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Did you know Glaucoma is often termed as the ‘Silent Thief of Sight’ because it is largely symptom-free and a large proportion of people with this condition are unaware of it at the time of diagnosis?
Glaucoma is an eye condition characterised by a progressive loss of vision due to progressive loss of axons in the optic nerve. The initial vision loss is mainly peripheral and not readily noticeable, and the patient may not experience any symptoms until late in the disease when most of the vision has already been irreversibly lost.
Based on World Health Organization (WHO) Global Data Bank on Blindness, glaucoma accounts for 5.1 million of the estimated 38 million blind in the world and is also the leading cause of irreversible blindness worldwide. In Singapore, approximately three per cent of people over the age of 40 have glaucoma. This percentage increases with age and reaches almost 10 per cent for those over the age of 70.
Glaucoma is classified according to the configuration of the angle (the part of the eye mainly responsible for drainage of aqueous humor) into primary open angle and angle closure glaucoma, and by intraocular pressure into normal and high-tension glaucoma.
While there is no cure for Glaucoma, treatment can prevent the condition from worsening to the point of blindness. Eye drops are usually prescribed to reduce the pressure and control the disease, but in advanced cases, laser therapy or surgery may be needed.
For March’s ‘Ask the Specialist’ forum, Dr Fiona Lim, Consultant with the Glaucoma Department at Singapore National Eye Centre (SNEC), a member of SingHealth group, answers your questions about the causes, symptoms and treatments for this sight blinding condition.
This forum is open from 1 Mar to 26 Mar 2021.
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If you have problems posting your questions, please email your questions to marcom@healthxchange.com.sg
Kindly note: Your question will only go live / appear on this page after the doctor answers it
Hello there, Dr.Fiona Lim.
How are you,hope you are well with your loving family. 2 to 3 days ago my vision blurry,and wondering what causes it.I believed my PC,are the culprit because I was doing couple of assessment for work, IS THIS THE CAUSE OF IT? or something elses.
However, how can I get back my sight as normal, currently trying to sleep early by 8pm and get up at 5.00am. Your advise be much appreciated.Please Help. Thank You.
Answered by Dr Fiona Lim, Consultant with the Glaucoma Department at Singapore National Eye Centre (SNEC)
Hi
Thank you.
If you experience blurring of vision for the past 2 days and it is not better, it is best you come and see an ophthalmologist to examine your eyes clinically to find out the cause. It is unlikely to be related to your sleeping timings.
I recently did a glaucoma test where my eye pressure is normal but the light test suggests that one of my optic nerve might not be sufficiently sensitive to light. Is this a possible glaucoma? I am 36 years old and myopic.
Hi,
For the light test, I presume you mean the Humphrey Visual field test? We have to assess your visual field pattern before we can make a proper analysis. It will be great if you can come for an eye consult for us to assess your optic discs and visual field to determine if you have glaucoma.
My mum was recently prescribed oral med to slow down the process. She feels that the med causes constipation. Is it true?
Can she reduce dosage to once a week instead of daily?
Can I enquire which is the oral medication that was prescribed to her? Is it Diamox (acetazolamide)? If the medication is Diamox, constipation is not a common side effect. In fact, it is more likely to cause diarrhoea instead of constipation. She should consult her doctor first before making changes to her medication regime.
Hello, My father has Gloucoma and I'm concern on my vision too as I've problem in reading smal characters even with my glasses,
I'm 54 years of age now, a Singaporean and would like to know how can I have a proper test to confirm and take all the possible prevention to prevent gloucoma,
Thanks in advance and appreciate your advice.
If your father has glaucoma, you should get yourself screened for glaucoma. You can see an ophthalmologist for a visual acuity assessment and eye examination and we will proceed with appropriate glaucoma tests from there.
Since Glaucoma is basically symptom free, where do I go for a basic eye check? Or any other signs to look out for? I am 42 years old.
You may go for a basic eye check with any ophthalmologist at your convenience. SNEC and other government institutions also hold regular eye screenings and you may keep a look out and register for them.
Open angle glaucoma is usually asymptomatic and symptomatic loss of visual field is usually a late sign. Acute angle closure can present with eye pain, tearing, blurring of vision, haloes, vomiting and headache.
What is the symptoms? Is it hereditary?
Open angle glaucoma can be asymptomatic. Subjective visual field loss is often a late sign.
Acute closed angle glaucoma can present with eye pain, redness, discomfort, nausea, vomiting and headache.
Those with a family history of glaucoma in a first degree relative is at risk of developing glaucoma.
I heard that the relatively new iStent / iStent inject surgeries are much less invasive than the traditional surgeries. How does one choose between drops, laser surgery, and others?
Istent is a type of minimally invasive glaucoma surgery, however, not everyone is suitable for it.
Usually the ophthalmologist will recommend treatment (whether drops, laser or surgery) depending on your disease severity, whether you have a preexisting cataract and your type of glaucoma. Everyone’s treatment is individualised.
Glaucoma is indeed something we need to be aware of. Since it might be too late when we have to consult an eye doctor on the matter, are there self-help preventive measures that we could adopt on a regular basis? Thank you for reply.
There are no self help preventive measures. The only way is early detection from early screening, so that one can receive treatment early to prevent progression.
Posted by Pauline
Dear Dr Lim, wish you are well and safe!
My eye pressures were found high and laser surgery was done, however, I have the tendency of red eye(s) both before and after the surgery, wonder if it is relevant? Would appreciate your kind attention, thank you.
Hi, thank you.
May I ask which type of laser procedure you underwent? If you had red eyes even before the laser procedure, it is unlikely that the laser procedure resulted in your red eyes. It would be best to get an eye check to investigate the cause of your red eyes.
Follow-up question by Pauline
Dear Dr Fiona Lim,
Thank you for your kind reply, the laser surgery I had was to prevent acute attack, and yes my red eye issue occurred even before the laser surgery hence non related, however wondering if it is a sign for future glaucoma or something?
I realised too that for the past few red eyes incidents, they occurred after I carried heavy items like dumbbells or groceries. Is this a concern?
Thank you for your kind attention.
Based on your history alone, it occurs after you carry heavy objects and straining it could be subconjunctival hemorrhage, it doesn’t prognosticate for glaucoma. However, it is hard for me to give you a diagnosis without examining your eye, hence when it happens it is best to consult an eye doctor to examine you clinically.
Posted by Albert
What is the difference between Glaucoma and Diabetic Eye. Any preventive measure and what type of treatment necessary. Is there an option using medication. Thank you.
Glaucoma and diabetic retinopathy are two completely different entities.
Glaucoma is a form of optic neuropathy characterized by a progressive loss of vision due to progressive loss of axons in the optic nerve.
Diabetic retinopathy occurs in diabetic patients. It is a diabetes complication that affects the eyes by causing damage to blood vessels of the retina.
If you have been diagnosed with glaucoma, the doctors will advise you on the treatment that is best suited for you. Treatment includes eyedrops, laser procedures and surgery. Yes, medication in the form of eyedrops are often given to control the intraocular pressure in glaucoma.
Posted by Patrick
Hi, recently I made a visit to my GP for sty but my GP pick up signs of glaucoma after a thorough check. He recommended me a referral to SNEC and the appointment is about 2 months away. Is there anything I can do in the meantime?
If your GP pick up signs of glaucoma you should come for an eye check to investigate for glaucoma. You should call up SNEC to ask for an earlier date.
Posted by David
Hi, I am a 70-year-old male with no known health issue. My eyesight has been pretty good up to now. I do not need to wear spectacles unless I am reading fine prints.
Recently I have a vision of a black circle in my right eye when I woke up from my afternoon nap and it seems to be floating around. Could this be a sign of glaucoma? Appreciate your answer. Thanks.
Your symptoms sound more like a floater than glaucoma. Nonetheless you should get your eyes checked if you have an acute onset of floaters.
Posted by Calvin
Hi, is there any link/relation between glaucoma and sleep apnoea?
Yes. Several papers in literature have published the association of glaucoma and sleep apnoea. Hence, patients with obstructive sleep apnoea should be screened for glaucoma.
Good afternoon ! Thank you for your kind reply, the laser surgery I had was to prevent acute attack, and yes my red eye issue occured even before the laser surgery hence non related, however wondering if it is a sign for future glaucoma or something?
I realised too that for the past few red eyes incidents, they occured after I carried heavy items like dumbbells or groceries. Is this a concern?
Thank you for your kind attention and hope to hear from you again.
Stay well and safe !
Regards, Pauline
Posted by Daniel
Posted by Alice
Dear Dr. Fiona Lim
I wear glasses for long sightedness when I’m driving. I don’t use my glasses when I move around. Hence, what are the symptoms that would tell me that I might be having glaucoma? Black spots when I move my eyes? Blurry when I see objects far away without my glasses? Please advise. Thank you.
P.S. Are these symptoms common for a 70 year old senior?
The symptoms that you described above are not typical of glaucoma and not uncommon for a 70 year old.
Glaucoma can be the open angle or closed angle type. Open angle glaucoma tends to be asymptomatic until advanced. Symptomatic visual field loss tends to be a late sign of disease. If the closed type of glaucoma present with acute angle closure, it can present with eye pain, blurring of vision, headache, nausea and vomiting.
Based on your history, it seems you have a refractive error which may need glasses, it is good to have that checked. If you experience black spots which move when you look around, it could possibly be floaters — if sudden onset and persistent, you should see an ophthalmologist for an eye examination.
Posted by LCT
Is high eye pressure the only sign of Glaucoma? What tests do I need to confirm a diagnosis? Is visual field test necessary for follow-up eye checks? Besides the expensive eye drop Simbrinza, is there other alternative eye drop? What is the long term side effect taking Simbrinza?
I have high blood pressure, high cholesterol, enlarged prostate. How can I best manage them together?
No, high eye pressure is not the only sign of glaucoma, there is an entity called normal tension glaucoma. We usually perform clinical eye examination, Humphrey visual field, a structural test in the form of optical coherence tomography of the retinal nerve fibre layer, measure the central cornea thickness and document disc appearance with disc photos. Yes, visual field test is very important for us in the follow up of glaucoma to assess for disease progression. Yes, besides simbrinza, there are alternative eyedrops and your doctor may assess your suitability for them. Some side effects of simbrinza that patients may experience include dry and red eyes, follicular conjunctivitis, allergic conjunctivitis and dry skin around the periorbital region.
It is good to let your treating physician know your medical history, so we can provide you with the most appropriate treatment. Currently, there is no absolute contraindication of any of the intraocular pressure lowering eyedrops with high blood pressure, high cholesterol and enlarged prostate.
Posted by Christopher
Dear Dr Lim,
With reference to glaucoma, I have experienced on many occasions temporary blurring of peripheral vision characterised by water-like reflective glaring from the outer corners of both eyes. This condition will last for 10-15 minutes each occurrence before normal vision returns. The condition does not last for more than 1 hour on each occasion before normal vision returns. Closing my eyes and resting helps to faster bring back normal vision. I do have some degree of astigmatism.
Your advice is much appreciated.
Glaucomatous damage is often permanent with no recovery after rest. Hence, what you described are probably not symptoms related to glaucoma. However, without an eye examination, we cannot rule out any ocular pathology and you should go for an eye check if you are concerned.
Posted by Victor
Hi, how is normal pressure Glaucoma being treated, since it is normal pressure, still need to reduce pressure? Is the COSOPT eyedrop only medicine for this treatment, any other medicine or other treatment available?
Yes, we treat normal tension glaucoma by lowering intraocular eye pressure. The term normal tension glaucoma refers to a particular form of open angle glaucoma characterized by glaucomatous optic neuropathy in patients with intraocular pressure (IOP) lower than 21mmHg (the value of 21 based on 2 standard deviations above population mean). However, in some patients, especially those with thin corneas, the target IOP of 21 may not be enough to prevent optic nerve damage. Hence, we often say target IOP is different for every glaucoma patient and glaucoma treatment is individualized.
No, cosopt is not the only medication. There are a number of other intraocular pressure lowering eyedrops which can be used which your ophthalmologist can prescribe based on your condition. Glaucoma can also be treated with surgery or laser.
Posted by Julie
Hi Dr. Lim,
I am 57 years old and wearing glasses. My dad has Glaucoma.
Should I make an appointment for a review or should I visit a polyclinic for an eye test first. Thank you & appreciate your advice.
If your father has glaucoma and you are 57 and have not have had an eye check, it is best you make an eye appointment for a review. We currently don’t do glaucoma testing in polyclinic yet.
