Understanding Glaucoma

Aug 7

Glaucoma is often called the “silent thief of sight,” and for good reason—it can gradually steal your vision without noticeable symptoms in the early stages. At Wink Optical and Eye Care, we believe that informed patients make empowered decisions. In this post, we’ll walk you through what glaucoma is, who’s at risk, how we detect it, and how it can be managed to protect your sight.

What Is Glaucoma?

Glaucoma is a group of eye diseases that damage the optic nerve—the part of your eye that sends visual signals to your brain. This damage often happens when there’s too much pressure inside the eye, a condition known as elevated intraocular pressure (IOP).

The most common form is called primary open-angle glaucoma (POAG). In this type, the drainage angle in your eye is open, but the fluid inside the eye (called aqueous humor) doesn't drain out as efficiently as it should. This can lead to pressure building up over time and damaging the optic nerve.

In most cases, the problem comes from the drainage system slowing down. But in some people, the pressure may rise because the eye is producing more fluid than usual. Either way, it’s the imbalance between how much fluid is made and how well it drains that puts the optic nerve at risk.

Glaucoma develops slowly and usually doesn’t cause symptoms early on—which is why regular eye exams are so important. According to large clinical studies, early treatment can significantly reduce the risk of permanent vision loss.

Who’s at Risk for Glaucoma?

Glaucoma can affect anyone, but some people are more likely to develop it. You may be at higher risk if:

You are over the age of 40
You have a family history of glaucoma
You are of African, Hispanic/Latino, or Asian descent
You have high eye pressure (elevated IOP)
You are extremely nearsighted (high myopia)
You have diabetes, high blood pressure, or sleep apnea
You’ve had an eye injury or surgery
You use steroid medications long-term

If you fall into one or more of these categories, it's especially important to get regular eye exams—even if your vision seems fine.

What Happens to the Optic Nerve in Glaucoma?

The optic nerve is like a cable that connects your eyes to your brain, made up of over a million tiny nerve fibers. In glaucoma, increased pressure or poor blood flow damages these fibers over time.

As more fibers are lost, small blind spots begin to appear—usually in your side (peripheral) vision first. These changes happen so gradually that most people don’t notice anything until the disease is more advanced.

Modern imaging, like optical coherence tomography (OCT), has helped us detect these changes earlier than ever. Studies have shown that thinning of the retinal nerve fiber layer and changes to the shape of the optic nerve head often happen before a person has any symptoms at all (Leung et al., Ophthalmology, 2009).

How Do We Screen for Glaucoma?

During your routine comprehensive eye exam, we check for early signs of glaucoma using:

Tonometry – Measures the pressure inside your eye
Ophthalmoscopy – Allows us to look at the shape and color of your optic nerve
Medical and family history review – Helps us assess your individual risk

If anything we find raises concern—such as high eye pressure or suspicious changes to your optic nerve—we may identify you as a glaucoma suspect. This doesn’t mean you have glaucoma, but it means your eyes show signs that need closer monitoring.

In that case, we’ll recommend baseline glaucoma testing to get a detailed view of your optic nerve and track any changes over time.

What Does Baseline Testing Involve?

If you're a glaucoma suspect, baseline testing helps us detect early changes and gives us a reference point for future visits. This more detailed exam may include:

OCT (Optical Coherence Tomography) – A scan that measures the thickness of the nerve fiber layers
Visual Field Test – Checks for early blind spots in your side vision
Gonioscopy – Allows us to examine the drainage angle in the eye
Pachymetry – Measures the thickness of your cornea, which can affect pressure readings
Optic Nerve Photography – Helps us track how the optic nerve looks over time

These tools give us a clearer picture of your eye health and help catch glaucoma in its earliest, most treatable stages.

How Is Glaucoma Treated?

There is no cure for glaucoma, but early treatment can help protect your vision and slow the disease’s progress. Treatment is tailored to your specific needs and may include:

1. Prescription Eye Drops

These are often the first line of defense. They help lower eye pressure either by reducing how much fluid your eye makes or helping it drain more efficiently. The Ocular Hypertension Treatment Study showed that early use of drops can reduce the risk of developing glaucoma by over 50% in high-risk patients (Kass et al., Arch Ophthalmol, 2002).

2. Laser Treatment

Selective Laser Trabeculoplasty (SLT) is a safe, in-office procedure that helps fluid drain better through your eye’s natural pathway. Studies like the LiGHT trial have shown that SLT can be just as effective as eye drops—with fewer side effects in some patients (Gazzard et al., The Lancet, 2019).

3. Minimally Invasive Glaucoma Surgery (MIGS)

If drops or laser treatments aren’t enough, newer surgical options like the iStent or Hydrus Microstent can be implanted to improve drainage with minimal disruption.

4. Traditional Surgery

In advanced or complex cases, procedures like trabeculectomy or glaucoma tube shunts may be needed. These surgeries create a new pathway for fluid to leave the eye and can be highly effective at reducing pressure.

What Can You Do?

The best thing you can do is stay ahead of the disease by coming in for regular eye exams—especially if you’re in a higher-risk group.

You can also:

Know your family history
Manage health conditions like diabetes and high blood pressure
Take medications exactly as prescribed
Protect your eyes from injury
Ask questions and stay informed