Glaucoma Diagnosis & Management — Abbotsford, BC

What Is Glaucoma?

Glaucoma is a group of eye diseases characterized by progressive damage to the optic nerve — the cable that transmits visual information from the eye to the brain. In most cases, this damage is associated with elevated intraocular pressure (IOP), caused by an imbalance between the production and drainage of the aqueous fluid inside the eye. However, optic nerve damage can also occur at normal pressures (normal tension glaucoma), making the condition more complex than a simple pressure problem.

Glaucoma is often called "the silent thief of sight" because it typically causes no pain and very few early symptoms. The peripheral (side) vision is usually the first to be affected, and most people do not notice this loss until the disease is already at a moderate or advanced stage. By the time central vision is affected, significant irreversible damage has already occurred. This is why regular screening is so important, particularly for individuals at elevated risk.

Glaucoma affects approximately 2–3% of Canadians over age 40, and its prevalence rises sharply with age. It is the second most common cause of blindness worldwide after cataract — but unlike cataract, the vision lost to glaucoma cannot be restored.

Types of Glaucoma

Primary Open-Angle Glaucoma (POAG)

The most common form in Canada. The drainage angle of the eye appears open and normal, but the trabecular meshwork — the eye's internal drain — is not functioning efficiently. Aqueous fluid builds up gradually, pressure rises slowly, and the optic nerve is damaged over years or decades. POAG is often asymptomatic until it is moderately advanced.

Angle-Closure Glaucoma

Occurs when the iris is positioned too close to the trabecular drainage angle, blocking aqueous outflow. It can present as a sudden, acute attack (acute angle-closure crisis) with eye pain, blurred vision, nausea, and halos around lights — a medical emergency requiring urgent treatment. It can also develop slowly as chronic angle-closure. The Fraser Valley's large South and East Asian populations are at higher risk for angle-closure glaucoma.

Normal Tension Glaucoma

The optic nerve is damaged despite intraocular pressures in the statistically normal range. The mechanism involves vascular insufficiency to the optic nerve alongside pressure-related factors. Management focuses on lowering IOP further below baseline, which still slows progression even in these cases.

Secondary Glaucoma

Glaucoma that arises as a result of another eye condition, such as pseudoexfoliation syndrome (flaking material depositing in the drainage angle), pigment dispersion syndrome, uveitis, or trauma. Secondary glaucomas can be more aggressive and may require earlier surgical intervention.

Risk Factors

Understanding your personal risk helps guide the right frequency of screening. Key risk factors include:

• Age: Risk increases significantly after age 60, and even more after age 70
• Family history: A first-degree relative with glaucoma increases your risk 4–9 fold
• Elevated intraocular pressure (ocular hypertension)
• Ethnicity: Individuals of African descent have a higher risk of primary open-angle glaucoma at younger ages. South Asian and East Asian communities in the Fraser Valley have elevated rates of angle-closure glaucoma
• Thin central corneal thickness: A structurally thinner cornea predicts higher risk of progression
• Myopia (nearsightedness): Associated with increased risk of open-angle glaucoma
• Long-term corticosteroid use: Topical, inhaled, or systemic steroids can elevate IOP
• Cardiovascular disease and low blood pressure: Reduced perfusion to the optic nerve head is a risk factor for normal tension glaucoma

Diagnosis

Glaucoma diagnosis requires a comprehensive assessment of several parameters — no single test is sufficient on its own. Dr. Sundaram's diagnostic workup includes:

Treatment Options

The goal of all glaucoma treatment is to lower intraocular pressure to a level where the optic nerve is protected from further damage. The target pressure is individualized for each patient based on their stage of disease, rate of progression, and optic nerve vulnerability. Dr. Sundaram offers a full range of glaucoma therapies:

Medical Therapy (Eye Drops)

Most patients begin with prescription eye drops that either reduce aqueous production (beta-blockers, carbonic anhydrase inhibitors, alpha agonists) or improve drainage (prostaglandin analogues). Prostaglandin analogues — such as latanoprost, travoprost, and bimatoprost — are typically used as first-line agents due to their effectiveness and once-daily dosing. Consistency with drops is essential; missed doses allow pressure to rise and the optic nerve to sustain further damage.

Selective Laser Trabeculoplasty (SLT)

SLT is an in-office laser procedure that uses targeted pulses of low-energy laser light to stimulate the trabecular meshwork cells and improve aqueous drainage. The procedure takes approximately 5 minutes, requires only topical anesthetic drops, and has no recovery time. SLT is effective in approximately 75–80% of patients, lowering IOP by an average of 20–30%. It can be used as a first-line treatment in place of drops, or as an add-on therapy. The effect can diminish over time, but SLT can often be safely repeated. It is covered by BC MSP.

Minimally Invasive Glaucoma Surgery (MIGS)

MIGS procedures are a newer category of surgical options that offer a better safety profile than traditional glaucoma surgery while still providing meaningful IOP reduction. They are often performed at the same time as cataract surgery. Examples include iStent (a tiny titanium implant that bypasses the trabecular meshwork) and goniotomy procedures that open the drainage angle directly.

Trabeculectomy

A trabeculectomy creates a new drainage pathway from inside the eye to a filtering bleb under the conjunctiva (the membrane covering the white of the eye). It remains the most effective IOP-lowering surgical procedure for advanced or refractory glaucoma, though it requires more intensive post-operative care than MIGS.

Glaucoma Drainage Devices

Tube shunt implants (such as the Ahmed or Baerveldt) direct aqueous fluid to a small plate sutured to the outer surface of the eye under the conjunctiva, where it is absorbed. These are used when trabeculectomy has failed or is unlikely to succeed, such as in eyes with significant conjunctival scarring.

Dr. Sundaram's Glaucoma Expertise

Dr. Aish Sundaram completed her ophthalmology training with a focus on glaucoma management and serves as a Clinical Instructor in the UBC Department of Ophthalmology & Visual Sciences, Glaucoma Division. Her academic involvement keeps her at the forefront of evidence-based glaucoma care, including advances in diagnostic imaging, laser therapy, and surgical technique.

Dr. Sundaram has contributed to published research in glaucoma screening and population-level detection strategies — work that is particularly relevant to the Fraser Valley, where significant South and East Asian communities face elevated risk of angle-closure glaucoma. She takes a patient-centered approach to glaucoma management, helping patients understand their diagnosis, their risk of progression, and the rationale for each treatment decision.