Glaucoma Awareness Month: MI-SIGHT Program

January is Glaucoma Awareness Month. More than 3 million Americans have glaucoma. Learn more about the symptoms and risks and the Michigan Screening and intervention for Glaucoma and eye Health through Telemedicine (MI-SIGHT) study funded by the Centers for Disease Control and Prevention, Vision Health Initiative.

Paula Anne Newman Casey, M.D., MS, associate professor of ophthalmology at the University of Michigan and principal investigator of the MI-SIGHT study, answers questions about glaucoma and MI-SIGHT.

Q. What is glaucoma?

Glaucoma is a group of eye diseases that can cause vision loss and irreversible blindness by damaging the optic nerve in the back of the eye, which carries images from the eye to the brain.

Q. What are the symptoms of Glaucoma?

A. Glaucoma doesn’t usually have any early symptoms. However, over time, people with glaucoma may start to slowly lose peripheral vision, which is the ability to see objects around them without turning their heads or moving their eyes. This is hard to notice as it is easy to turn your head to see things. What people may notice more is not noticing cars or pedestrians until the last minute or having trouble reading, especially when the type does not have a lot of contrast, or even having trouble adjusting between light and dark.

Q. What is glaucoma screening?

A. Glaucoma screening involves more than checking your vision with the Eye Chart. One of the most important parts of glaucoma screening is evaluating the optic nerve. The optic nerve is like the electricity cable that connects the eye to the brain. The optic nerve brings all of the pixels from images the eye captures to the brain to project for us to see. In glaucoma, the optic nerve is damaged and pixels from the images we view are not transmitted to the brain. There are multiple ways to evaluate the optic nerve, including directly inspecting it through a dilated eye examination with an eye care provider, evaluating its health with a photograph or scan such as optical coherence tomography or evaluating its function through a visual field test. High eye pressure above 22 mmHg is also a risk factor for glaucoma and checking it can also be part of the glaucoma screening.

Q. Why is screening for glaucoma important?

A. People may not know they have glaucoma because often there are no early symptoms. Although the most common forms of glaucoma primarily affect the middle-aged and the elderly, glaucoma can affect people of all ages. Currently, there is no cure for glaucoma. But there is effective treatment. Therefore, early detection and early treatment are vital to stop the progress of this disease.

Q. Who is most at risk for glaucoma?

A. Anyone can get glaucoma, but some people are at higher risk. People over age 60, especially if they are Hispanic/Latino, African Americans over age 40, and people who have family members already diagnosed with glaucoma are at higher risk. Some individuals at higher-risk also face multiple barriers to accessing eye care, such as high costs, lack of health insurance, difficulty with transportation to the eye doctor and a lack of availability of trusted eye care providers nearby. These barriers are known as social determinants of health because where you live impacts your ability to access high quality care.

Q. What can people who are at higher risk do to prevent vision loss associated with glaucoma?

A. If you are at higher risk of glaucoma, you should see an eye care provider for a dilated eye exam. This, along with any testing your eye care provider recommends like a visual field or optical coherence tomography testing, are important ways to detect glaucoma in its early stages. Treatment can then be started early, which prevents vision loss. Your doctor may recommend eye drop medications, laser treatment or surgery to treat glaucoma. You should talk to your doctor about whether any of these treatments are right for you.

Q. How is the MI-SIGHT program at Michigan reaching people at higher risk for glaucoma?

A. Our MI-SIGHT program uses community-based strategies to reach those at higher risk of glaucoma who face systemic barriers to accessing eye care. We have partnered with two community clinics, a Federally Qualified Health Center and a free clinic which both serve people who are uninsured or underinsured and are located in communities with high levels of poverty. We have a Community Advisory Board that helped us implement the program in the two clinics and get the word out in the community. The Board recommended distributing flyers about our program in community churches, food banks, senior centers, barber shops and throughout the clinics as well as recommending advertising on public television, buses and radio. Now, people are predominantly coming to the program through word-of-mouth.

Q. What services does the MI-SIGHT program offer to people at high risk for glaucoma?

A. When people come to the MI SIGHT program at the community clinic, an ophthalmic technician measures for glasses, and takes a number of ocular measurements as well as photographs of the back of the eye to test for glaucoma and other eye diseases. Using telemedicine, the data is transmitted to ophthalmologists at the University of Michigan for review and interpretation. The person returns to the community clinic and the ophthalmic technician fits their low-cost glasses, explains the doctor’s recommendations and helps the person obtain recommended follow-up if it is needed. Using this process, we have provided low-cost glasses and eye disease detection to 2,500 people and counting.