Glaucoma
What Is Glaucoma?
Glaucoma is a group of eye conditions that damage the optic nerve, which is vital for good vision. This damage is often caused by an abnormally high pressure in your eye. Known as the ‘silent thief of sight’, glaucoma usually damages your vision so slowly that you do not notice the gradual loss until the disease is in its late state.
Why Is It Important To Diagnose And Treat Glaucoma Early?
Glaucoma is the leading cause of irreversible blindness. The number of people with this condition in Asia is estimated to increase from 59 million in 2020 to 80 million in 2040.
In Singapore, 3% of people over the age of 50, and 10% of those over the age of 70 have Glaucoma.
While Glaucoma is not curable, blindness is preventable if checked, diagnosed and treated early. There are usually no warning signs; Glaucoma is usually detected from doing regular eye tests with your Eye Specialists.
Symptoms Of Glaucoma
As the disease can develop slowly, you may not be aware of the gradual loss of sight until very late in the disease when there is tunnel vision.
Symptoms of primary open-angle glaucoma or chronic angle closure glaucoma include:
Patchy blind spots/gradual loss in your side vision (peripheral vision), frequently in both eyes.
Tunnel vision (advanced stages)
Symptoms of acute angle-closure glaucoma include:
•Severe headache and eye pain
•Nausea and vomiting (accompanying the severe eye pain)
•Sudden onset of visual disturbance, often in low light
•Blurred vision
•Halos around lights
•Eye redness
Risk Factors Of Glaucoma
Risk factors of glaucoma include:
•Age. Your risk increases when you are over 60 years old.
•Chronic diseases. You are at increased risk if you have diabetes, high blood pressure or heart diseases.
•Ethnicity. Asians are more susceptible to angle-closure glaucoma than Caucasians.
•History of traumatic eye injuries or certain types of eye surgeries.
•Family history
•Use of corticosteroids (whether as eye medications or oral form)
•Refractive error (short-sightedness or myopia is a risk factor for open-angle glaucoma and far-sightedness or hyperopia for closed angle glaucoma)
Symptoms Of Glaucoma
As the disease can develop slowly, you may not be aware of the gradual loss of sight until very late in the disease when there is tunnel vision.
Symptoms of primary open-angle glaucoma or chronic angle closure glaucoma include:
- Patchy blind spots/gradual loss in your side vision (peripheral vision), frequently in both eyes.
- Tunnel vision (advanced stages)
Symptoms of acute angle-closure glaucoma include:
- Severe headache and eye pain
- Nausea and vomiting (accompanying the severe eye pain)
- Sudden onset of visual disturbance, often in low light
- Blurred vision
- Halos around lights
- Eye redness
Risk Factors Of Glaucoma
Risk factors of glaucoma include:
- Age. Your risk increases when you are over 60 years old.
- Chronic diseases. You are at increased risk if you have diabetes, high blood pressure or heart diseases.
- Ethnicity. Asians are more susceptible to angle-closure glaucoma than Caucasians.
- History of traumatic eye injuries or certain types of eye surgeries.
- Family history
- Use of corticosteroids (whether as eye medications or oral form)
- Refractive error (short-sightedness or myopia is a risk factor for open-angle glaucoma and far-sightedness or hyperopia for closed angle glaucoma)
Types Of Glaucoma
Chronic Glaucoma: results from gradually increasing eye pressure which slowly causes irreversible damage to the eye. This condition usually shows no early symptoms and thus often goes undetected without regular eye checks. Left untreated, chronic glaucoma can cause partial or total vision loss.
There are two main types of chronic primary glaucoma:
- Primary Open-Angle Glaucoma (POAG)
- Primary Angle-Closure Glaucoma (PACG)
Acute glaucoma is regarded as a medical emergency because optic nerve damage and consequent loss of vision can occur extremely rapidly (within hours or days). Look out for symptoms such as one-sided headache, nausea and vomiting, haloes, eye pain, and blurring of vision. If you are experiencing such symptoms, consult a doctor immediately. If such a situation occurs after usual clinic hours, we recommend going to A&E – do not wait until the next day.
Normal Tension Glaucoma: also known as low tension or normal pressure glaucoma, is a form of open angle glaucoma in which damage occurs to the optic nerve without eye pressure exceeding the normal range. In general, a “normal” pressure range is between 10 to 21 mm Hg. Currently, this condition is still not fully understood. However, evidence has shown that lowering intraocular pressure can help to slow its progression.
Secondary Glaucoma: refers to any form of glaucoma in which there is an identifiable cause of increased eye pressure, resulting in optic nerve damage and vision loss. As with primary glaucoma, secondary glaucoma can be open-angled or closed-angled and it can occur in one or both eyes. It may be caused by previous eye injury, inflammation (which can be related to autoimmune diseases), certain drugs such as steroids, diabetes mellitus and hyper-mature cataracts.
Childhood Glaucoma: is a rare condition that can start developing in infancy, childhood, or adolescence. It may cause enlargement of the infant’s eyes, corneal haze, tearing and unusual light sensitivity.
What Are The Treatment Options For Glaucoma?
Glaucoma cannot be cured, but in most cases it can be successfully controlled. Treatment will depend on the type of glaucoma you are diagnosed with.
Glaucoma treatments include:
- Eye drops and oral medications
- Laser procedures
- Minimally Invasive Glaucoma Surgery (MIGS)
- Filtering surgery with or without drainage implants.
Currently, the mainstay of glaucoma treatment is to lower intraocular pressure so as to reduce disease progression. Treatment is life-long, and can be achieved with topical medications, laser or surgery.
FAQ
Unfortunately, glaucoma cannot be prevented. But early screening and detection is very important in arresting it during its early stages or slowing down its progression and ultimately preventing vision loss.
As a general rule, one should have a comprehensive eye exam every one to two years if you are between 50 to 60 years old; and every year if you’re older than 60.
However, if you’re at risk of glaucoma, it is advisable to have an eye check once you are above 40 years old, and thereafter every one to two years, or as advised by your eye specialist.
Open-angle glaucoma cannot be prevented but if diagnosed and treated early, it is possible to prevent visual damage and blindness.
Closed-angle glaucoma, however, may be potentially preventable. In the early stages of the disease (when the eye has closed angles but has not developed glaucoma yet), a laser procedure called laser peripheral iridotomy (LPI) offers a potential way of preventing blindness caused by closed-angle glaucoma.
LPI involves using laser energy to create a hole in the iris (the brown part of the eye), causing the drainage angles to become ‘wider’.
This treatment is potentially a low-risk, once-only treatment to prevent acute primary angle closure, as well as reduce the chances of developing chronic closed-angle glaucoma.
An ophthalmologist who has specific experience and skills to diagnose and treat glaucoma can be considered a glaucoma specialist in Singapore. They are proficient in controlling glaucoma in patients by creating customised treatment plans to cater to their specific needs.
Ophthalmologists in Singapore use a variety of techniques to treat glaucoma depending on the seriousness of the condition. The treatment types include medication, laser therapy and surgery. These treatments help in preserving vision and lowering intraocular pressure.
There is no definite cure for glaucoma, however, with early detection and suitable treatment plans you will be able to minimise visual loss and control the development of the illness. You can always book an appointment with a glaucoma doctor in Singapore if you need to get a checkup.
You can consider glaucoma surgery if other non-surgical methods like eye medication and laser therapy will not be effective with the status of your glaucoma condition.
Glaucoma surgery just like any other type of surgery carries some risk, but the overall results of the procedure can be considered effective and safe. The severity of the glaucoma surgery will also depend on the techniques used and the health status of the patient.
With technological advancements, new treatment methods like MIGS have become popular. This offers patients additional alternative methods for managing their glaucoma conditions.
Yes, a patient suffering from glaucoma can lead a normal life with the right treatment methods and continuous monitoring from eye specialists.
Depending on the chosen course of therapy and the severity of your glaucoma condition, the eye care specialist will advise you on how frequently you will need to visit the clinic.
Glaucoma can affect anyone at any age, but the risk of it will increase with age. There are some types of glaucoma that are often seen among the younger generation such as congenital glaucoma or secondary glaucoma.
Glaucoma Screening & Testing
Glaucoma Screening
- Visual Acuity/Auto-Refraction
- Eye Pressure Check (Tonometry)
- Corneal Thickness Measurement
- Optic Nerve Scan/Optical Coherence Tomography (Nerve)
- Optic Disc Photography
- Doctor’s Report
*Does not include consultation with Doctor.
Cataract/Glaucoma/Age-Related Macular Degeneration Screening
- Visual Acuity/Auto-Refraction
- Eye Pressure Check (Tonometry)
- Corneal Thickness Measurement
- Optic Nerve & Macular Scan/Optical Coherence Tomography (Nerve & Macular)
- Optic Nerve & Retinal Photography
- Doctor’s Consult
Our Glaucoma Specialist
Dr. Tan Yar Li
MBBS (Singapore), M.Med (Ophth)
MRCSEd (Ophth), FAMS (Ophth)
Senior Consultant | Eye Surgeon
Sub-specialties: Glaucoma, Cataract, Refractive Surgery (LASIK)
Languages: English, Mandarin, Hokkien, Teochew
Fellowship Trained Specialist
Former Consultant at Singapore National Eye Centre (SNEC)
Former Deputy Head of the Department of Ophthalmology at Changi General Hospital
- Dr Tan Yar Li was awarded 3 gold medals for Best Candidate in Glaucoma,
- Vitreoretinal as well as Neuro-ophthalmology in the Eye Specialists’ Exit exam
- Dr Tan was one of the first few surgeons in Singapore to perform
- Minimally Invasive Glaucoma Surgery (MIGS)
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