Glaucoma is the world’s second-leading cause of blindness, affecting about three million Americans. Unfortunately, researchers say, the majority of people with glaucoma aren’t aware they have it. In an interview with Vision Monday, Dallas-Fort Worth area ophthalmologist Ashish Singh, M.D. explains how patients and eye care providers (ECPs) can effectively manage the “silent thief of sight” with the newest and up-and-coming glaucoma treatments.*

What are glaucoma’s early signs and how can it be prevented?

Singh says one of glaucoma’s most challenging aspects is that it’s very hard to detect the disease’s early signs. Since there’s no pain, the disease often progresses for years before people receive a diagnosis.

• Peripheral vision is the first to be affected, which is hard for patients to detect.
• Glaucoma is already advanced by the time it affects central vision.

“The best way for patients to protect themselves from developing glaucoma,” says Singh, “is to have an annual eye exam with their eye doctor for glaucoma screening.”

Who’s the typical glaucoma patient?

A typical patient profile for glaucoma is:

• Over 60 years of age
• Nearsighted 
• With thin corneas
• Hispanic or African American
• Having high internal eye (intraocular) pressure, or IOP
• Living with concurrent conditions such diabetes and high blood pressure

Many glaucoma patients also have an extensive family history of the disease, which plays a major role in its development.

How can ECPs better identify and treat glaucoma?

Singh advises optometrists and ophthalmologists to be on high alert for glaucoma in people who fit the typical profile. He recommends that they:

• Pay close attention to IOP 
• Conduct a detailed optic nerve exam, looking at size, neuro-retinal rim health, and symmetry
• Perform optic nerve imaging (OCT), the Humphrey Visual Field test, and other supportive tests to help with diagnosis

Pivotal studies like the Ocular Hypertension Treatment Study (OHTS) highlight how critical early glaucoma treatment is to preserving the optic nerve and saving vision.

Newer and up-and-coming therapies

Early detection and treatment can help patients maintain “an excellent quality of life,” Singh says, adding that there’s been an “explosion” of new glaucoma treatments in the last 10 years, including new:

• Medicated eye drops, making it easier for fluid to leave the eye or reducing fluid made in the eye, and
• Surgeries to clear or widen the eye’s existing drainage system, or to create new drainage pathways.

Minimally invasive glaucoma surgeries (MIGS) are still fairly new in glaucoma treatment and most often coupled with cataract surgery. Singh, who specializes in these surgeries, says the treatment is safe and moderately effective. Examples of MIGS procedures include:

• iStent inject, where two bypass valves are implanted in the eye as alternative drainage sites, and
• Kahook Dual Blade Goniotomy, in which tissue is removed for better fluid flow.

Up-and-coming glaucoma treatments include: 

• MIGS procedures that target or create other fluid drainage pathways
• Medication-releasing rings inserted underneath the eyelid
• Smart contact lenses that monitor IOP 24/7 (including one that responds to increased IOP by releasing an appropriate amount of medication)

Concluded Singh, “It’s truly an exciting time in the field of glaucoma!”

*Kane, M. (2023, January 13). What’s on the Horizon for Glaucoma Treatment and Detection? Vision Monday. https://www.visionmonday.com/scene-and-heard/todays-read/article/whats-on-the-horizon-for-glaucoma-treatment-and-detection