#SeeTheMusic and More – Glaucoma, the silent thief of sight

Eye conditions and the performing arts professional

Being the only performing arts eye care specialist in the UK as well as the only optician registered with BAPAM , we fully understand how issues with the eyes can negatively affect a performer’s career.

Musicians, dancers, singers, presenters, camera operators, sound engineers, and video technicians have all benefited from our assistance.

We all may experience vision problems at some point in our lives. Most of these problems are caused by refractive errors, which affect the way the eyes focus light, rather than an underlying condition or illness. Nevertheless, eye conditions affect many people. The purpose of this blog series is to examine common eye disorders experienced by performing arts professionals.

Glaucoma – What exactly is it?

The term “glaucoma” refers to a group of diseases that affect the optic nerve, which connects the retina to the brain, resulting in a loss of peripheral vision. Primary open-angle glaucoma (POAG) is the most common form of glaucoma.

Of the multiple types of glaucoma, the two main types are open-angle and angle-closure glaucoma.

Variants of open-angle and angle-closure glaucoma include:

  • Secondary Glaucoma.
  • Pigmentary Glaucoma.
  • Pseudoexfoliative Glaucoma.
  • Traumatic Glaucoma.
  • Neovascular Glaucoma.
  • IridoCorneal Endothelial Syndrome (ICE)
  • Uveitic Glaucoma.

As glaucoma is asymptomatic, but causes irreversible vision loss, it has been referred to as the “silent thief of sight.”. According to the World Health Organisation, it’s a leading cause of irreversible blindness (World Health Organisation, 2010). (Bunce et al., 2010) cites it as the second most common cause of visual impairment registration in England and Wales. Glaucoma is an umbrella term for a large group of disorders with a wide variety of clinical and pathological characteristics. The common characteristics are: 

  • Optic nerve damage
  • Visual field loss

The disease is a silent progressive disease and, if detected and treated early, is preventable and can lead to significant visual impairment or blindness. Diagnosis is crucial, and adherence to treatment is essential to prevent vision loss.

Glaucoma accounts for the majority of the workload (1 million visits per year) in  UK eye clinics. About 2% of people over 40  years of age and nearly 10% of people over  75 have primary (chronic) open-angle glaucoma (POAG). Only about half are diagnosed (National Institute for Health and Care Excellence, 2009). The social and economic burden of glaucoma-related vision loss and  workload is likely to increase due to longer life expectancy (Coleman and Miglior, 2008; Burr et al., 2007). Because glaucoma patients may  have no symptoms until they have lost their vision, then the loss of vision is irreversible. Once vision loss is apparent, 90% of the fibres of the optic nerve  may be irreparably damaged (NICE, 2009). Treatment slows progression by lowering intraocular pressure (IOP).

Consequences of glaucoma for the performer

Damage to nerve cells in the retina leads to damage to the visual field. Peripheral fields are usually damaged first. Loss of peripheral vision may go unnoticed until it reaches a significant level, due to the small role that peripheral vision plays in the overlapping vision of our eyes and in perceiving what most people can see. Deterioration usually progresses slowly over the years, although some types of secondary open-angle glaucoma can progress faster.

Performers, particularly musicians who play larger instruments such as pianos, organs and large percussion use their peripheral vision more than most. As a result the symptoms of peripheral vision loss may well be detected sooner. 

Some instrumentalists however may be at an increased risk of the condition. Recent studies suggest that musicians playing high-impedance wind instruments may be susceptible to glaucoma. This could be because the Valsalva manoeuvre is generated when blowing into a high impedance wind instrument. The Valsalva manoeuvre has been reported to cause high intraocular pressure (IOP). 

High and low resistance wind musicians experience a temporary increase in intraocular pressure while playing their instrument. The magnitude of the IOP increase is greater for high resistance players than for low resistance players. High-resistance wind musicians have a lower incidence of visual field loss than other musicians but IOPS are significantly higher, which is associated with lifetime playing time. The cumulative effects of long-term intermittent elevated IOP while playing high-resistance wind instruments could cause cell damage and possibly lead to an increased risk of developing glaucoma.

How do we check to see if you are at risk of glaucoma?

Tonometry

Our optometrists perform a number of different tests to look for glaucoma. We use a device called a tonometer to measure the pressure inside your eye. Our optometrist will put a small amount of anaesthetic and dye into the front of your eye. They will then shine a light into your eye and then use a tonometer to measure the pressure in your eye. Some optometrists use a different instrument that uses a puff of air called a non contact tonometer which does not touch the eye to check the pressure.

A visual field test determines whether any portions of vision are missing. It’s possible that you’ll be shown a series of light dots and asked to press a button to indicate which ones you saw. Some little dots may appear at the periphery of your vision (peripheral vision), which is generally the first area of glaucoma to be impacted. If you can’t see the spots you may be at risk of glaucoma.

Evaluation of the optic nerve 

Because the optic nerve, which connects your eye to your brain, can be damaged in glaucoma, an examination may be performed to determine its health.

Slit Lamp Exam

Eye Drops will be used to dilate your pupils for the test. Your eyes are then examined using a slit lamp (a microscope with a bright light) Slit-lamp examination of the optic nerve magnifies the view with hand-held lenses, allowing for greater control over the examination. This technique produces a stereoscopic, inverted image of the optic nerve.

Optical coherence tomography (OCT) tests create a topographical map of the optic nerve by taking cross-section pictures of the retina with non-invasive light waves. The thickness of the nerve fibre layer, which is the portion of the optic nerve most vulnerable to eye pressure elevation, is measured by an OCT test.

Referral to a specialist

If signs of glaucoma are detected during any of the tests, you will be referred to an ophthalmologist for further investigation. If you do have glaucoma the ophthalmologist will confirm your diagnosis and find out:

  • how far the condition has progressed
  • how much damage has been done to your eyes
  • what may have caused the condition

The ophthalmologist will be able to advise on treatment. 

In some cases, your ophthalmologist will continue to treat you. But for less serious types of glaucoma, you may be referred back to the opticians.

Treatment

There are a few courses of action to treat glaucoma, including eye drops, laser treatment and surgery. The best treatment for you will depend upon your condition.

Eye Drops

Treatment can’t reverse any vision loss but it starts with eye drops. These can help reduce IOP by improving drainage from your eye or by reducing how much fluid your eye makes. Depending  how low your eye pressure should be, more than one type of the eyedrops may be recommended.

Laser Treatment

Laser treatment might be suggested in the event that eye drops don’t work.

This is where a high-energy light is focused on part of your eye to stop or reduce fluid build up.

Sorts of laser treatment include:

laser trabeculoplasty

a laser is used to open up the vessels inside the eye,  to allow more fluid  to empty out and reduce the tension inside

cyclodiode laser treatment

a laser is utilised to remove a small amount of eye tissue that delivers the fluid, which can then decrease pressure in the eye

laser iridotomy

a laser is used to make openings in the iris to permit liquid to escape from your eye.

Surgery

In situations where eyedrops or laser treatments haven’t been successful surgery may be offered.

The most well-known sort of a medical procedure for glaucoma is called trabeculectomy. It includes removing part of the eye’s drainage mechanisms to permit more liquid to escape without any problem.

There are other glaucoma surgical options, including:

trabeculotomy — similar to a trabeculectomy, other than a tiny segment of the eye-drainage vessels are removed using an electric current.

A segment of the white outer covering of the eyeball (the sclera) is removed to allow fluid to drain more easily from the eye.

Deep sclerectomy — the drainage channels in the eye are enlarged, sometimes with the insertion of a small device.

trabecular stent bypass – a small catheter is inserted into your eye to improve fluid outflow.

Conclusion

Patients with chronic conditions, such as glaucoma, should work with their optometrist and other eye care professionals. Preventing irreversible and severe vision loss necessitates early detection and screening.

Getting regular eye exams is now the easiest approach to avoid major glaucoma damage.

Most people can keep their vision with early identification and meticulous, lifetime treatment. In general, a glaucoma check should be performed:

  • under age 40, every two years
  • from age 40 to age 64, every 12 months
  • after age 65, every six to 12 months

A screening should be done every year or two in those with high risk factors after 35. In addition to people of African descent and people with diabetes, those with a family history of glaucoma and wind instrumentalists have an elevated risk of getting glaucoma. If you have a parent or sibling with glaucoma, you are at higher risk.

Benefits of Exercise

A moderate exercise program is beneficial to your overall health, and studies have shown that moderate exercise, such as jogging or walking, three or more times a week, can lower IOP.

You can only reap the benefits of exercise for as long as you continue to exercise; this is why moderate exercise on a regular basis is recommended. The practice of yoga can be beneficial, but it’s important to avoid inverting positions, such as headstands and shoulder stands, as these can increase IOP.

If you have any questions or concerns regarding an exercise program, you should speak with your doctor.

Keep Your Eyes Protected

While participating in sports or doing home improvement projects, it is important to wear protective eyewear.

Protecting your eyes from injury is another way to prevent glaucoma. Traumatic glaucoma and secondary glaucoma are both caused by injury to the eyes.

The best defence against glaucoma and other eye diseases is a regular comprehensive eye exam.

In Summary

The optometrists at Allegro Optical have the technology, facilities, including our fantastic 3D OCT eye scanners, and experience to determine if your eye flashers are serious. Early detection and treatment are critical for preserving your vision, eye health, and performing arts career.

As the UK’s only specialist Performing Arts eye care provider we understand more than most just how much dry eye conditions can impact a performer’s career and everyday life. 

Our optical specialists understand the demands of professional musicians and performing arts professionals. Working in collaboration with our dispensing opticians and optometrists, we are able to assist musicians. It is surprising how many musicians are unaware of the many solutions available to them. 

With the precision of our performing arts eye exams, the expertise of our optometrists and dispensing opticians using cutting edge diagnostic equipment and dispensing procedures our unique approach can help to resolve performing arts practitioners’ vision problems. 

If you are suffering from any of the symptoms mentioned above or have any of the symptoms described then please speak to one of our staff.  To book an appointment or find out more about our exclusive dry eye programme, Call us today and speak to a member of our team. 

Contact: To find out more about Allegro Optical, the musicians’ opticians go to; https://allegrooptical.co.uk/services/musicians-optical-services/

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