily living aids may help.

o 4 wheel rollator

o 3 wheel rollator

• Lighting – good lighting around the home can help if glaucoma is affecting a person’s vision. Lighting can make hobbies and tasks easier to see, and make getting around the house safer – particularly at night.

o Night light with motion sensor

o High Vision Daylight Reading Lamp

o Remote control lightbulb

• Magnifiers – some people with advanced glaucoma symptoms may find reading more difficult as they lose visibility in their central vision, and a magnifier may help with this.

o Hands free magnifier with light

o Folding A4 magnifier

o Table lamp

• Food preparation and eating/drinking aids – if a person’s vision has been severely affected by glaucoma, they may find preparing or eating food and drinks difficult. There are several daily living aids that may help.

o Coloured mug

o Kura care cutlery (contrasting colour)

o Coloured plates

o Food workstation

• Medication reminders – useful for people who have a variety of tablets to help keep their glaucoma under control, as opposed to eye drop treatment. These can be filled either by the person, a pharmacist or a family member.

o Automatic pill dispenser

o Pill organiser

o Alarm reminder pill box

• Telephones and clocks – if a person has advanced glaucoma, the condition may well affect their central vision as well as peripheral vision, which may cause issues with seeing the time or using a telephone.

o Big button telephone

o Simple mobile phone

o Talking alarm clock

This is not an exhaustive list, and if you are looking for products that may help you, we have a team of Occupational Therapists at NRS Healthcare who can advise you on the products that will best suit your needs. Contact them by emailing productadvice@nrshealthcare.co.uk or calling 0345 121 8111.

Glaucoma treatment will depend upon which type of glaucoma a person is diagnosed with and how advanced it is.

Eye drops are commonly prescribed which have to be used up to four times a day, and these work to reduce eye pressure. If a person has glaucoma, it is really important they keep up the eye drop usage and do not miss a dose, to ensure their sight is not affected. Some people find using eye drops to be strange or uncomfortable at first, but get used to it eventually.

If eye drops do not seem to be an effective glaucoma treatment, laser treatment may be used which involves a beam of light being directed into the eye to stop fluid build-up. This may involve making more holes to drain the fluid, opening the drainage tubes or making the eye produce less fluid by removing some of the liquid-producing tissue.

Surgery is also a possible treatment option if the other two treatments are not effective. This minor operation is carried out under local anaesthetic and involves removing some of the eye drainage tubes to make fluid drain better. There are risks involved and vision can be affected for several weeks afterwards.

Glaucoma and employment

Many people with a diagnosis of glaucoma are able to work as long as their vision is good and they keep on top of their treatment. Certain people may experience some sight loss and this may affect their ability to work – read more about sight loss from glaucoma and employment.

Glaucoma diet

A healthy, balanced diet is important for everybody. Some research suggests that getting the right nutrition can help prevent glaucoma developing. Excess salt intake has been linked with glaucoma. High levels of fruit and vegetables, antioxidant foods such as green tea, foods rich in omega-3 such as oily fish and nuts, and staying hydrated are all important factors in a healthy glaucoma diet, or to help prevent glaucoma occurring.

Keeping to a healthy weight and getting regular exercise for glaucoma patients is important, as is quitting smoking, which is linked to an increased risk of glaucoma.

The NHS provide information on eating a balanced diet.

Glaucoma Support – a Facebook group for people living with glaucoma to share stories, advice and experiences

International Glaucoma Association Forum – online forum for people with glaucoma to share their experiences and talk about their situations, symptoms, treatments and vision

International Glaucoma Association – a charity that provides advice and information on all aspects of glaucoma as well as an online forum, research projects, free literature and a shop

NHS – provides official medical information on all aspects of glaucoma and related conditions

RNIB – UK charity for people experiencing sight loss or visual impairment and their families, featuring information on all eye conditions, including glaucoma, real life stories from people living with sight loss, factual information on practical issues, such as finances, and lots more support

Aqueous fluid

– liquid within the eye which is clear and watery (not related to tears) and which flows between the lens and the cornea to nourish and lubricate

Congenital

– a condition that is present from birth and potentially hereditary

Optic nerve

– transmits impulses to the brain from the retina

Peripheral vision

– the ability to see objects positioned at the side of the body, without moving your head or eyes

Retina

– positioned at the back of the eyeball, the retina triggers nerve impulses that pass through the optic nerve to the brain, forming a visual image