Glaucoma is a progressive eye disease without symptoms until the damage has been done.

A leading cause of blindness affecting Americans of all ages, glaucoma is a progressive condition that damages the optic nerve. It’s the third most common cause of preventable blindness. By the time a patient first notices vision loss caused by glaucoma, a large percentage of the optic nerve may be irreversibly damaged. The risk of glaucoma rises significantly for people over 60, African-Americans or Hispanic populations over 40, and anyone with a family history of the disease.

A law enforcement officer with 40 years of service, George Day has known for years he is at risk for glaucoma.

“It runs in my family – my parents had it, my grandmother had it. For years, doctors have warned me about the risk. Although I don’t have it, I’m a glaucoma suspect,” reports George.

“I was referred to Dr. Fridman by my doctor of many years, Dr. Richards. He recommended Dr. Fridman because he said she was a particularly skilled glaucoma expert – and a very caring doctor, too.”

Gretta Fridman, MD, is a fellowship-trained ophthalmologist and founder of New Tampa Eye Institute.

“I liked Dr. Fridman right away. She is very personable. And she explains exactly what she’s going to do and then does it. For me, that alleviates a lot of stress.

“So far, all my treatment has been preventative,” explains George. “They’ve taken pictures of the back of my eye and checked the retinas to keep track of what’s going on. And Dr. Fridman gives me a vision check once a year.”

“It’s imperative for patients like Mr. Day to have these regular check-ups,” cautions Dr. Fridman. “And just because you have elevated intraocular pressure, that doesn’t necessarily mean that you have glaucoma. That’s why it’s important to have a dilated eye exam in the office, where your eye doctor can specifically look at the optic nerve to see whether there is any evidence of glaucoma developing.

“Mr. Day knows that because of his family history, he must be proactive about preventative treatment. This is very important. Patients like Mr. Day with a first degree relative who has glaucoma have ten times the chance of developing the condition,” cautions Dr. Fridman.

Understanding glaucoma

Glaucoma is an eye disease characterized by the gradual deterioration of the fibers of the optic nerve. If the deterioration goes untreated, it causes these fibers to atrophy. Once this occurs, the fibers are no longer able to carry visual signals to the brain. Since damage begins with the outermost optic nerve fibers, those responsible for peripheral vision, patients often don’t notice the gradual impairment until significant, irreversible damage has been done.

According to the National Glaucoma Research program, the condition takes different forms. Normal-tension glaucoma, where the pressure remains normal, results in optic nerve damage and the loss of peripheral vision. This highlights the need for a comprehensive exam, as the glaucoma will not be picked up by pressure check alone.

“Open-angle glaucoma, affecting about ninety-five percent of sufferers, develops as eye pressure gradually builds,” explains Dr. Fridman. “This pressure, unnoticed by the patient, eventually impairs the optic nerve, eliminating peripheral vision. Total blindness can result without treatment.

“Closed-angle glaucoma occurs when the normal flow of eye fluid between the lens and the iris is blocked. In the acute form, symptoms include blurred vision, nausea, vomiting, severe pain, and a rainbow halo encircling lights. This type is considered a medical emergency. Blindness may occur within a day or two without treatment. The chronic type of closed-angle glaucoma has a much slower progression and can also damage the eye without symptoms.

“Juvenile glaucoma is the name for open-angle glaucoma found in children and adolescents. Congenital glaucoma is specific to infants born with an eye defect that prevents normal drainage of fluid. Secondary glaucoma results from another eye or medical condition elsewhere in the body.

“About fifty percent of those affected by glaucoma are unaware of the condition, which typically has no warning symptoms,” reports Dr. Fridman. “Without a doubt, the best way to minimize or perhaps prevent its effects is to have regular eye exams. For patients between the ages of eighteen and sixty, we advise routine checkups every two years and annual exams for those over sixty years of age.”

Increased risk

“African-American and Hispanic patients are at increased risk for glaucoma. For these patients, screening is recommended every three to five years between the ages of twenty and twenty-nine, every two to four years between the ages of thirty and forty, and every two years beyond the age of forty. Even if glaucoma is correctly identified and treated, we want patients to understand it is a chronic condition and must be monitored for life. Vision loss resulting from glaucoma cannot be regained.

“Patients with one or more risk factors for the disease should plan on having frequent checkups. Those risk factors include: age, family history, ethnic background, elevated eye pressure, moderate to severe nearsightedness, a history of severe eye injuries or chronic eye conditions, corticosteroid use, and certain medical conditions such as hypothyroidism, diabetes, heart disease, or high blood pressure.

“There are a few more ways, in addition to regular eye exams, to protect vision from the effects of glaucoma,” confirms Dr. Fridman. “First, if the patient’s eye pressure is found to be elevated, they should be careful to follow the prescription schedule faithfully. Also, control weight and blood pressure to avoid hypertension and obesity. And because stress, along with many other factors, is said to be a possible trigger for acute closed-angle glaucoma, I encourage my patients to find healthy ways to manage stress. And finally, protect the eyes with goggles when using power tools or playing sports that hold the possibility of eye injury.

“Patients will typically notice vision loss first in peripheral, or side, vision. Because they may compensate by turning the head to the side without noticing they are doing so, significant vision loss is possible before the condition is diagnosed. If left untreated, the effects of glaucoma will progress from blind spots in the peripheral vision to tunnel vision to total blindness.

“In addition to drops, we have laser treatments, such as SLT, available in the office setting to reduce eye pressure. In more advanced stages, there are a number of surgical options available, from minimally invasive interventions to the more involved procedures, such as trabeculectomy, which is a procedure to open the drainage passages and improve the flow of the eye fluid.”

George emphasizes that Dr. Fridman is great to work with. “She’s very accessible and easy to talk with. She tells you in lay terms so you can understand instead of throwing around a bunch of big doctor words. She tells you like it is; I like that. I’d recommend her to anyone.”