Glaucoma is a group of eye diseases that leads to the death of neurons that connect the retina to visual centers in the brain. This connection is through the optic nerve located in the back of the eye, through which in a healthy eye more than 1 million neurons come together to enter the brain.

The cause of cell death is not known, but one theory is that the neurons are mechanically impinged as they enter the optic nerve, obstructing the metabolism of the neuron, leading to cell death. This optic nerve, the width of 150 microns (one-tenth the diameter of angel hair pasta) is evaluated by the ophthalmologist through a microscope and technologically sophisticated imaging systems. These techniques allow the ophthalmologist to detect neuronal damage, and when found, help monitor for any progression.

In addition to direct evaluation of the optic nerve, the visual field test is an extremely useful tool in diagnosis and following for progression in glaucoma. This is due to the often insidious nature of untreated glaucoma, in which in the early stages only peripheral vision is affected. Unfortunately, in advanced disease the damage is not limited to the peripheral vision; central vision may also be affected.

Glaucoma is a relatively common condition. The American Academy of Ophthalmology estimates that at least 2.25 million individuals in the United States from 45 years of age or older have this disease. It was once believed that glaucoma was caused by high pressures in the eye. It is now known that high pressure is not the cause of glaucoma, but rather a risk factor, and that there are other factors that can place a person at risk for glaucoma, including family history of the disease, age, African or Hispanic descent, prior eye trauma, and systemic illnesses such as migraine headaches and diabetes.

In conjunction with internists who monitor systemic illnesses, the most significant risk factor that the ophthalmologist can modify is the pressure in the eye. This is most commonly done with pressure-lowering eye drop medications. Various forms of laser therapy also can be used, depending on the specific type of glaucoma being treated. Additionally, surgical treatments can be performed, typically if the above treatments fail.

There is no cure for glaucoma at this time. However, through early detection, diagnose and treatment, the ophthalmologist can help preserve the vision of the patient with glaucoma.

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