American Medical Association Family Medical Guide - American Medical Association [740]
My brother was not so lucky—he has glaucoma and didn’t start his treatment early enough, and has lost some of his vision.
Treatment
Although damage to the optic nerve caused by chronic open-angle glaucoma is permanent, treatment with medication and surgery can usually slow the disease or prevent it from progressing. An ophthalmologist will prescribe medication, usually given in eyedrops, that either reduces the pressure inside the eyeballs by slowing the flow of fluid into the eyes or improves fluid drainage from the eyes. Because pills may produce more serious side effects, they are prescribed only if the eyedrops are ineffective. You will need to take the medication for the rest of your life to control the pressure in your eyes. If the drugs lose their effectiveness over time or cause unpleasant side effects, a doctor may change the dosage or prescribe a different medication.
To treat chronic open-angle glaucoma that cannot be controlled with medication, the doctor can use a laser (a highly concentrated beam of light) to alter the shape of the drainage angle to make it easier for fluid to drain from the eye. This painless procedure usually is performed in the doctor’s office or in an outpatient facility. In some cases, the effects of laser surgery may wear off over time and the procedure must be repeated. If glaucoma cannot be controlled with medication or laser surgery, an ophthalmologist may recommend a surgical procedure called trabeculectomy, in which an alternate outlet for aqueous fluid is created to lower the pressure inside the eyeball. This type of surgery is performed in a hospital.
Emergency treatment for acute closed-angle glaucoma involves a brief, painless surgical procedure called iridotomy. In this procedure, the doctor usually uses a laser to create a small drainage hole in the iris to change the shape of the structure of the eye and help fluid drain from the eye to relieve pressure inside the eyeball. Iridotomy usually is performed in the doctor’s office or in an outpatient facility.
Macular Degeneration
Macular degeneration is a disease characterized by irreversible deterioration of the light-sensitive cells of the macula—the part of the retina (the light-sensitive membrane lining the back of the eye) that provides sharp focus in the center of the field of vision. The retina transforms light into electrical signals that travel along the optic nerve to the brain, which perceives them as visual images. Sharp central vision allows you to see fine details clearly, which is essential for such everyday activities as reading, driving, and recognizing colors and faces. As you age, the macula can deteriorate. This process can occur rapidly, or it can be slow and progressive. Macular degeneration often affects both eyes, one after the other. In the United States, age-related macular degeneration is the leading cause of blindness in people over 60.
There are two main forms of age-related macular degeneration—dry and wet. About 90 percent of people who have the disease have the dry form, in which the macula breaks down slowly, gradually resulting in blurred central vision. The other 10 percent have the wet form, which progresses more rapidly and carries a greater risk of vision loss. In the wet form, fragile, abnormal blood vessels grow under the retina and bleed and leak fluid, causing internal scarring and formation of a large blind spot in the center of the field of vision. Some hereditary forms of macular degeneration can affect children and adolescents. These forms of the disease are rare and can be referred to collectively as juvenile macular degeneration or dystrophy.
Risk Factors
Age is the greatest risk factor for macular degeneration, and the risk increases with age. In some people, the disease can occur as early as middle age but usually develops after age 60. People with a family history of macular degeneration are more likely to develop the disease. Risk factors include smoking, long-term exposure to sunlight, nearsightedness, coronary artery disease, high blood