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Sudden and severe pain in the eyes can signal glaucoma - a serious eye condition. But often, glaucoma progresses with no symptoms at all -- so regular eye checks are important to keep this silent thief of sight at bay.     

What is Glaucoma? 

Glaucoma is an eye disease, where the high fluid pressure within your eye damages the delicate fibres of the optic nerve.  These delicate nerve fibres are responsible for carrying visual impulses from your eye to the brain.  This damage is irreversible and can lead to blindness in advanced cases.  Glaucoma accounts for 40% of blindness in Singapore.

                     Normal Vision
    Vision affected by glaucoma

What causes Glaucoma?

The excessive build-up of pressure in your eye occurs because of an imbalance between fluid production and its drainage out of the eye. There are different types of glaucoma.

Primary open-angle glaucoma accounts for the majority of the cases. It affects the elderly and those who are middle-aged. The glaucoma progresses slowly and painlessly, so you may not notice that your vision is deteriorating. Peripheral and night vision will be affected before your central reading vision. 


Optic nerve damaged by glaucoma 

Acute angle closure glaucoma usually affects elderly and middle-age Chinese women in Singapore. The onset of this form of glaucoma is sudden with the eye pressure rising rapidly and dramatically in the eye. This results in eye pain and redness, headache and nausea. Other accompanying symptoms include blurred vision and seeing of coloured rings around lights.

Chronic angle-closure glaucoma progresses gradually and often goes unnoticed for a long time. It is caused by the progressive blockage of drainage channels in the eye causing a slow, prolonged rise in eye pressure.

Secondary glaucoma is usually the result of a pre-existing eye condition such as inflammation, severe diabetic eye disease and tumors.  Previous eye injury or surgery as well as long term steroid use may also cause secondary glaucoma.    

How do I know if I have Glaucoma?

The disease can develop slowly and you may not be aware of the gradual loss of sight until very late in the disease when your vision is seriously affected.

This is an interactive illustration demonstrating the loss of the field of vision at different stages of glaucoma severity.

  • Please use the mouse, click and hold down the blue arrow.

  • As you begin to slide the blue arrow towards the right, you will see a magnified view of a normal healthy optic nerve in the right box.

  • As this optic nerve is normal and healthy, the field of vision shown on the left box is normal.
    However once a patient develops glaucoma, there is progressive optic nerve damage from the loss of healthy nerve fibres (see right box image), thus leading to progressive loss of the visual field.

  • The patient will experience this as a progressive 'tunnelling' of vision or constriction of the field of vision (see left box image).

  • This is illustrated by sliding the blue arrow between the points indicating "Early Glaucoma" and "Advanced Glaucoma".        

What puts me at risk of Glaucoma?

• Age – your risk increases once you are over 50 years old. In Singapore, glaucoma affects about
  3 percent of those aged over 50. This risk increases with age; the percentage of people aged
  over 70 affected by glaucoma is 10 percent
• Chronic diseases – you are at an increased risk of certain types of glaucoma if you have diabetes
   and high blood pressure
• Ethnicity – Asians and Afro-caribbeans are more susceptible to certain types of glaucoma than
• Eye injuries
• Extreme nearsightedness or shortsightedness
• Family history of glaucoma
• Use of steroids  

What can I do to prevent Glaucoma?

Most risk factors of glaucoma such as age, hereditary risk and race cannot be prevented. If you have a family history of glaucoma or are taking medications that put you at risk, regular eye examinations are essential (Find out the importance of an eye examination). Early diagnosis is the key to prevent blindness as glaucoma nerve damage is irreversible.   

What kinds of treatments are available for Glaucoma?

Glaucoma cannot be cured, but it can be successfully controlled in most cases. Treatment depends on the type and severity of glaucoma and it may be in the form of medication, laser therapy or surgery.

Our Glaucoma Consultants at SNEC perform various glaucoma surgeries for both paediatric and adult patients.  The glaucoma surgeries include:

▶ Goniotomy
▶ Trabeculectomy with anti-metabolites
▶ Combined Trabeculectomy (with anti-metabolites) and Cataract surgery
▶ Glaucoma Drainage Devices such as the Ahmed and Baerveldt tubes as well as novel devices such
   as the ExPRESS mini shunt.
▶ Goniosynechiolysis

Your doctor will determine the most appropriate individualised treatment for you after a detailed clinical evaluation.

Clinical Outcomes

The Glaucoma Service at SNEC conducts an independent surgical audit annually. The success rate of a surgical procedure is evaluated and defined as an achievement of an intraocular pressure of less than or equal to 21mmHg at the end of the first postoperative year.  In the 2010 surgical audit, the overall success rate of a trabeculectomy surgery in primary glaucoma was 98.8%, while that of an aqueous shunt surgery was 94.6%.  The overall success rate for a combined trabeculectomy and cataract surgery was 98.5%.  Our surgical results are in keeping with all established international indicators for surgical success, reflecting our delivery of world-class glaucoma care.   

Please visit the following relevant links :- 

Glaucoma Service
Outcome Results on Glaucoma Procedures
Glaucoma Clinical Staff
I Want an Eye Examination / an Appointment
Importance of Eye Examination
How the Eye Works
SNEC Smartphone Apps for Patients

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