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Glaucoma: Straight Talk About a Dangerous Disease

Early testing can save your sight

SUNDAY, Jan. 19, 2003 (HealthDayNews) -- Rajia Idris had struggled with vision problems for much of her life, but she never thought she'd go blind.

The 46-year-old San Franciscan started having problems with her eyes at age 9. By 17, she was diagnosed with glaucoma. Idris could see, however, and she wasn't going to let glaucoma slow her down.

She lived actively, as if nothing were wrong, until her mid-20s, when she lost all sight in her right eye and could barely see out of the left one. Finally, she realized she'd have to begin her life again, without vision.

"I knew I was going through glaucoma, but I never in my wildest dreams thought I was going blind," Idris says. "Then I couldn't see, and I realized I had no choice. I didn't want to go, but I had to go to the blind school."

"It's like relearning how to live," she adds. "I had to learn Braille, and how to use a cane to get around. They teach you how to cook and sew a button without using your eyes."

While Idris suffers from an aggressive form of glaucoma, her experience isn't uncommon. An estimated 3 million to 4 million Americans have the sight-robbing disease, making it the second leading cause of blindness in the United States, behind macular degeneration.>

However, half of those with glaucoma don't even know it, and the number afflicted in America is expected to double or triple during the next 30 years as the population ages.

Although recent advances in treatment and diagnosis have greatly improved the chances that those with glaucoma won't lose their sight, it has to be detected early. Unfortunately, the main symptom of glaucoma, loss of peripheral vision, usually doesn't appear until it's too late, which is why the illness is often referred to as the "silent thief of sight."

"The greatest sadness for me is that people don't come in early enough," says Dr. Andrew Iwach, an ophthalmologist and assistant professor at the University of California, San Francisco.

Because January is Glaucoma Awareness Month, eye doctors emphasize that people in high-risk groups -- including blacks, who are six to eight times more likely to get glaucoma; the elderly, of which 2 percent have glaucoma; or those with a family history of the illness -- should schedule eye tests to catch the "silent thief" before it sets in. New, more accurate tests let ophthalmologists detect glaucoma much earlier than in the past.

Glaucoma is most often caused by the buildup of fluid in the eye. In a normal eye, fluid cycles through continuously, nourishing the pupil, lens, iris and other essential components. However, if the drainage passage is clogged, the fluid builds up, increasing pressure in the eye.

"It's kind of a plumbing system. Part of it is a faucet and part of it is the drain, which sometimes gets clogged," says Dr. Martin Wax, head of ophthalmology research at the Pharmacia Corp. in St. Louis and a professor at Washington University School of Medicine.

The elevated pressure then pushes on the optic nerve in the back of the eye. The nerve, which has about 1 million strands, carries a visual signal from the eye to the brain. Over time, this pressure damages many of strands in the nerve, reducing the field of vision communicated to the brain. First peripheral vision goes, then straight-ahead vision, and the damage is irreparable.

"The higher the pressure, the shorter the amount of time it takes to damage the visual cortex," Wax says. "It's early detection that is the key. There are very few reasons that a person should go blind from glaucoma if it is detected early."

Once detected, glaucoma is often treated with medicated eye drops, laser surgery to improve fluid flow in the eye, or conventional surgery to open up new drainage openings.

"In many ways, we haven't improved upon the idea of draining the eye by making a hole where the fluid can drain. They started doing that in the early 20th century," Wax says.

As early detection improves, it becomes more and more important that people get eye tests, so they won't have to go through surgery.

Idris had gone through six different surgeries to try to improve her sight. Until three years ago, none of them was effective. However, a recent surgery helped slow the loss of sight in her remaining good eye, and released pressure in her eyes, easing accompanying headaches.

Still, Idris is legally blind, and can only make out the faintest images. However, she hasn't let that stop her from raising a family and tackling outdoor adventures.

"Of course, things are not hunky-dory all of the time," she says. "But it's like any grieving process, you have to eventually move on. Gradually you come to accept it, and you adapt. Now, I do things I never would have done. I do river rafting and tandem biking, and in February I'm going cross-country skiing in Alaska."

What To Do

To learn more about glaucoma awareness, read this brochure from the National Eye Health Education Program. For a detailed explanation of glaucoma, read this fact sheet by the National Eye Institute, or this one by the Glaucoma Research Foundation.

SOURCES: Andrew Iwach, M.D., opthalmologist, Glaucoma Associates of Northern California, and assistant professor, clinical ophthalmology, University of California, San Francisco; Martin Wax, M.D., senior director and head, ophthalmology research, Pharmacia Corp., and professor, ophthalmology and visual sciences, Washington University School of Medicine, St. Louis; Rajia Idris, San Francisco
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