Download Glaucoma Diagnosis, Treatment

Baseball Playoffs:
Time to Remember Kirby Puckett—and Glaucoma
By Dr. Michael Richie, MD
Richie Eye Clinic – Faribault, MN
Fall season brings brisk evening temperatures, brightly colored leaves, and
playoff baseball.
As the World Series gets underway, memories of 1987 and 1991 conjure
images of Homer Hankies, huge crowds, and Dome Dogs. Most memorable,
however, is Kirby Puckett scaling the left-center field wall to make “the
catch” and blasting the game-tying home run to send the series to Game 7.
For a decade, Puckett was the face of the Twins, always a
smile on his face, a bounce in his step, and a quote for the
microphone. Suddenly, however, his bat fell silent, the jokes
were no more and the career was over; glaucoma, they said,
had robbed Puckett of his vision virtually overnight.
The man who went 4 for 5 in his major league debut, who twice had 6 hits
in a single game, and who won the hearts of millions with his boyish grin
would never play again? Glaucoma in a world-class athlete? And only 36
years old? How could that be?
Well, pull up a chair and let’s talk…
Glaucoma, often called the silent thief, can in fact sneak up on you and steal
your vision because, you see, glaucoma has no symptoms until it is too late.
Glaucoma is a disease of the eyes in which high pressure, combined with
other factors that we do not completely understand, causes damage to the
optic nerve, which results in gradual, progressive, irreversible loss of vision.
The elevated intraocular pressure (IOP) is not high enough to cause pain or
discomfort, does not cause watery or tearing eyes, and will not make vision
blurry in the early stages so the key is early diagnosis and effective longterm treatment.
Since glaucoma really has no symptoms, one of the keys to diagnosis is
determining who is at greatest risk of developing the disease. Family
history, for example, is the single biggest risk factor but others include
African-American or Latino heritage, previous eye trauma, use of steroids
like prednisone for asthma or arthritis, diabetes, near-sightedness, or
specific ocular conditions called “pigment dispersion” and “pseudo
exfoliation syndrome.”
Next, we must evaluate the current status of the eye: the visual acuity and
IOP, the optic nerves, the peripheral visual field, and the thickness of the
cornea. The diagnosis of glaucoma, however, is made over time looking for
changes in the visual fields and the optic nerves over months and years. If
we find enough evidence to suggest that damage is occurring, or is likely to
occur, treatment must be initiated to lower the pressure.
Once we make the decision to treat, we set a “target pressure” and begin
therapy, usually with eye drops alone or in combination, until the target is
reached. Ultimately, laser treatment or even surgery may be required to
achieve the “target” but the reality is simple: we must lower the pressure to
the point where the glaucoma no longer progresses.
This is not a disease with a cure, but rather a condition that requires
treatment daily for the rest of your life…every day…whether you feel like
putting in your drops or not. Treatment is, however, quite successful; over
95% of people on treatment for glaucoma never have significant problems
and live out their lives happily, with good vision, taking their drops daily.
But if this is the case, what happened with Kirby Puckett?
Simply put, Puckett’s disease went undetected for so long that the pressure
rose high enough to cause a blocked blood vessel in the eye: Puckett lost
vision due to a blocked vein in his eye caused by untreated high pressure.
To think…a Hall of Fame baseball career cut short because he never had a
routine eye exam. The Twins will never make that mistake again, and
neither should you.