WHAT TYPE OF GLAUCOMA DO I HAVE?The type of glaucoma diagnosed by your ophthalmologist determines the treatment options available to you. Here we cut through the confusing medical terminology and provide an explanation for each one. When I share my diagnosis of glaucoma with a patient, I take as much time as necessary to explain the type of glaucoma that they have and to answer their questions. I do this not just because it is good medicine, but because I have found that the better a patient understands my diagnosis, the more it helps me to explain their treatment plan to them. Answering patients' questions helps to demystify glaucoma and motivates them to participate actively in their treatment. There are many types of glaucoma and scientists have developed a number of ways to organize them. But for our purposes, the classification scheme used is not particularly relevant. To explain the difference, I first have to start with secondary glaucoma. This type of glaucoma has an identifiable disease process, injury, or other source that is causing the glaucoma, such as diabetes, head injury, cataracts, and extended use or overuse of corticosteroids. In other words, the glaucoma is secondary to another health problem. Primary glaucoma is what is called a diagnosis of exclusion in medicine. This means that I have looked at other reasonable secondary possibilities, like those mentioned previously, and did not find any. The only cause of the glaucoma remaining is a defect within the eye itself.
As an ophthalmologist, when I see evidence of glaucoma in a patient, I look for secondary causes first. If I am unable to identify any, I then treat the condition as primary glaucoma. Believe it or not, this process is very important. To illustrate, let's consider a patient with secondary glaucoma due to diabetes that is not well controlled. If the patient does not disclose that they have diabetes to me, or my examination of the patient fails to reveal that diabetes is the underlying problem, then I would treat it as a primary glaucoma case. I would prescribe eye drops to reduce intraocular pressure as a first step in treatment. However, if the patient's diabetes remains poorly controlled, the desired effect of the eye drops will be undermined and the glaucoma will continue to get worse. For this reason, it is absolutely essential that you disclose all aspects of your medical history along with all medications, prescription or otherwise, that you are taking to your ophthalmologist. Doing this could mean the difference between early diagnosis of the type of glaucoma that you have with effective treatment to manage it, and a delayed diagnosis that allows the glaucoma to worsen before its true underlying cause is identified. Equally important is following the entire treatment plan prescribed by your ophthalmologist. In the previous example, taking eye drops as prescribed but failing to follow the prescribed treatment plan to control your diabetes, will result in your glaucoma getting worse. The reverse of this also is true. Getting serious about controlling your diabetes but not taking your eye drops as prescribed still can cause additional damage to your optic nerve.
When considering the various types of glaucoma, it is important that you do not lose sight of the fact that they all have a common outcome. This is damage to the optic nerve that if left unchecked can result in progressive, permanent vision loss.
In its acute form, intraocular pressure rises rapidly and is accompanied by pain, along with other symptoms such as red eye, cloudy vision, seeing halos around light sources, and occasionally vomiting. Similar to POAG, the chronic form develops slowly, usually without noticeable symptoms.
DEVELOPMENTAL GLAUCOMA Developmental glaucoma is a rare condition in which the canals that drain aqueous humor from the eye do not form properly. Infants with the disease tend to be sensitive to light and may have cloudy corneas. Cases of developmental glaucoma can have primary and secondary characteristics. For this reason, it treated as a separate category. There are three primary types.
SECONDARY GLAUCOMA Secondary glaucoma can occur because of an eye injury, inflammation, tumor, advanced cases of cataract or diabetes, and certain drugs such as steroids. This type of glaucoma may be mild or severe. Treatment options depend on whether it is open angle or closed angle disease.
Traumatic glaucoma occurs when there is injury to the eye. The injuries can be caused by blunt trauma that bruise the eye, injuries that penetrate the eye, and even infection. The glaucoma can present itself immediately following the injury or years later. Inflammatory glaucoma is typically associated with any disease process that causes uveitis, or inflammation of the middle layer (uvea) of the eye. These include systemic disorders, such as systemic lupus erythematosus, infectious agents, such as Herpes simplex and Herpes zoster, and inflammatory syndromes, such as Fuchs Heterochromic Iridocyclitis. Phacomorphic glaucoma is a form of angle closure disease, usually caused by cataracts or other processes that cause forward displacement of the lens of the eye.
Intraocular hemorrhage is a condition in which blood is pooling inside the eye. There are two forms that can cause glaucoma: hyphema and hemolytic glaucoma. Additional secondary causes include a variety of conditions that can raise intraocular pressure.
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The main thing to understand is the difference between primary and secondary glaucoma. This distinction relates to underlying cause and is used in naming some types of glaucoma.
