GLAUCOMA TESTING AND TREATMENT

WHAT IS GLAUCOMA?

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The optic nerve is a bundle of about 1 million individual nerve fibers that transmits the visual signals from the eye to the brain. In the most common form of glaucoma, primary open-angle glaucoma, the fluid pressure inside the eye increases. This increase in pressure may cause progressive damage to the optic nerve and loss of nerve fibers. Advanced glaucoma may even lead to blindness. Not everyone with high eye pressure will develop glaucoma, and some people with normal eye pressure will develop glaucoma. When the pressure inside a person's eye is too high for a particular optic nerve, whatever that pressure measurement may be, glaucoma will develop. Glaucoma is the second-leading cause of blindness in the U.S. It most often occurs in people over age 40, although an infant (congenital) form of glaucoma exists. People with a family history of glaucoma, African Americans over the age of 40 and Hispanics over the age of 60 have an increased risk of developing glaucoma. Other risk factors include thinner corneas, chronic eye inflammation and taking medications that increase the pressure in the eyes.

 

Types of Glaucoma

 

Open Angle: This is the most common type. It is slowly progressive and has no symptoms until the late stages of the disease when the patient has significant vision loss. It is only detect with a comprehensive eye exam. If detected early, it can be treated and vision loss can be prevented or stabilized.

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Closed Angle: This condition is less frequent and is characterized by increase pressure in the eye due to insufficient drainage of the fluid. It can be acute closed angle or chronic narrow angle. Acute closed angle is an ocular emergency where the angle closes causing a rapid rise in pressure. Symptoms are a painful eye, redness, blurred vision, and brow ache. If untreated can lead to severe vision loss within 72 hours. If you have these symptoms seek care immediately.

 

Risk Factors

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• Age - Over age of 40

• Race - African Americans are significantly more likely to get glaucoma than Caucasians, and they are much more likely to suffer permanent vision loss. People of Asian descent and Native Alaskans are at higher risk of angle-closure glaucoma. People of Japanese descent are more likely to develop low-tension glaucoma.

• Family history of glaucoma

• Medical conditions - Some studies indicate that diabetes, high blood pressure, and heart disease may increase the risk of developing glaucoma.

• Physical injuries to the eye

• Corticosteroid use

 

Diagnosis

 

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Since open angle glaucoma has no symptoms, it is initially diagnosed through a comprehensive eye exam. Once the doctor suspects the presence of glaucoma, they will schedule the patient for additional testing.

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Additional glaucoma testing includes:

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• Serial Tonometry - Multiple Intraocular Pressure Testing

• Visual field testing (also called threshold perimetry) - This test measures your side (peripheral) vision and central vision to determine if glaucoma is present.

• OCT testing - This is a non invasive test that scans the optic nerve and nerve fiber layer to evaluate for any damage to the nerve from glaucoma

• Pachymetry - This is a corneal thickness measurement. Thinner corneas are more likely to develop glaucoma

• Gonioscopy - This is a contact lens that is placed on the eye to evaluate the drainage system of the eye.

 

Treatment

 

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Medications: A number of medications are currently available to treat glaucoma. Typically, medications reduce elevated pressure in the eye. A single medication or a combination of medications may be prescribed. The type of medication may change if it is not reducing pressure enough or if the patient is experiencing side effects.

 

Surgery: Procedures include laser treatment, making a drainage flap in the eye, inserting a drainage valve, or destroying the tissue that creates the fluid in the eye. All procedures aim to reduce the pressure inside the eye when medication is not sufficient. Surgery cannot reverse vision loss.

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