Specialists from the Glaucoma Department at Singapore National Eye Centre (SNEC), answer your questions on the causes, symptoms and treatments for glaucoma.
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 often termed 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 a group of diseases that damage the nerve at the back of the eye, often associated with increased eye pressure, thereby resulting in vision loss and blindness.
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.
There are four main types of Glaucoma, namely:
Open angle glaucoma,
Angle closure glaucoma,
Secondary glaucoma and
Congenital glaucoma
1. Open angle glaucoma
In open-angle glaucoma, the eye’s drainage canals become clogged over time. It accounts for majority of glaucoma cases in most countries. It is often asymptomatic and progresses slowly. The rise in intraocular pressure is often slow and painless.
2. Closed-angle glaucoma
In closed-angle glaucoma (sometimes also termed “narrow angle” glaucoma), the drainage angle between the iris and cornea is closed, reducing fluid drainage and causing increased eye pressure. It can be either acute or chronic. The acute form of glaucoma is characterised by a sudden, dramatic increase in intraocular pressure which results in severe eye pain, redness, blurred vision, and the appearance of haloes around lights. Headaches, nausea, and vomiting may follow. This is a medical emergency which requires prompt treatment.
3. Congenital glaucoma
Congenital glaucoma is rare and usually occurs at birth. Enlargement of the infant’s eyes, corneal haze, tearing and unusual light sensitivity are symptoms that warrant an eye examination.
4. Secondary glaucoma
Secondary glaucoma is caused by conditions such as poorly controlled diabetes, inflammation of the eye, tumours, previous eye surgery, injuries or cataracts in their advanced stages, or the use of steroid medications on the eye.
Treatments for glaucoma
While there is no cure for glaucoma, treatment is aimed at reducing eye pressure, so as to control the disease and prevent it from worsening to the point of blindness. Eye drops are often prescribed in most patients, but in certain cases, laser therapy or surgery may be needed.
In this ‘Ask the Specialist’ forum, specialists from the Glaucoma Department at Singapore National Eye Centre (SNEC), a member of SingHealth group, answer your questions on the causes, symptoms and treatments for this sight blinding condition.
This 'Ask the Specialist' forum has closed. Thank you for your interest and participation.
1. Question by p********
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 Lim:
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.
2. Question by p********
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.
Answered by Dr Lim:
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.
3. Question by c*******
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?
Answered by Dr Lim:
Hi,
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.
4. Question by K*******
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.
Regards.
Answered by Dr Lim:
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.
5. Question by v***********
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.
Answered by Dr Lim:
Hi,
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.
6. Question by C******
If someone has lower pressure glaucoma, how can eye drop help to control glaucoma? Are they any other way to address the optic nerve issue? Is there any supplement that will help?
Answered by Dr Lim:
Hi,
I presume you are referring to the type of glaucoma called normal tension glaucoma. We treat normal tension glaucoma by lowering intraocular eye pressure (IOP) with eyedrops. The term normal tension glaucoma refers to a particular form of open angle glaucoma characterized by glaucomatous optic neuropathy in patients with 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.
As for supplements, there are several studies ongoing that investigate agents with neuroprotective effect. Some of these including brimonidine eyedrops (which is also one of the eyedrops used for its IOP lowering effect), gingko biloba and vitamin B3 have shown promise but large scale clinical trials are inconclusive or still on the way.
7. Question by k********
My mother has severe dry eyes and also severe glaucoma. The eye drops for dry eyes, according to the doctor, worsens the condition for glaucoma. Is there anyway to go around that, as my mother has opted for the glaucoma eye drops and stopped her medication for dry eyes, relying only on refresh now to lubricate her eyes. Laser for glaucoma does not seem to be a good option as she has gone for laser, only to have complications which resulted in two additional emergency procedures. Any advice would be much appreciated.
Answered by Dr Lim:
Hi,
Refresh is one of the brands of lubricant eye drops in the market. She can instill her lubricant eye drops at least 10-15 minutes apart from her glaucoma eyedrops. Lubricant eyedrop does not worsen the glaucoma but it will dilute the concentration of glaucoma eyedrops and make it less effective if instilled at the same time.
Further treatment options will depend on her condition and her glaucoma specialist will assess her clinically before deciding on the best option.
8. Question by E********
What are the symptoms of Glaucoma and what are the differences between Glaucoma and Cataract? Will diet and/or supplements help to slow down the progression of Glaucoma?
Answered by Dr Lim:
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.
Glaucoma and cataract are 2 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. Cataract is a condition in which the lens of the eye becomes cloudy, preventing sufficient light from entering the eye, therefore reducing vision.
Currently there is no special diet which is scientifically proven to slow down the progression of glaucoma.
9. Question by J****
I'm currently 42 and for the past 3 weeks have experience twitching of eye muscle on right eye and can feel pressure difference between left and right eye. I thought it was from eye strain n would go away but it has been 3 weeks and am concerned it could be something else, I saw a doctor who diagnosed it as active oil gland but 4 days into treatment with antibiotics n eye solution, there doesn't seem to be any relief from the symptoms, could this be glaucoma? Test was done which the doc said the pressure seems fine, hence am not treated for glaucoma, would like to check if the above are indeed symptoms of active oil gland or if it is serious eye strain or potentially early glaucoma?
Answered by Dr Lim:
Hi,
Glaucoma does not typically cause twitching of the eyelid muscle — glaucoma is most commonly asymptomatic at early stages. Your symptoms could be related to ocular surface problems as your doctor mentioned but it is very hard for us to comment or make any diagnosis without examining your eyes, so I suggest you come and see us or any ophthalmologist for second opinion if you are concerned.
10. Question by d**********
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.
Answered by Dr Lim:
Hi,
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.
11. Question by Anonymous
I'm a Glaucoma patient on long term eye drops daily. What's the latest development to replace costly and inconvenience of daily eye drops, besides eye surgery?
Answered by Dr Lim:
Hi,
Unfortunately, glaucoma is a condition which needs long term follow up. Besides eyedrops, there are other treatment options including laser and surgery (including the more recent minimally invasive glaucoma surgery) but treatment is individualized to your condition and your doctor will advise you on what is best for your condition.
12. Question by H*******
Hi my mom complained she cannot see newspaper clearly over time after her second cataract Ops. So she gave up reading newspaper. But she can see tablet, not sure due to brighness of screen compared to newspaper.
Can advise how and where to test whether due to glaucoma?
Answered by Dr Lim:
Hi,
Does reading glasses help her with reading newspaper? Based on what you have described, her symptoms could be due to presbyopia. It is possible that the font size in the tablet is bigger allowing her to read more easily.
You can get her checked by any ophthalmologist at your convenience to rule out any pathological cause of blurring if vision—we will screen for glaucoma at the same time. It is also good to get a refraction and near vision check for her as well, which can be done in the eye clinic or any optometrist in the optical shop.
13. Question by J*******
What is the symptoms? Is it hereditary?
Answered by Dr Lim:
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.
14. Question by c******
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?
Answered by Dr Lim:
Hi,
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.
15. Question by N******
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.
Answered by Dr Lim:
Hi,
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.
16. Question by P******
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.
Answered by Dr Lim:
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 P******
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.
Answered by Dr Lim:
Hi,
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.
17. Question by A*****
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.
Answered by Dr Lim:
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.
18. Question by P******
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?
Answered by Dr Lim:
Hi,
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.
19. Question by D****
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.
Answered by Dr Lim:
Hi,
Your symptoms sound more like a floater than glaucoma. Nonetheless you should get your eyes checked if you have an acute onset of floaters.
20. Question by C*****
Hi, is there any link/relation between glaucoma and sleep apnoea?
Answered by Dr Lim:
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.
21. Question by K*******
Dear Dr Fiona Lim,
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 !
Answered by Dr Lim:
Hi,
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.
22. Question by D*****
I have an existing condition of Glaucoma, and have been on prescribed eye drop (from SNEC) over the past 4-5 years. It’s also probably hereditary as my dad has it - though my younger brother does not have this condition (he is 6 years younger than I, and did a LASIK to correct his eye sight about 10 years ago).
1.Given the "family history", what are the chances that both my sons will also suffer from Glaucoma as they aged, and if so, when would the first signs show up? They are 25 & 18 respectively.
2.Other than eye drops, what else can be done to slow down the process of deterioration?
3.What would exacerbate the condition?
Answered by Dr Lim:
Hi,
1.Having a positive family history increases the risk of glaucoma and this risk increases with age. Hence, your children should be screened for glaucoma though the disease may not manifest so early in life. Usually, open angle glaucoma is asymptomatic in the early stages.
2.Besides eyedrops, we can control intraocular pressure with laser procedure or surgery.
3.Taking steroids (oral, topical or inhaled) can cause increase in intraocular pressure and worsen glaucoma.
23. Question by A****
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?
Answered by Dr Lim:
Hi,
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.
24. Question by L**
Dear Dr Fiona Lim,
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?
Answered by Dr Lim:
Hi,
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.
25. Question by C**********
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.
Answered by Dr Lim:
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.
26. Question by V*****
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?
Answered by Dr Lim:
Hi,
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.
27. Question by J****
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.
Answered by Dr Lim:
Hi,
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.
28. Question by C****
Hi, I would like to ask:
What is the normal and safe eye pressure for glaucoma patients? If the patient's eye pressure is within the normal range, will he still have glaucoma? Thanks in advance.
The target pressure for each and every glaucoma patient is different, hence there is no arbitrary number.
There is an entity called normal tension glaucoma, whereby the eye pressure is seemingly normal but the optic nerve is glaucomatous. Hence, we examine the optic disc to determine if the patient has glaucoma.
29. Question by M******
Hi Dr Fiona,
I had laser peripheral iridotomy done by Dr Arun on both my eyes at SNEC in September 2020 to correct the close angle problem I have. Since the procedure, I often felt "blurriness" over my left eye (I received more laser shots for the left eye than the right). I will try to wipe my eye to clear the vision but the problem still persists.
I had a review at the end of September and I told the doc about my problem… he used a long cotton bud to remove a fine particle from my left eye and gave me a night gel to apply for a month. I still experience the blurriness over my left eye quite often.
Pls advise. Thank you.
I will need to have a look at you clinically to determine the cause of blurring of vision. One possible differential could be that your cataract may have increased.
30. Question by D****
Good Evening Dr Lim,
Thank you very much for taking my below questions:
1.What are the causes of narrow angle and cataract growth?
2.Is there any food to avoid or eat to avoid these from happening?
3.Can laser iridotomy and cataract surgery be carried out at the same time? What is the period of time after laser Iridotomy can cataract surgery be carried out?
4.Does sleeping on a high pillow help with the narrow angle before or after the laser iridotomy?
5.When is a good time to have the cataract surgery, meaning do we have to wait till the whole lens is affected OR?
6.Does cataract grow again after surgery? if yes, how long will it take?
7.Besides treatment, what can we do to maintain/develop the glaucoma/cataract condition?
8.Does it help the eyes when we stay away from the computer every after 45 min or so?
9.How does using the mobile in the dark hurt our eyes?
10.Laser eye surgery to correct the nearsightedness - is this for life?
Looking forward to your replies.
Answered by Dr Lim:
Hi,
1.Aging is the most common cause. As you get older, the cataract increases and your angles can get narrower.
2.Nothing that is proven scientifically.
3.We do not usually do both at the same time. When to do the cataract surgery after laser iridotomy will depend on many factors and varies with individual. There is no arbitrary number.
4.No
5.You should consider cataract surgery if your daily life is affected as your visual requirements are not met and your doctor recommends it
6.No, cataract does not grow back after it is completely removed.
7.Regular monitoring
8.In children yes, it helps to prevent myopia progression. It doesn’t affect glaucoma
9.In kids, such poor eye habits worsen myopia progression.
10.You mean LASIK for presbyopia? Your presbyopia degree may change as you get older, hence it may not be as effective (to remain glasses free) with time
31. Question by J********
Please advise all the causes of increased eye pressure? What can I do to prevent pressure in the eyes from increasing? Thank you.
Answered by Dr Huang:
Increased eye pressure is due to a higher rate of production of aqueous humour (the fluid within the eye) compared to the rate at which it is drained out. There can be many reasons for this.
Primary glaucoma is when we cannot find an obvious cause for the raised eye pressure and this is often due to genetic causes. Secondary glaucoma is when there is something causing the high eye pressure, which can include a number of causes, including trauma to the eye, steroid use, inflammation or bleeding within the eye, previous complicated or complex eye surgeries, tumours in the eye, or uncontrolled diabetes etc.
It may sometimes be difficult to fully prevent pressure in the eyes from increasing sometimes, especially if the cause is due to genetics. A healthy lifestyle, balanced diet, avoiding steroid use and major injuries to the eyes may be helpful.
32. Question by g********
1. How can one test if the vision problem is indeed glaucoma?
2. Where can I go for such test/s to ascertain if the vision problem is glaucoma or otherwise?
Answered by Dr Huang:
Glaucoma is diagnosed via comprehensive eye examination and specific glaucoma investigations which can be done by an ophthalmologist (eye doctor) at the eye clinic.
33. Question by 1********@gmail.com
What are the causes? How do we prevent it?
Answered by Dr Huang:
There can be many reasons for developing glaucoma.
Primary glaucoma (which is the more common type of glaucoma) is when we cannot find an obvious cause for the raised eye pressure and this is often due to genetic causes.
Secondary glaucoma (which is less common) is when there is something causing the high eye pressure, which can include a number of causes, including trauma to the eye, steroid use, inflammation or bleeding within the eye, previous complicated or complex eye surgeries, tumours in the eye, or uncontrolled diabetes etc.
It may sometimes be difficult to fully prevent pressure in the eyes from increasing sometimes, especially if the cause is due to genetics. A healthy lifestyle, balanced diet, avoiding steroid use and major injuries to the eyes may be helpful.
34. Question by H**
I frequently rub my eyes, will that caused glaucoma?
Answered by Dr Huang:
Eye rubbing can cause an increase in eye pressure, and prolonged recurrent or continuous rubbing of the eyes can contribute to an increased risk of developing glaucoma. Therefore it is not advisable to rub the eyes.
35. Question by s******@yahoo.com
Hi Dr Olivia, may i know if regular eye screening will help detect Glaucoma? Further, are there any way to prevent Glaucoma? Thank you.
Answered by Dr Huang:
Yes, eye screening will be helpful to detect glaucoma, as the early stages of glaucoma do not often have symptoms that are noticeable to the patient.
It may not be possible to fully prevent glaucoma as factors like genetics which may play a part in the development of glaucoma are unmodifiable.
Avoiding major trauma to the eye, or avoiding certain drugs which may increase the risk of glaucoma (e.g. steroids) as far as possible may help to reduce the risk of glaucoma.
A healthy lifestyle including balanced diet and exercise is also generally good for the health of the eyes.
36. Question by Anonymous
I have been diagnosed as early stage of the open angle glaucoma. Should I just put eye drop for the rest of my life that is so troublesome or opt for a surgery to fix the problem once and for all? I am 66 years of age. Thank you.
Answered by Dr Huang:
Options for treating early stage of open angle glaucoma can include glaucoma eyedrops, laser (e.g. selective laser trabeculoplasty), or surgery (e.g. minimally invasive glaucoma surgery).
Each of the treatment options have their own risks and benefits. For instance, while eyedrops are often fairly safe and effective, and are often used as first line treatment, they may sometimes be difficult to instill or comply with, and may also sometimes produce unintended side effects.
Laser and surgery can also help to lower eye pressure, but there are also slight risks of the laser and surgery, and their effect may not last a lifetime.
Treatment has to be individualised according to the patient’s unique situation and needs, and therefore is best to be discussed with the attending eye doctor.
37. Question by j*******
Hi Dr,
I am diagnosed with csr and cnv. Will these lead to glaucoma?
Answered by Dr Huang:
CSR (central serious retinopathy) and CNV (choroidal neovascularisation) are not known to lead to glaucoma.
38. Question by A*****
Hi Dr,
It said that a large proportion of people with glaucoma are unaware of it as it is largely symptom free. 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.
My question is thus, surely there must still be some early symptoms one can look out for before glaucoma develops? when the loss of peripheral vision occurs, this is certainly late already. And how can one prevent glaucoma from ever occurring?
Answered by Dr Huang:
The early stages of glaucoma may include visual symptoms such as loss of peripheral vision, loss of contrast sensitivity and glare, and these symptoms are usually quite subtle and may not be easily noticed by the patient. Loss of central vision, which is more obvious to the patient, is a sign of advanced disease. Therefore, screening for the disease would be helpful to pick up early disease. It would be wise to go for eye screening especially if there is a family history of glaucoma.
Unfortunately, it may not be possible to fully prevent glaucoma as factors like genetics which may play a part in the development of glaucoma are unmodifiable.
Avoiding major trauma to the eye, or avoiding certain drugs which may increase the risk of glaucoma (e.g. steroids) as far as possible may help to reduce the risk of glaucoma.
A healthy lifestyle including balanced diet and exercise is also generally good for the health of the eyes.
39. Question by J****
Dear Dr Olivia,
Would appreciate to be enlightened with regard to Closed Angle Glaucoma as follows:
1.What is the most effective and safest recommended treatment for Closed Angle Glaucoma?
2.Is there a possibility of recurrence after treatment?
3.Peripheral Iridotomy is one form of treatment. Any side effects like halos etc
4.How would one know is time to go for treatment for Closed Angle Glaucoma? What are the critical signs and symptoms?
5.If the person has not proceed with the treatment and one day there is a sudden onset of high pressure etc, will the person suddenly loses vision or there is still time to savage the situation? With how many hours must treatment be carried out to prevent loss of vision?
Answered by Dr Huang:
Treatment options for primary angle closure glaucoma would include addressing the angle closure via either a laser peripheral iridotomy or cataract extraction, as well as managing any high eye pressure.
There is still a possibility of recurrence after treatment but the risk is very low.
Laser peripheral iridotomy may have a small chance of side effects such as glare, haloes and visual disturbances as there is extra light entering through the iridotomy (the small opening made by the laser in the iris). Some patients may experience visualising a "line" at the bottom of their field at certain positions of gaze. However, most patients find these visual disturbances tolerable. There may be a small chance of slight bleeding after the procedure, and this can be treated with more frequent application of steroid eye drops. Occasionally, the eye pressure will rise transiently immediately after laser treatment, but this can be managed with medical therapy. Closure of the iridotomy is possible (though uncommon) and can be managed with repeat laser. Damage to the cornea causing it to lose its clarity is also possible, but is a rare complication.
If one does not proceed with treatment, and one day there is a sudden onset of high pressure, there is a chance of permanently losing vision, especially if the eye pressure goes extremely high, or is high for a prolonged period. This is because the high eye pressure can cause death of the optic nerve cells.
If there is any high eye pressure, treatment must be given as soon as possible to prevent vision loss. As the higher the eye pressure, or the longer the duration of high eye pressure, the higher the risk of irreversible blindness.
40. Question by H****
Hello Dr Olivia Huang,
I am a 62-year-old male with dry eyes conditions and right eye with pterygium for almost 20 years under prescribed and advised uses of UV sunglasses & Natural Tears eye drops.
Recently I'm feeling some "pressure pains" in my right eye especially during the COVID pandemic lockdown times when PC / online meetings were intensified.
Seen an Ophthalmologist and was told there's no pressure build-up in my right eye after checks and measurements were performed.
Was prescribed "VITBION FORTE " tablets to "soothe" the nerves in my eyes. After a month consumption of the tablets there's apparently no improvement.
May I have your views and thoughts please as I'm now working outside Singapore. Thanks.
Answered by Dr Huang:
"Pressure pains" in the right eye are a non-specific symptom, and a full eye evaluation will be required to pinpoint the exact cause of the symptom.
More commonly, long hours of screen time can cause dryness and tiredness of the eyes which can contribute to eye discomfort.
Other causes of pressure pain can also include glaucoma or high eye pressure, so it is good that you have already had these evaluated for, and that your doctor has advised that there is no pressure build-up in the eye.
Vitbion Forte tablets contain Vitamin B1, B6 and B12 which is a supplement that can help with nerve protection.
If your eyes are having discomfort due to long hours of screen time, you may try the following:
1.Reducing screen time, or taking frequent breaks during screen time. It is recommended that after every 20 minutes of screen time, to take at least 20 seconds to rest the eyes and look far.
2.Moisturising/lubricating eyedrops to alleviate dryness. These can be purchased over the counter.
3.Maintaining the eyelid hygiene. This can be done by cleansing the eyelid with eyelid cleansers, and doing warm compresses.
If your symptoms still persist despite the above, it would be advisable to see your doctor to get the eyes checked again.
ABOUT DR FIONA LIM
Dr Fiona Lim is currently a glaucoma consultant at the Singapore National Eye Centre (SNEC) and Changi General Hospital (CGH) Eye Department.
She graduated from National University of Singapore, Yong Loo Lin School of Medicine in 2010 with distinction in surgery. She subsequently trained under the ACGME-I (American Council of Graduate Medical Education – International) accredited SingHealth Ophthalmology Residency Program in SNEC and was awarded the Ministry of Health Training Award for her specialist training in 2013. She obtained her Master of Medicine (Ophthalmology) by National University of Singapore in 2016 and attained specialist accreditation in 2018. She qualified as Fellow of the Academy of Medicine, Singapore (FAMS) and a Fellow of the Royal College of Ophthalmology (London) that same year. She completed her glaucoma fellowship in SNEC in 2020.
Dr Lim is also actively involved in postgraduate and undergraduate education of ophthalmology trainees and medical students, as well as paramedical staff, including optometrists and nurses.
In addition to education, research is another area that Dr Lim is active in. She has published several scientific papers in respected peer-reviewed medical journals, including Ophthalmology and British Journal of ophthalmology.
Her current research interest is in glaucoma and she actively participates in presentations at international and local conferences. She is committed to serving the community – besides being involved in the setting of up primary eye care in the community, she has volunteered for several community eye screenings and provision of educational talks at public forums on cataract and glaucoma. She was a recipient of the GEM awards for excellence in Clinical care in 2013.
About Dr Olivia Huang
Dr Olivia Huang is a Consultant with the Glaucoma Department at the Singapore National Eye Centre (SNEC). She has received multiple academic, teaching and service awards, including the Gold Medal for Best Candidate in Cataract and Refractive Ophthalmology in the Specialists’ Exit Examination, the SingHealth Outstanding Resident and the SingHealth Inspiring Resident Educator Award for Ophthalmology.
Dr Huang regularly volunteers at community eye screening projects, and provides educational talks at public forums to promote public awareness of glaucoma. She is also active in research, particularly in glaucoma, and has published various scientific papers in respected peer-reviewed medical journals, and presented her research work at numerous international and local scientific conferences.
Ref: I23
