Vision Loss from Glaucoma is Irreversible

Paul A. Sieving, MD PhD, director of the National Eye Institute in Native Health. Discussion »

Paul A. Sieving, MD PhD

BETHESDA, MARYLAND - Glaucoma is a major cause of vision loss in the United States, affecting about 2.2 million Americans. The National Eye Institute, NEI, leads research toward better prevention, detection, and treatment of this often silent but devastating disease. During Glaucoma Awareness Month, the National Eye Institute highlights research advances, showcases education and awareness efforts, and reminds Americans that early detection and treatment is the best way to prevent vision loss. The National Eye Institute advises all Americans at risk of glaucoma to get a comprehensive dilated eye exam every one to two years.

Glaucoma is a group of diseases that damages the optic nerve, the bundle of nerve cells that relays visual information from the eye to the brain. In the most common form of glaucoma, called primary open angle glaucoma, nerve damage results from an increase in intraocular pressure - the pressure inside the eye. Increased intraocular pressure occurs when the fluid that circulates in and out of the front part of the eye drains too slowly.

Glaucoma is usually painless, initially affects peripheral vision, and progresses slowly, which helps explain why half of all people with glaucoma are unaware they have it. Without adequate treatment, glaucoma eventually affects central vision and progresses to blindness. Vision loss from glaucoma is irreversible.

Glaucoma is a complex disease and progress toward preventing or reversing the condition has been slow; however, the National Eye Institute's multipronged approach to glaucoma research is making great strides. Epidemiological studies funded by National Eye Institute have identified populations at higher risk of glaucoma, including African Americans ages 40 and older; everyone age 60 and older, especially Mexican Americans; and people with a family history of the disease.

The National Eye Institute -led Ocular Hypertension Treatment Study and the Advanced Glaucoma Intervention Study helped refine strategies for reducing glaucoma-related vision loss. The Ocular Hypertension Treatment Study established that medicated eye drops to reduce intraocular pressure are effective at delaying or preventing disease among people identified to be at high risk of glaucoma. The Glaucoma Intervention Study found that specific traits such as race/ethnicity can help predict which type of surgical treatment is more likely to achieve better visual results.

NEI continues to fund research to advance techniques such as confocal laser scanning ophthalmoscopy and optical coherence tomography, which are used to image the retina and optic nerve. Studies such as the Diagnostic Innovations in Glaucoma Study and the Advanced Imaging for Glaucoma Study are using these techniques to develop better tools to diagnose and manage glaucoma.

NEI researchers are devising new techniques to study glaucoma disease mechanisms, such as new mouse models that simulate glaucoma. Such models enable scientists to study how increased eye pressure causes optic nerve cell death.

Some people have normal intraocular pressure despite having glaucoma. A major focus of NEI glaucoma research is the development of neuroprotective treatment strategies. NEI scientists are pursuing gene therapy, stem cells, and vaccines as potential therapies to protect precious optic nerve cells. Such therapies may apply to multiple visual neuropathies and, importantly, glaucoma that does not respond to eye pressure-lowering treatments.

The National Eye Health Education Program provides a variety of educational resources, in English and Spanish, as part of its broad eye health outreach effort. New this year is the Keep Vision in Your Future Glaucoma Toolkit, designed for health professionals and community organizations to raise awareness about the importance of comprehensive dilated eye exams for early detection of glaucoma.

According to a National Eye Institute survey, more than 90 percent of Americans have heard of glaucoma. However, only 8 percent are aware glaucoma has no early symptoms. During Glaucoma Awareness Month, the National Eye Health Education Program is targeting people at higher risk of glaucoma by working with media outlets to disseminate glaucoma information.

Help spread the word this January. Early detection and treatment is the best way to prevent vision loss from glaucoma. Encourage those at risk to get a comprehensive dilated eye exam.

Dr. Sieving became director of the National Eye Institute, NIH, in 2001. He came from the University of Michigan Medical School where he was the Paul R. Lichter Professor of Ophthalmic Genetics and the founding Director of the Center for Retinal and Macular Degeneration. He received an honorary Doctor of Science from Valparaiso University in 2003 and has been named among the 'Best Doctors in America' multiple years. He has received numerous awards, including the Research to Prevent Blindness Senior Scientific Investigator Award, 1998; the Alcon Research Institute Award, 2000; and the Pisart Vision Award from the New York Lighthouse International for the Blind in 2005. Dr. Sieving was elected to the Institute of Medicine of the National Academy of Sciences in 2006.

posted January 5, 2011 6:00 am est