Cataracts happen to us all eventually. This clouding of the normally clear lens is the eyes’ equivalent of graying hair. If the cataract does not bother you, it can be watched. Eventually surgery may be needed, and is usually successful, but no or minimal symptoms mean no need to do anything.
Glaucoma is different. It has been called “the sneak thief of sight,” because it can be doing serious and often permanent damage without you being aware.
The exact way glaucoma damages the eye is complicated and not fully understood. One way to think of it is that the pressure inside the eye is too high, and this pressure damages the optic nerve, the nerve that carries impulses from the retina to the brain.
Most people with glaucoma have increased eye pressure, which the optometrist or ophthalmologist can easily measure.
The reason it is complicated is that a small fraction of people have high pressures but never develop damage, while others can have classic glaucoma damage with normal pressures.
Let’s leave these outliers to the specialists and focus on the large majority, who have high intra-ocular pressure and evidence of eye damage.
The damage to the optic nerve is slow – it may take 25 years between onset and blindness. It also damages the peripheral (side) vision first, sparing the straight-ahead vision. This is what makes it so sneaky. Looking straight ahead, your vision may be fine, while you are slowly developing tunnel vision. The loss is usually permanent; progression can be stopped, but what you have lost cannot be restored.
Treatment is well-studied. For most people, eyedrops at bedtime are all that is needed. Some sufferers need two or three different drops, and a minority do not respond to drops and need surgery.
The key is early detection. Even if your vision is fine, when you hit forty, get an eye exam. You cannot suspect glaucoma yourself, and early detection is the best way to preserve your vision.
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