What is Neovascular Glaucoma?

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Neovascular glaucoma (NVG) is a type of glaucoma that results from the growth of new blood vessels in the iris and the drainage angle of the eye. These new blood vessels are abnormal and fragile, and they can cause blockages in the drainage system of the eye, leading to increased intraocular pressure (IOP) and damage to the optic nerve.

NVG can be a secondary complication of several underlying conditions, such as diabetic retinopathy, central retinal vein occlusion, ocular ischemic syndrome, and carotid artery occlusive disease. These conditions can cause insufficient blood flow to the retina, triggering the release of growth factors that stimulate the growth of new blood vessels.

NVG is a severe and rapidly progressing type of glaucoma that can cause severe vision loss and blindness if left untreated. The treatment for NVG typically involves a combination of medical therapy, laser treatment, and surgery to control the IOP and prevent further damage to the optic nerve.

Causes of Neovascular Glaucoma

Neovascular glaucoma (NVG) is caused by the growth of abnormal new blood vessels in the iris and the drainage angle of the eye. The growth of these blood vessels is typically triggered by underlying conditions that cause a lack of blood flow and oxygen supply to the retina, which in turn releases certain growth factors that stimulate the growth of new blood vessels.

Conditions that can lead to NVG include:

Diabetic retinopathy

High blood sugar levels damage the blood vessels in the retina, leading to reduced blood flow and the release of growth factors.

Central retinal vein occlusion

A blockage in the main vein of the retina can lead to the growth of new blood vessels.

Ocular ischemic syndrome

A condition caused by reduced blood flow to the eye, often due to blockages in the carotid arteries.

Carotid artery occlusive disease

Blockages in the carotid arteries can reduce blood flow to the eye and trigger the growth of new blood vessels.

The abnormal new blood vessels in NVG can cause blockages in the drainage system of the eye, leading to increased intraocular pressure and damage to the optic nerve, which can result in vision loss and blindness if left untreated.

Symptoms of NVG

Neovascular glaucoma (NVG) can cause several symptoms, including:

Severe eye pain

The increased pressure in the eye can cause pain, especially around the brow and temple areas.

Vision loss

As the optic nerve becomes damaged, vision loss can occur. This can start with the loss of peripheral vision and progress to complete blindness if the condition is left untreated.

Blurred vision

The increased pressure in the eye can cause vision to become blurry or distorted.

Redness of the eye

The eye may appear red and swollen due to increased pressure and inflammation.

Halos around lights

People with NVG may see halos or rainbows around lights, which can be a sign of increased intraocular pressure.

Headaches

The increased pressure in the eye can cause headaches, especially in the temple area.

It is important to note that many people with NVG may not experience any symptoms in the early stages of the condition. Regular eye exams are crucial to detecting the condition early and preventing permanent vision loss.

How is it diagnosed?

Neovascular glaucoma (NVG) is typically diagnosed through a comprehensive eye exam that may include the following tests:

Tonometry

This test measures the pressure inside the eye, which is typically elevated in people with NVG.

Visual field testing

This test measures the extent of a person’s peripheral vision, which can be affected by NVG.

Gonioscopy

This test allows the eye doctor to examine the drainage angle of the eye to see if there are any blockages or abnormalities.

Dilated eye exam

This test allows the eye doctor to examine the back of the eye, including the optic nerve and retina, to look for signs of damage or abnormalities.

Fluorescein angiography

This test involves injecting a dye into a vein in the arm, which then travels to the blood vessels in the eye. The eye doctor can then take pictures of the eye to look for abnormal blood vessel growth.

If NVG is suspected, additional tests may be performed to determine the underlying cause, such as blood tests to check for diabetes or carotid artery disease. Early detection and prompt treatment are crucial to preventing permanent vision loss from NVG.

Who is most at risk for neovascular glaucoma?

Several factors can increase a person’s risk of developing neovascular glaucoma (NVG), including:

  1. Underlying conditions: NVG is most commonly associated with underlying conditions that cause a lack of blood flow and oxygen supply to the retina, such as diabetic retinopathy, central retinal vein occlusion, ocular ischemic syndrome, and carotid artery occlusive disease.
  2. Age: NVG is more common in people over the age of 50.
  3. Gender: NVG is slightly more common in women than men.
  4. Race: NVG is more common in people of African or Hispanic descent.
  5. Eye trauma or surgery: Trauma or surgery to the eye can increase the risk of developing NVG.
  6. Prolonged use of corticosteroids: Long-term use of corticosteroid medications can increase the risk of developing NVG.
  7. Family history: People with a family history of glaucoma may be at increased risk for developing NVG.

It is important to note that many people with NVG have no known risk factors, and early detection and prompt treatment are crucial to preventing permanent vision loss from the condition.

How is each condition treated that leads to NVG?

The treatment of neovascular glaucoma (NVG) involves not only controlling the intraocular pressure but also treating the underlying condition that is causing the growth of new blood vessels in the eye. The specific treatment will depend on the underlying cause of NVG. Some common treatments for the underlying conditions that lead to NVG include:

Diabetic retinopathy

Treatment for diabetic retinopathy may include laser therapy to reduce the growth of abnormal blood vessels or medications to improve blood sugar control and slow the progression of the disease.

Central retinal vein occlusion

Treatment may include medications to reduce the growth of abnormal blood vessels or surgery to improve blood flow in the retina.

Ocular ischemic syndrome

Treatment may include medications to improve blood flow to the eye or surgery to improve blood flow in the carotid artery.

Carotid artery occlusive disease

Treatment may include medications to improve blood flow to the eye or surgery to remove the blockage in the carotid artery.

In addition to treating the underlying cause, the intraocular pressure must also be controlled to prevent further damage to the optic nerve. Treatment for elevated intraocular pressure in NVG may include:

  1. Eye drops: Medications, such as prostaglandin analogs or beta blockers, may be prescribed to lower intraocular pressure.
  2. Laser therapy: A type of laser treatment called trabeculoplasty may be used to improve the drainage of fluid from the eye.
  3. Surgery: Procedures such as trabeculectomy or tube shunt surgery may be performed to improve the drainage of fluid from the eye.

Overall, the treatment of NVG is complex and often requires a team of healthcare providers, including ophthalmologists and specialists in the underlying condition causing the growth of new blood vessels.

What is the prognosis?

The prognosis for neovascular glaucoma (NVG) depends on several factors, including the underlying cause, the severity of the condition at the time of diagnosis, and how quickly the condition is treated.

If left untreated, NVG can lead to irreversible vision loss and blindness. However, with prompt and effective treatment, the progression of the disease can be slowed, and in some cases, vision loss may be partially or fully restored.

In general, the prognosis for NVG is better when the underlying cause is treated aggressively and the intraocular pressure is controlled early in the course of the disease. However, in some cases, the damage to the optic nerve may be irreversible, and vision loss may be permanent.

Regular eye exams are important for people who are at risk of developing NVG due to underlying conditions such as diabetic retinopathy, central retinal vein occlusion, ocular ischemic syndrome, or carotid artery occlusive disease. Early detection and prompt treatment of these conditions can help prevent the development of NVG and reduce the risk of permanent vision loss.

Preventing NVG?

The best way to prevent neovascular glaucoma (NVG) is to control the underlying conditions that can cause the growth of abnormal blood vessels in the eye. Some steps that can be taken to reduce the risk of developing NVG include:

Managing diabetes

If you have diabetes, it is important to maintain good blood sugar control to prevent damage to the blood vessels in the eye.

Controlling blood pressure and cholesterol

High blood pressure and high cholesterol can increase the risk of developing ocular ischemic syndrome, which can lead to NVG. Managing these conditions can help reduce the risk.

Regular eye exams

Regular eye exams are important for people who are at risk of developing NVG due to underlying conditions such as diabetic retinopathy, central retinal vein occlusion, ocular ischemic syndrome, or carotid artery occlusive disease. Early detection and treatment of these conditions can help prevent the development of NVG.

Avoiding eye trauma

Trauma to the eye can increase the risk of developing NVG. Wear protective eyewear when engaging in activities that could cause eye injury.

Avoiding long-term use of corticosteroids

Long-term use of corticosteroid medications can increase the risk of developing NVG. If you are prescribed corticosteroids, follow your doctor’s instructions carefully and do not use them longer than prescribed.

Overall, preventing NVG requires careful management of underlying conditions that can cause the growth of abnormal blood vessels in the eye. Working closely with your healthcare team and having regular eye exams can help reduce the risk of developing this condition.

Summary

Overall the best defense against developing neovascular glaucoma is to live a healthy and active lifestyle. Eat a healthy diet, get plenty of exercise,s and keep these aforementioned underlying diseases at bay. Once you get to the point where NVG is developing it can be a downhill struggle. Take action sooner than later to get these conditions under control.

FAQ’s

Neovascular glaucoma: Is it considered an emergency?

Neovascular glaucoma is a serious eye emergency that has a high risk of permanent, quick vision loss. The most common causes of this illness are proliferative diabetic retinopathy (mainly from T2DM) and central retinal vein occlusions, however, it can be brought on by a wide range of ocular/systemic disease processes.

Is there a cure for neovascular glaucoma? 

Neovascular glaucoma has a rapid clinical progression and is typically unresponsive to medical treatment alone. During the past few decades, surgical methods for treating this complex type of glaucoma have developed, but frequently still leave patients with a guarded visual prognosis. 

The frequency of neovascular glaucoma. 

Around 3.9% of all cases of glaucoma are NVG. NVG has a low overall frequency in the US, yet it nevertheless causes considerable morbidity and vision loss. Those who are older are more likely to have it.

What are the stages of neovascular glaucoma?

Neovascular glaucoma (NVG) does not have defined stages like some other eye diseases. However, the progression of the disease can be classified based on the severity of symptoms and the degree of optic nerve damage.

In the early stages of NVG, there may be few or no symptoms, and the intraocular pressure may not be significantly elevated. As the disease progresses, patients may experience symptoms such as eye pain, redness, blurred vision, and halos around lights. The intraocular pressure may also increase, causing damage to the optic nerve and leading to vision loss.

In advanced stages of NVG, the optic nerve may be severely damaged, and vision loss may be irreversible. In some cases, the eye may need to be removed to prevent further damage to surrounding tissue.

It is important to note that the progression of NVG can vary widely depending on the underlying condition causing the abnormal blood vessel growth and how quickly the condition is diagnosed and treated. Early detection and prompt treatment can help slow the progression of the disease and improve the prognosis.

About the Author:
Dr. Shaun Larsen

Dr. Shaun Larsen

Dr. Shaun Larsen is an optometrist who specializes in low vision services and enhancing vision with contact lenses. He has a passion for making people's lives better by helping them see well enough to read, write, or drive again. He always keeps up with the latest technology so he can help people regain their independence.

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