Glaucoma is a condition that affects the eye and causes changes in your vision, which can lead to blindness. As you age you become more at risk for glaucoma, therefore it is especially important for you to know the risks as well as the warning signs in order to protect your eyesight and prevent injuries. When discussing glaucoma we want you to know what it is, who is at risk and what may be happening to your eyesight if you have this disorder. We will also cover the tests for glaucoma, why it is important, and when you should have the tests done. There are different treatments for glaucoma and we will explain how these tests are done and what the goals are of each.
Glaucoma is caused by increased pressure in your eye. A normal eye has fluid known as aqueous humor, which helps to maintain the shape of the eye. If the flow of that fluid is interrupted, pressure can build up and put stress on the optic nerve, which produces your vision. The stress on the optic nerve causes gradual loss of eyesight. The loss of sight begins on the sides (known as peripheral vision) and if not treated can lead to blindness.
The most common reasons for people to get glaucoma are: their age (over 60), infection, tumors, trauma, family history, diabetes or anything that interrupts the flow of the fluid in the eye. Glaucoma is described as seeing halos around lights. Another common complaint is tunnel vision; Imagine if you had on sunglasses and we took a paintbrush and painted white paint on the outside of the lenses. Now imagine that we started painting on the outside and left just a small hole in the middle of the glasses for you to see through; that is tunnel vision. It is very hard for people with tunnel vision to see to the side without having to turn their heads and body. Tunnel vision can cause problems with the ability to judge distances and make many of the day’s activities much more difficult and dangerous. If you have glaucoma you may also have mild aching or pressure in your eye and other vision problems that are not improved with eyeglasses.
It is necessary to see a doctor and discuss any difficulties that you are having with your vision. Glaucoma can either be very slow or quite fast to occur, depending on the type. It is also a major cause of blindness in older adults, so regular eye tests are very important. Some of the tests for glaucoma include reading the eye charts and testing what and where you can see.The doctor will also perform further tests, to measure the pressure in your eye. These tests will let the doctor know how to treat your specific glaucoma. Again, these tests should not cause pain. Detecting glaucoma early is so important because treatment can not return eyesight that has already been lost.
Treatment for glaucoma focuses on slowing the damage to your optic nerve, which means lowering the pressure in your eyes. The treatment options available are medications, laser and surgery. The success of treatment for glaucoma depends on your learning about the disease, which includes using your medications correctly and getting regular checkups to lower the chance of problems. Medications such as eye drops, pills and liquids that you drink are normally used before surgery is considered. If these medications cannot control the pressure in your eye, then surgery must be performed. Surgery is done with either a laser or an incision (cut) and simply creates an opening to allow fluid to drain from the eye; this will reduce the stress on the optic nerve. The surgery usually takes less than one hour and although there may be some burning or stinging, it should not be painful.
Interim HealthCare staff is trained to assist you before and after glaucoma surgery, if you need or want assistance before surgery the goal is to aid you in avoiding injuries that may occur due to poor vision. The staff will help you prepare your home to make sure that it is safe and allows you to live as independently as possible. Interim HealthCare staff will let you know which items may be dangerous to you, such as throw rugs, clutter or cords. Lighting will be checked to make sure that you are able to see as well as possible, especially if you have stairs or other obstacles. Your bathroom will be assessed for any areas that may be dangerous and also for safety equipment that might be needed. Furniture and beds will be tested to make sure that they are secure and safe for you to get in and out of, and also to see if you have a phone or assistive device such as a call light close by. The kitchen is also an area of concern and the staff will help you to organize the space in the safest way possible. Labeling faucets, stoves, thermostats and other hazardous objects will help you to prevent burns and injuries. Creativity and planning ahead, using items like pill boxes, large-print reading materials, voice-activated switches, electronic timers and
other equipment will allow you to remain at home in a safe environment for as long as possible.
Here is a short review on Glaucoma:
• High pressure in eye which damages the optic nerve
• Risk factors include:
– Age
– Infection
– Tumors
– Trauma
– Family history
– Diabetes
• Signs and Symptoms:
– Eye pain
– Loss of peripheral (side) vision
– Seeing halos around lights
• Complications include:
– Blindness
• Open Angle vs. Closed Angle Glaucoma:
o Open Angle is chronic
Insidious onset and slow progression
Mild aching in the eye
Loss of peripheral vision
Loss of visual acuity un-correctable with glasses
Seeing halos around lights
o Closed Angle can be acute
Ophthamalic Emergency!!
Rapid onset
Unilateral pain and pressure over affected eye
Moderate pupil dilation
Nonreactive to light
Cloudy cornea
Photophobia (sensitivity to light)
Decreased or blurred vision
Seeing halos around lights
• Diagnostic and Laboratory Tests for Glaucoma
o Tonometry (measures intraocular pressure)
o Silt-lamp examination (visualize cornea)
o Gonioscopy (determines angle of anterior chamber of eye)
o Visual field test
• Pharmacology for Glaucoma
o Topical beta blocker (betaxolol, Timoptic) eye drops
o Epinephrine
o Diuretics
o Miotic eye drops (pilocarpine)
• High pressure in eye which damages the optic nerve
• Risk factors include:
– Age
– Infection
– Tumors
– Trauma
– Family history
– Diabetes
• Signs and Symptoms:
– Eye pain
– Loss of peripheral (side) vision
– Seeing halos around lights
• Complications include:
– Blindness
• Open Angle vs. Closed Angle Glaucoma:
o Open Angle is chronic
Insidious onset and slow progression
Mild aching in the eye
Loss of peripheral vision
Loss of visual acuity un-correctable with glasses
Seeing halos around lights
o Closed Angle can be acute
Ophthamalic Emergency!!
Rapid onset
Unilateral pain and pressure over affected eye
Moderate pupil dilation
Nonreactive to light
Cloudy cornea
Photophobia (sensitivity to light)
Decreased or blurred vision
Seeing halos around lights
• Diagnostic and Laboratory Tests for Glaucoma
o Tonometry (measures intraocular pressure)
o Silt-lamp examination (visualize cornea)
o Gonioscopy (determines angle of anterior chamber of eye)
o Visual field test
• Pharmacology for Glaucoma
o Topical beta blocker (betaxolol, Timoptic) eye drops
o Epinephrine
o Diuretics
o Miotic eye drops (pilocarpine)
References:
Allender, J., & Spradley, B. (2005). Community Health Nursing (6th ed.).
Philadelphia: Lippincott Williams & Wilkins.
Black, J., Hawks, J., & Keene, A. (2001). Medical-Surgical Nursing (6th ed.).
Philadelphia: W.B. Saunders Company. Allender and Spradley.
Cass, P., Luckmann, J., Nigro, C., Schlapman, N., & Timby, B. (2002). Content
Mastery Series Registered Nurse Medical-Surgical Review Module (4.1
ed.). United States: Assessment Technologies, LLC.
Cleveland Clinic Cole Eye Institute. (2004, October). Cataract Surgery. Retrieved
October 17, 2005, from http://my.webmd.com
Division of Aging and Seniors Health. (1999). Communicating with Seniors
[Brochure]. Ottawa, Ontario.
Ellman, M. (2005). Glaucoma Surgery. Retrieved October 17, 2005, from
http://www.somersetmedicalcenter.com
Jarvis, C. (2000). Physical Examination and Health Assessment (3rd ed.).
Philadelphia: W.B. Saunders Company.
Knolle, G. (2004, August 3). Cataract Awareness. Retrieved October 17, 2005,
from http://my.webmd.com
Porth, C. (2002). Pathophysiology Concepts of Altered Health States (6th ed.).
Philadelphia: Lippincott Williams & Wilkins.
Rayfield, S., & Manning, L. (2004). Nursing Made Insanely Easy (4th ed.).
Bossier City, LA: I CAN Publishing.
Allender, J., & Spradley, B. (2005). Community Health Nursing (6th ed.).
Philadelphia: Lippincott Williams & Wilkins.
Black, J., Hawks, J., & Keene, A. (2001). Medical-Surgical Nursing (6th ed.).
Philadelphia: W.B. Saunders Company. Allender and Spradley.
Cass, P., Luckmann, J., Nigro, C., Schlapman, N., & Timby, B. (2002). Content
Mastery Series Registered Nurse Medical-Surgical Review Module (4.1
ed.). United States: Assessment Technologies, LLC.
Cleveland Clinic Cole Eye Institute. (2004, October). Cataract Surgery. Retrieved
October 17, 2005, from http://my.webmd.com
Division of Aging and Seniors Health. (1999). Communicating with Seniors
[Brochure]. Ottawa, Ontario.
Ellman, M. (2005). Glaucoma Surgery. Retrieved October 17, 2005, from
http://www.somersetmedicalcenter.com
Jarvis, C. (2000). Physical Examination and Health Assessment (3rd ed.).
Philadelphia: W.B. Saunders Company.
Knolle, G. (2004, August 3). Cataract Awareness. Retrieved October 17, 2005,
from http://my.webmd.com
Porth, C. (2002). Pathophysiology Concepts of Altered Health States (6th ed.).
Philadelphia: Lippincott Williams & Wilkins.
Rayfield, S., & Manning, L. (2004). Nursing Made Insanely Easy (4th ed.).
Bossier City, LA: I CAN Publishing.
