January 2020 could very well be called vision month. It is the first month in the year that bears the numbers we’ve come to associate with perfect vision. It is also the month in which Americans celebrate the life and work of a visionary, Martin Luther King Jr.  And, it is Glaucoma Awareness Month. How much do you know about glaucoma? Your answer may determine whether you have vision for the future.

According to the National Council for Aging Care, “Glaucoma is the root cause of about 10 percent of total blindness in the United States, and many of the people affected are seniors (those over the age of 65).” It is among the four common causes of vision loss in the elderly, the other causes being age-related macular degeneration, cataracts and diabetic retinopathy. But older adults should pay special attention to glaucoma.

What is glaucoma?

Glaucoma is the name of a group of eye diseases caused by a buildup of fluid pressure in the eye (intraocular eye pressure) resulting in damage to the optic nerve and loss of field vision. Glaucoma is the leading cause of irreversible blindness throughout the world. It is projected that 80 million people will be affected by glaucoma in 2020. This number is expected to increase as the population ages.

There are two forms of glaucoma: early onset forms and adult onset forms.

Early onset forms of glaucoma are rare in the population. They include:

• ·         Juvenile open-angle glaucoma
• ·         Primary congenital glaucoma (PCG)
• ·         Anterior segment development syndromes

Adult onset forms of glaucoma are common in the population and include:

• ·         Primary open-angle glaucoma (POAG)
• ·         Angle-closure glaucoma
• ·         Exfoliation glaucoma

Who is at risk?

The Glaucoma Research Foundation says everyone is at risk of glaucoma, from babies to senior citizens. Babies can be born with glaucoma. Young adults can get glaucoma; African Americans are especially susceptible to the disease at a young age. Older adults are at a higher risk for glaucoma.

Among the illnesses that affect the eye, glaucoma is particularly insidious. It is fittingly called the “sneak thief of sight.” Not only is there no cure for glaucoma, there is no treatment or surgery to reverse vision lost, as with cataracts; and there is no known way of preventing glaucoma.

In the case of  primary open-angle glaucoma, there are no early warning signs or symptoms until significant vision loss has occurred. In the case of angle-closure glaucoma, however, the symptoms are noticeable and “can include hazy or blurred vision, severe eye and head pain, nausea or vomiting (accompanying severe eye pain), the appearance of rainbow-colored circles around bright lights, or sudden sight loss.”

Therefore, early detection of glaucoma is the key to reducing loss of vision due to the disease.

Early detection is possible only when you are having your eyes tested regularly by an ophthalmologist. Older adults must keep this in mind, because the risk of glaucoma increases with age. If glaucoma is caught early,  it is possible to halt further loss of vision with medication and/or surgery.

So, one of the commitments you must keep this year is to have a dilated eye exam administered by an ophthalmologist. This type of eye examine is the best and most effective way to detect glaucoma. And, if you’ve ever been diagnosed with open-angle glaucoma, remember, you must be monitored for life, because this is a chronic condition.

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Regular dilated eye exam by an ophthalmologist is the critical step in eyecare. But there are several other important things you must do to protect the health of your eyes and secure your vision as you age.

• ·         Eat leafy diet
• ·         Know your family’s eye-health history
• ·         Wear sunglasses when outdoors
• ·         Quit smoking, if you smoke; if you don’t smoke, don’t start
• ·         Take Omega 3 Fatty Acids

Some good news

Admittedly, the news about glaucoma is depressing. But there is some good news on the horizon. As the population ages and the number of glaucoma patients increases, the focus of research and funding is moving toward “curative and potentially preventative therapies.” Innovations are being made in the areas of glaucoma

• ·         drug delivery,
• ·         pharmaceuticals,
• ·         devices;
• ·         developments in vision restoration,
• ·         telemedicine;
• ·         work with the FDA; and
• ·         Venture capital funding for more research, namely, glaucoma genetics research.

The most promising work is in the area of glaucoma genetics. According to Janey L. Wiggs, MD, PhD, an ophthalmologists certified in both ophthalmology and medical genetics, genetic studies have identified glaucoma genes and biological pathways. These discoveries are significant in two ways. One, genes point to what causes the disease to develop; what scientists call the “pathways and biological processes.” Two, genes identify potential targets for therapy that could “cure disease or have potential to protect from developing disease.”

The first gene to be identified was the myocilin gene. Another was the TEK Angiopoietin genetic factors, Angiopoietin 1 and Angiopoietin 2. When these genes mutate—behave in a way they were not designed to work—they cause the cell to overproduce protein, as in the case of the myocilin gene, or raise eye fluid pressure, as in the case of the TEK Angiopoietin genetic factors, eventually resulting in damage to the optic nerve.

Scientists have also discovered a connection between cholesterol and glaucoma. Says Dr. Wiggs, there are four genes associated with both cholesterol metabolism and glaucoma.  Three of these genes interact with each other to promote the expulsion of cholesterol from cells. The fourth gene is important to the production of cholesterol.

Another important relationship that has been identified is between mitochondria and glaucoma. Mitochondria is needed for energy production in the eye. In patients with primary open-angle glaucoma, researchers have found evidence that the mitochondria have less capacity to stave of free radicals and reactive oxygen species that damage mitochondria and surrounding tissues.

What could all of this mean for patients with glaucoma?

For glaucoma patients who carry mutating myocilin gene, gene editing may provide a cure.

For glaucoma patients who carry defects in the TEK Angiopoietin genetic factors, augmenting tech signalling promises to be the form of treatment.

Where cholesterol and lipid metabolism are a risk factor for elevated intraocular pressure and primary open-angle glaucoma, then statins could potentially be a cure or preventative treatment for some glaucoma patients.

Where mitochondrial function is identified as possible cause of the disease, scientists are looking at how to support mitochondrial function and potentially retinal ganglion cell function.

Simply translated: Lots of work is being done in glaucoma genetics to identify new areas for treatments that cure and prevent glaucoma. However, lots more work needs to be done.

Action Plan

The onus is on you to protect you vision for the future. Glaucoma can affect anyone, but older adults and younger African Americans are susceptible to adult onset glaucoma. Glaucoma can lead to blindness if it is left untreated. The best way to preserve your sight is to have to have an annual dilated eye exam administered by an ophthalmologist to test for the disease. There is no cure for glaucoma yet, but researchers are working, particularly in the area of genetics, to develop cures and preventive treatments. January 2020 is a good month to focus on protecting and securing your vision for the future.