Glaucoma Care

Glaucoma is a group of ocular conditions that cause damage to the optic nerve and if left untreated can lead to vision loss and blindness. There are many different causes of glaucoma including an increase in the eye's fluid pressure, blocked drainage of the eye fluid as well as inflammatory and injury related glaucomas. Glaucoma is known as the sneak thief of sight because the patient may have no symptoms alerting them to the problem. That is why an annual eye exam is crucial to look for signs of glaucoma.

Common Types of Glaucoma

The most common form of glaucoma is called primary open angle glaucoma. It is where the internal eye pressure rises slowly over time leading to optic nerve damage and possible vision loss. Patients with this type of glaucoma will have elevated eye pressures when examined by our eye doctors.

The second most common form is called low tension glaucoma. This is where the eye pressure remains within the normal range, but still develops optic nerve damage. This condition may be caused by low blood pressure and/or cardiovascular disease.

Our Glaucoma Clinic and Diagnostic Center

Our practice uses the lastest in technology to diagnose each new case of glaucoma. In diagnosing glaucoma, our doctors order a variety of tests to ensure the proper diagnosis and course of treatment for each patient.

Posterior Ocular Coherence Tomography (OCT)

We use a Zeiss Cirrus Ocular Coherence Tomographer (OCT)  to evaluate the optic nerves. This test analyzes the nerve fibers as they leave the optic nerve and distribute out over the retina. In glaucoma, we will see areas that have a thinner nerve fiber layer than the normal population. The Cirrus OCT is able to help detect early nerve fiber loss in patients just starting to lose nerve fibers due to glaucoma.

We also use our Cirrus OCT to perform anterior OCT which allows us to visualize the anterior chamber of the eye. In glaucoma patients, it is crucial to make sure that the drainage of fluid out of the eye is unadultered. This test allows the doctors to visualize the drainage angle and ensure that the drainage angle is not being compromised leading to increased eye pressures.

Anterior Ocular Coherence Tomography (OCT)

Our Cirrus OCT also has the capability to perform imaging of the anterior chamber and cornea of an eye as well. This is used for patients with glaucoma to ascertain if they have adequate drainage angles to allow fluid to leave the eye. If the angle of the eye is narrow, then different treatment options may be needed for that patient.

 Peripheral Visual Fields

Our offices use Humphrey Visual Field Analyzers to test eaach patients' side vision. Due to how the optic nerves fibers distrubute across the retina, patients lose their peripheral vision first. Automated visual field testing will indicate how advanced the glaucoma is and test results are watched for any changes which may indicate progression of the condition.

Pachymetry: Corneal Thickness

Each patient who is suspect for glaucoma will have the thickness of their corneas taken. Standard eye pressure readings were based on calculations of a normal thickness cornea. It did not take into account if someone has a very thin cornea or a very thick cornea. By measuring this, we can determine if an eye pressure is abnormally elevated due to thickness of the cornea or if the pressure is low due to a thinner than normal cornea. We use this to determine if treatment is needed.

Eye Pressures

Another test that we use to diagnose and monitor glaucoma is meaursing the internal water pressure within the eye. We use Goldmann tonometry which is the standard of care for monitoring accurate eye pressures. We do not use the air puff tests. Goldman tonometry, also known as the "blue light" test, applies a small probe on the cornea after instilling an anesthetic eyedrop with a yellow dye in it. It allows the doctor or technician to obtain an accurate eye pressure. Our office has two ways to test eye pressure. One is using the slit lamp and the other method is by a portable Goldmann tonometer.

Treatment

With so many advancements in technology, earlier detection of glaucoma is available which leads to less vision loss over time. Treatment for glaucoma begins with eye drops to lower the internal eye pressure. Some may only require one eye medication to control their glaucoma. Others may require additional medications to lower the eye pressures and decrease the chance for further vision loss. If medication does not completely control the glaucoma, our doctors may refer the patient for possible glaucoma surgery to help lower eye pressures further.