Next Tuesday I’m going to have eye surgery. I have glaucoma in both eyes and every other remedy has been tried with only limited effect, so surgery it is. It is, as surgical procedures go, a swift and low-risk one with a very high success rate. I’ll be back home the same day. I’m also lucky enough to have one of the best eye consultants and surgeons in the country right here in sleepy North Devon. It will all be just fine. If I am terrified – and I am – it’s because I’ve managed to get through nearly 42 years of life without any surgery at all and I’m squeamish and needle-phobic at the best of times. But, like I say, this is relatively low-risk and, more importantly, it will save my eyesight.
When is the last time you had an eye test? If it’s been more than a year, please book one soon. If you’ve been putting it off because your eyesight seems fine so why bother to find the time and go to the expense of an eye test, please go anyway. I don’t want to nag. I’m sorry if I sound like your mother, or some dreary public information message, or like a convert to a cult that’s trying to drag you in for a personality assessment. It’s just that glaucoma is one of a number of eye conditions that can be detected in a standard eye test so an eye test is more than about whether or not you can read a car number plate from 50 yards, or whatever – it’s about whether or not you might be going blind and not realise it.
Glaucoma is called the silent thief of sight because you could be losing your vision without even being aware of it. There’s a little pocket of fluid at the front of your eye, in front of the lens. The fluid slowly flows through this chamber, keeping various components of your eye clean and clear. The fluid drains out through a mesh of microscopic channels and is reabsorbed into your bloodstream. In the most common form of glaucoma, this mesh becomes blocked somehow (it’s not clear how) and so the fluid escapes at a slower rate than it flows in. This causes the pressure inside the whole eyeball to increase and, at the back of the eye, the optic nerve starts to get slowly squished and damaged.
If you have the most common form of glaucoma, you won’t feel a thing. There are no clues or noticeable symptoms of any kind. My eyes don’t feel uncomfortable or painful or high-pressure-y at all. And, because it first affects your peripheral vision, and usually in one eye more than the other, you won’t notice any sight loss until it’s too late. My glaucoma has given me a blind spot in my right eye, above and to the left of my centre of vision. If I’m looking at you and I close my left eye and look at your left shoulder, I can make your nose disappear. Otherwise, I wouldn’t know I was suffering any loss of vision at all. But the thing about vision loss is that it can’t be reversed. My surgery will stop any more damage being done, but that blind spot will always be there. If you let glaucoma go undetected and untreated, you can eventually get tunnel vision and, finally, go blind.
My glaucoma was detected by Specsavers in Barnstaple – but any optician anywhere in the country would have spotted it. My point is that all it takes is a standard eye test. That thing they do where a machine blows a little puff of air into the front of your eye is an eye pressure test. It’s not a particularly accurate test, but it’s enough to let the optician know if there’s a potential problem, and they’ll refer you to your nearest eye clinic if they think something needs investigating.
No one really knows what causes glaucoma. It’s not a bacterial or viral disease. You are at greater risk if you are older but young people, even children, can have glaucoma. Men and women are equally at risk. If you are Asian (I am half-Indonesian) you are at slightly greater risk because our eyes are a slightly different shape to those of white Europeans. If you are black, you are at greater risk still – I have read that glaucoma is the leading cause of blindness in African-Americans. There appears to be a genetic component to glaucoma, so you are at greater risk if one of your parents has/had it. But no one is ‘immune’ to it. Seriously, you should get your eyes checked.
There is nothing scary about being diagnosed with glaucoma. Everything that’s been done to me has been easy, quick and painless. My life hasn’t been turned upside down by it. There’s nothing I can’t do because of the glaucoma. I can drive as safely as someone without glaucoma (I had to notify the DVLA of my glaucoma and they asked me to do a quick and simple test at an optician to confirm that I was safe to drive). I can read as easily. If I were the kind of person who did active things like sport, I would be as able to do those things as if I didn’t have glaucoma.
Every few months, I’ve had the pressure in my eyes checked. The consultant at the eye clinic puts anaesthetic drops in my eyes – they don’t sting or hurt and they don’t affect your vision; they wear off after half an hour or so. Then he sits me down in front of the same kind of contraption that a high street optician has to look into your eyes – that metal frame with a chin rest and a forehead rest to keep your head still. He puts a glass rod against the front of my eye – but, because of the anaesthetic drops, I literally don’t feel a thing – and I assume there’s a little gauge on there that measures how much the rod can be pushed against the eye in order to determine the internal pressure. You usually get a figure between 10 and 20 (I have no idea what the unit of measurement is). Low teens is normal. Around 17 or 18 is where it starts to be a bit worrying. I’ve had as high as 24, and as low as 12. Your eye pressure changes over time – it even fluctuates during the course of the day.
The other thing I have to do every few months is have a ‘field test’ to detect blind spots in my field of vision. You sit in front of what looks like the inside of a large white plastic box. It appears to be blank on the inside, apart from a little white light in the centre which is what you focus on. As you focus on this light, other little points of light will appear, one by one and of varying levels of brightness, all around your peripheral vision. They give you a button and you press this each time you see a light. It takes about five minutes for each eye. The machine then gives a printout of where in your field of vision, if anywhere, it thinks you might be losing your vision. Again, it’s quick, easy and painless.
I’ve had other tests, all of which have been a breeze. (By the way, isn’t it great that we have a National Health Service that can do all this and I haven’t had to worry about whether or not I can afford it?) I’ve had an MRI scan which didn’t bother me at all – the main thing you notice is that it’s a lot noisier than you expect. I had an OCT scan which was so uninvasive that I didn’t even realise I’d had it done – I thought they were just taking photos of my eyes. I had a fluorescein angiogram – where they inject a fluoresecent dye into your arm and take photos of your eye very rapidly to see the progression of the dye through the blood vessels in the eye. I didn’t like this because of my needle phobia but, apart from the needle in my arm, I didn’t feel a thing. (Your wee turns a really bright fluorescent orange for a couple of days afterwards which is alarming at first, but you learn to have fun with it after a while and you start to miss it when it goes back to normal.)
There is no cure for glaucoma, but treatment of it is also nothing to worry about. For most people with glaucoma, eye drops are all you need – albeit that you have to take them for the rest of your life. I’ve been through various eye drops, increasing in strength as I went along. Currently, I take one type of drop twice a day, and another once a day – it’s just part of my routine getting out of bed in the morning and going to bed in the evening, so really easy. One of the drops has no side effects on me at all. The other makes my vision blurry for about thirty seconds; gives me a slightly bitter taste at the back of my tongue for a few minutes (which is a little bit freaky, if you think about it); and can make my eyes feel dry and scratchy sometimes, for which I have a third set of drops for when it gets uncomfortable.
If the drops don’t do the trick – as was the case for me – you can move on to laser treatment. This was a doddle. They put anaesthetic drops in and then held a glass lens against the front of my eye (with an aqueous gel between the lens and my eye to let them move the lens about). The lens was used to focus and aim the laser. In short, repeated bursts, the laser was fired at different points around the edge of the iris in each eye, to stimulate that drainage mesh that I mentioned earlier into working better. It was uncomfortable, but not painful. I did feel, occasionally, what felt like little pin-pricks on my eye which I was told was because I have dark brown eyes that absorb more of the laser light than paler eyes, so the laser makes itself a bit more powerful to compensate. It was really no big deal, though. It took about twenty minutes and they check you an hour later to make sure it’s all OK before sending you home. I had it done twice, about a month apart – the top half of each iris first time, the bottom half the second time.
My eyes are clearly stubborn things, so I’m now having to go for surgery. I won’t go into the squeamish detail about the procedure – Google ‘trabeculectomy’ if you want to know what it entails. Suffice to say that I will have a general anaesthetic (it can be done under local, but I think I’d freak out if it were). It will take about an hour and I’ll go home that afternoon. I’ll have a bandage over my eye for the night. I will have to go back into hospital to be checked frequently, at first, but then less regularly as it heals and they are satisfied that it’s all gone well. I’ll be out of action for a week or so but, after that, I should be able to go back to life as normal pretty quickly. I’ll have more eye drops to take, a lot more frequently than my current ones, for a few months. In six months’ time, I’ll have the other eye done and go through it all again. But, once that eye has healed, I will effectively have a near-permanent remedy. No more eye drops or lasers. No more vision loss. I will probably have to go back in about 30-40 years to have the procedure done again, but that’s a small price to pay for keeping my sight.
This blogpost probably seems very self-indulgent – why should anyone else care about what’s happening to my eyes? My purpose is partly to reassure anyone who might have glaucoma that it’s a condition that is easy and painless to treat and to live with. A lot of the information you’ll find online about glaucoma is a bit technical and jargon-filled. You don’t get to find out what it really feels like to have glaucoma and be treated for it. I can only share my own experience – I imagine it’s different for each person depending on the nature of their condition and the treatment they receive. If you’re being investigated for glaucoma, or you’ve just been diagnosed, you may have a very different experience to mine. But I think my experience is fairly typical. I hope this blogpost will, to some extent, set your mind at ease.
More importantly, my purpose is to convey this simple message: get your eyes tested. My journey – through diagnosis, treatment and now surgery – started with an ordinary eye test from an ordinary optician. That little puff of air saved my sight. It could save yours, too.