Glaucoma Center

FIVE MOST FREQUENTLY ASKED QUESTIONS

WHAT IS GLAUCOMA?

 

Glaucoma is a disease of the optic nerve.  It causes a characteristic loss of nerve tissue manifested by loss of the nerve cells or axons going into the optic nerve.  There are many different types of glaucoma.  Two of the most common are primary open angle glaucoma and angle closure glaucoma.  Glaucoma is not a lifestyle disease and thus it is not caused by diet or lack of exercise like so many other illnesses.  While we always recommend a healthy lifestyle, the cause of glaucoma is largely due to genetics, family history, and simple aging.  Over 100 genes have now been found to cause glaucoma and it is important to realize sometimes these genes can show up even without a family history.  glaucoma continues to be one of the leading cause of blindness worldwide.

WHAT ARE THE SYMPTOMS AND HOW IS GLAUCOMA DIAGNOSED?

Early glaucoma has no symptoms.  This can be a problem because even though you have no symptoms, the damage to your eye is being done.  Often glaucoma is caused by high eye pressure but there are cases in which the eye pressure is normal.  This is called low pressure or normotensive glaucoma.  Routine eye exams are important to check for glaucoma and detect it in its earliest stages.   A dilated exam and check of eye pressure is done as well a variety of other scheduled tests such as optic nerve function, imaging tests, and peripheral vision exams.  Glaucoma is easiest to treat and prevent further deterioration of the nerve in the early stages.

WHY ARE SO MANY TESTS NECESSARY FOR GLAUCOMA?

Glaucoma is not easy to diagnose in its earliest stages and detecting progressing disease can be tricky.  Each test uses different methods to measure optic nerve function.  Imaging tests called retinal nerve fiber tests or Optical Coherence Tomography (OCT) tests measure the thickness of the optic nerve fibers.  Visual  field tests (VF) measure the sensitivity of light seen in the peripheral vision which is one key finding in all glaucoma especially as it advances.  A new technique now available at the Eye and Lasik Center is called VEP or ERG testing.  These tests measure the electrical signals from the optic nerve or retina and can detect subtle abnormalities in function.  A study from Bascom Palmer Eye Institute in Florida found this new test can detect glaucoma 8 years earlier than our traditional ODT and VF tests.  All tests can have a false positives and false negatives and variability.  The only way to know if a patient is truly getting worse is to do these tests multiple times.  With this information your doctor can develop a “rate of progression” and be able to know how aggressively to treat your glaucoma.  This allows your doctor to personalize your care to your particular needs.

 

HOW IS GLAUCOMA TREATED?

Glaucoma treatment consists off three methods including medications, laser, or surgery.  The treatment is based on the type of glaucoma and the severity.  For mild “open angle” glaucoma, a once a day drop may be all that is necessary.  For “closed narrow angle” sometimes called acute glaucoma, a laser procedure is often done called a laser iridotomy.  This creates a small hole in the iris and allows for fluid to easily pass through the eye into the drainage canals and prevents the iris from blocking fluid in this time of glaucoma.  Another type of laser is called Selective Laser Trabeculoplasty (SLT) which is for “open angle” glaucoma allows better fluid drainage from the eye.  SLT has a good safety record and can also be used in place of drops as a good alternative.  Surgery for glaucoma Trabeculctomy and Tube Shunt procedure typically involves making a new drain.  It is only done for more serious types of glaucoma when vision is threatened.  Some newer techniques such as istents and ciliary ablative procedures are currently being developed at Eye and Lasik Center and maybe available shortly.  It is important to know that all medications, lasers, and surgeries have unique benefits and risks.  A discussion with your doctor will help determine which treatment is best for you.

 

WILL I GO BLIND FROM GLAUCOMA?

Glaucoma is still the second leading cause of preventable blindness in the USA despite all our treatments.  The main reasons for this is the fact that the disease has no symptoms in the beginning of the disease, problems adhering to medications that may have side effects, and compliance with difficult treatment regiments.  Uncommonly the disease itself is difficult to treat due to its unique genetics.  It is important to know there is great variability in glaucoma and that it is not really one disease but a disease of a thousand different cause and each must be treated uniquely to you.  The good news is that with today’s early diagnosis, better diagnostic instruments, better medications, improved surgeries, and good follow up care, the vast majority of patients will avoid any serious vision loss.  Glaucoma is clearly an illness that needs careful medical care to optimize good results.

TYPES OF GLAUCOMA:

  • Chronic or primary open-angle glaucoma
  • Acute closed-angle glaucoma.
  • Congenital glaucoma
  • Pigmentary glaucoma
  • Secondary glaucoma