Evaluation and Treatment

Glaucoma is one of the leading causes of blindness in the United States. Glaucoma is a complex disease in which damage to the optic nerve leads to irreversible vision loss. It is the second most common cause of blindness in the United States. The most common type of glaucoma, Chronic open-angle glaucoma, causes a slow, “silent” loss of vision, giving glaucoma the characteristic title of “the silent thief of sight.” Most patients do not experience any symptoms during the early stages of glaucoma, including no pain and no vision loss. This makes it difficult for many patients to know if they have the disease. With routine eye exams, early signs of glaucoma which can only be detected by your ophthalmologist, can be managed and treated appropriately. As Glaucoma progresses, patients may experience a loss of peripheral or side vision. Another, less common type of glaucoma, narrow angle, or closed-angle glaucoma, can cause sudden eye pain, headache, blurred vision or the appearance of halos or rainbows around lights. This disease is best detected and treated with regularly schedule eye visits. 

Diagnosing Glaucoma

We offer the latest in diagnostic technology including two Humphrey Visual Field Analyzers and Optical Coherence Tomography (OCT) machines, with state of the art analysis capabilities, specific for diagnosing glaucoma. During each eye examination, several different tests are performed in addition to checking your visual acuity. Goldmann applanation tonometry is performed to measure the intraocular pressure (IOP) at every visit, and a pachymeter is used to measure the thickness of the cornea to assess future glaucoma risk progression. Other tests may be performed, such as optic disc photos (pictures of the optic nerve), peripheral vision tests, and tests to see how well patients can see at various distances.

Types of Glaucoma

Glaucoma is an eye disease in which the optic nerve, the nerve that leads from the eye to the brain to allow people to see, becomes damaged. This damage leads to loss of the peripheral vision that is irreversible. The main risk factor, and only treatable risk factor to prevent vision loss is eye pressure. In a healthy eye, fluid is produced in the ciliary body and then drains through tiny passages called the trabecular meshwork. In people with glaucoma, this drainage is inadequate and intraocular pressure rises. Patients diagnosed with the most common type of glaucoma, primary open-angle glaucoma, have increased eye pressure. Many forms of glaucoma exist. They are as follows:

  • Pseudoexfoliation glaucoma (residue from the inside of the eye blocks the drain in the eye leading to increased eye pressure)
  • Narrow Angle glaucoma (the drain of the eye becomes narrowed with time, leading to less drainage of fluid and high eye pressure)
  • Angle Closure Glaucoma (Painful eye emergency where the eye pressure increases and patients experience blurry vision, red eye, nausea and pain, This is an eye emergency)
  • Steroid-Induced Glaucoma (Optic nerve damage from use of steroid medications)
  • Traumatic Glaucoma (Optic nerve damage from trauma to the eye or head)
  • Normal Tension or Low Tension Glaucoma (Nerve damage in the presence of normal eye pressures)

Not all types of glaucoma are treated the same, and not all types of glaucoma respond the same to treatment. Some patients may have risk factors for glaucoma, but only require careful monitoring without treatment to prevent future vision loss. To learn more about your risk factors, please call to schedule an appointment.

Glaucoma Treatment

Once glaucoma has been diagnosed, treatment should begin as soon as possible to help minimize the risk of permanent vision loss. There is no cure for glaucoma, so treatment focuses on relieving symptoms and preventing further damage from occurring. Most cases of glaucoma can be treated with eye drops, laser or microsurgery. The best treatment for your individual case depends on the type and severity of the disease, and can be discussed with your doctor.

Glaucoma Treatment

  • Eye drops are used to reduce fluid production in the front of the eye or to help drain excess fluid, but can lead to redness, stinging, irritation or blurry vision. Patients should tell their doctor about any allergies they have to minimize the risk of side effects.
  • Laser surgery for glaucoma aims to increase the outflow of fluid from the eye, eliminate fluid blockages, or decrease the amount of fluid made in the eye.
  • Types of lasers include: Laser peripheral iridotomy (LPI), iridoplasty, selective laser trabeculoplasty (SLT) , or cyclophotocoagulation (Micropulse Laser, endocyclophotocoagulation)
    • Laser Peripheral Iridotomy (LPI) – For patients with narrow-angle glaucoma. A small hole is made in the iris to increase the angle between the iris and cornea and encourage fluid drainage.
    • Argon Laser Trabeculoplasty (ALT) and Selective Laser Trabeculoplasty (SLT) – For patients with primary open angle glaucoma (POAG). The trabecular passages are opened to increase fluid drainage. ALT is effective in about 75% of patients, and SLT may be repeated.
    • Laser Cyclophotocoagulation (CP) – For patients with severe glaucoma damage who have not been helped with other surgeries. The ciliary body that produces intraocular fluid is treated.
  • Glaucoma Surgery (MIGS) in conjunction with or separate from cataract surgery. These procedures are at lower risk with less surgical recovery time. They are commonly performed at the same time as cataract surgery and they aim to help reduce eye pressure by opening existing channels (drains in the eye). MIGS procedures, such as iStent inject and Visco 360 are often performed after medication and laser procedures have failed.

Risk Factors for Glaucoma

While there are no ways to prevent glaucoma from developing, regular screenings and early detection are the best forms of protection against the harmful damage that the disease can cause. While anyone can develop glaucoma, some people are at a higher risk for developing disease. These people may include those who:

  • Are over the age of 60
  • Have a family member (sibling, parent, aunt, uncle) with glaucoma
  • Have elevated intraocular pressure (IOP) as measured on exam
    Have thin corneas (central corneal thickness-CCT) as measured on exam
  • Have poor vision
  • Have diabetes
  • Have a history of trauma to the eye or head
  • Have used certain medications such as steroids in the past (given by mouth, or used as creams or nasal sprays)
  • African Americans over the age of 40

Patients over the age of 40 should undergo a comprehensive dilated eye exam at least once every 2 years. Patients over the age of 60 should have an examination every year, and those with risk factors for glaucoma may encouraged to test more frequently.

To learn more about glaucoma and how you can be tested for this condition, please call us today to schedule an appointment.

Traditional Glaucoma Surgery

Many cases of glaucoma can be treated with medications and microinvasive glaucoma surgical procedures. For others, traditional surgery is required to lower eye pressure once medications and/or laser procedures have failed. Common surgeries include:

  • Filtering Microsurgery (Trabeculectomy) – For patients who have not been helped with laser surgery or medications where a new drainage passage is created by creating a small hole in the sclera (the white part of the eye) and forming a collection pouch between the sclera and conjunctiva (the outer covering of the eye) underneath the eyelid.
  • Glaucoma Drainage Device (Tube) Surgery – May be recommended for patients with neovascular glaucoma, failed trabeculectomy, or susceptibility to developing scar tissue, or difficulty with allergies to medication eye drops. A thin, flexible tube (a shunt) with a silicone pouch is placed on the eye underneath the eyelid to create a new drainage system from the eye and facilitate lowering eye pressure. The fluid that flows through the tube is then channeled into the natural venous system.

For patients requiring a more traditional surgical approach, the shunts are placed strategically to minimize other’s from noticing any surgery has been performed. Often, other ophthalmologist will refer patients to glaucoma specialists for combined cataract and glaucoma procedures.