Glaucoma Awareness

Interview with Dr. Robert Fechtner

Spencer Platt/Getty Images News/Getty Images

Glaucoma is an eye disease often referred to as the sneak thief of sight because most types of glaucoma have no symptoms. Glaucoma is usually caused by chronic elevated eye pressure that causes damage to the optic nerve. If left untreated, glaucoma can cause significantly reduced vision. During March of each year, the World Glaucoma Association promotes World Glaucoma Week to promote glaucoma awareness.

Dr. Robert Fechtner is the Executive Vice President of the World Glaucoma Association. In addition to this role, he is also a Professor of Ophthalmology, Director of the Glaucoma Division at Rutgers New Jersey Medical School and sits on the editorial boards of a number of glaucoma and vision journals. In order to learn more about World Glaucoma Week, I asked Dr. Fechtner to elaborate on the following questions.

What is the World Glaucoma Association?

The World Glaucoma Association is a large, independent, global organization founded to share information about the science and care of glaucoma. The association holds the World Glaucoma Congress annually and invites physicians, researchers, nurses, technicians and patients to come together to share, network and learn more about glaucoma. The World Glaucoma Congress is the largest glaucoma conference in the world. In addition to information sharing, there is also a large technical exhibit area that is available to learn about the latest diagnostic and therapeutic technology.

What happens during World Glaucoma Week?

Besides holding the congress, many glaucoma societies and patient groups arrange activities and campaigns and post them to the World Glaucoma Association website for all to view. This year there is a movement all over the world to hold a “B.I.G” breakfast. B.I.G.

translates to “beat invisible glaucoma.” Many of these events are held at a local, community level to bring awareness to glaucoma. Glaucoma is often referred to as the "sneak thief of sight" so awareness is key in receiving an earlier diagnosis and treatment. The best way to beat glaucoma is to bring awareness to our communities so people will know to get tested for glaucoma.

How do you explain the disease of glaucoma to patients?

It is really a challenge to explain to somebody a disease that has no symptoms. Glaucoma is not only about elevated eye pressure but also about the damage that occurs inside the eye to the optic nerve itself. The optic nerve is the nerve cable that connects the eye to the brain. There are many tests that check for glaucoma but one of the very best tests is to have your experienced doctor physically see you in their office and visualize the optic nerve and look for damage. Then, he or she may order additional tests such as visual field testing or nerve fiber analysis to further support and show you what is going on in the eye. Once again, the most important part of glaucoma testing is to simply let your eye doctor look at your eye and your nerve. People often get caught up in what the actual eye pressure number is.

Eye pressure is very important, but eye pressure alone plays a smaller part in the overall scheme of a glaucoma patient.

Is there a normal range of what eye pressure should be?

Statistically, average eye pressure is less than 24 mm Hg. However, there are some individuals that can have eye pressure above 24 and not develop glaucoma and some with eye pressure lower than 24 that seem to develop significant glaucoma. Eye pressure varies daily and even changes from hour to hour during the day. We used to consider 16 mm Hg an average or normal eye pressure and we used to define glaucoma as pressure above 21.

However, we are learning not to categorize it this way but instead look at other factors, not only the level of the pressure. When I think about defining glaucoma, I think about what that eye pressure number is doing to that particular eye. Each person should be looked at individually. Although eye pressure is still the center of treatment, we are starting to look more at what the average trend of that person’s eye pressure is rather than trying to get the pressure down to a certain number.

Does having a family history of glaucoma increase your risk of developing the disease?

Having a first degree relative, a sibling or parent, with glaucoma raises your risk about 10 fold. If you have a family history of glaucoma, you should be getting your eyes examined regularly because you are at increased risk. The American Optometric Association and the American Academy of Ophthalmology both have good guidelines to follow as far as eye exam schedules go but depending on age and family history, I believe it is very important that young people under 18 years of age have at least one comprehensive eye exam where their eye is examined carefully from front to back. Then, I would have an examination every couple of years depending on health and family history.

Do any systemic diseases raise your risk for developing glaucoma?

Diabetes and hypertension are the two most common systemic conditions that put someone at risk for glaucoma. In fact, if you have either of these two conditions, you should be having an annual eye examination anyway.  Another systemic condition that many people do not hear about often is pseudoexfoliation syndrome. This condition carries a fairly high risk of glaucoma.

Besides using pressure lowering eye drops, is there anything else people with glaucoma can do to lower their risk of glaucoma progression?

First and foremost, using medicational eye pressure lowering eye drops is the most important key to preventing progression of glaucoma. However, we do recommend things that may be considered complimentary to traditional medical care. For example, a heart-healthy lifestyle is good for the eyes.  There are some studies that show that vitamin supplements are good for eye health, but it is important to note that these are done in addition to medication, not in place of medication. Recently, marijuana has received a lot of attention as an alternative treatment of glaucoma. Marijuana does lower eye pressure a bit but the duration of action of the active ingredient is quite short so a person would have to ingest so much that they would be very intoxicated and most would consider that an adverse effect.

Will glaucoma cause blindness?

When patients are diagnosed with glaucoma they are often very concerned and ask, “Doctor, am I going to go blind?" Almost everyone with glaucoma in which the condition is detected early and treated effectively preserves good vision for their entire life. When glaucoma is detected late, there is a risk of vision loss. The World Glaucoma Association is working very hard to promote World Glaucoma Week to raise the awareness of glaucoma so that it is detected very early. Get tested and find out if you have a risk for glaucoma, because the treatment could save your sight.