Glaucoma

What is glaucoma and how is it caused?

Glaucoma is a disease of the optic nerve which usually arises as a result of excess pressure within the eye.  Glaucoma is a major cause of blindness in the United States, and is more prevalent in people of advanced years. The key to prevention and successful glaucoma outcomes is to obtain treatment by an eye care professional at an early stage.
Routine checks for glaucoma, an integral part of regular eye care, are essential to detect and treat glaucoma since high pressure in the eye has no discernable symptoms.  Without routine eye exams, people often do not realize that they have a significant problem until it is too late to prevent visual loss.
Glaucoma results from an accumulation of fluid in the eye.  Usually this type of build up occurs because the fluid is unable to drain out through the natural exit pathways of the eye.  The build up of this flow of fluid increases the pressure on the optic nerve.  If untreated, this pressure, over a period of months to years will cause damage to the optic nerve. This damage causes decreased vision and visual field loss. 

GLAU2



There are several different types of glaucoma. The most common type, which affects over 90% of glaucoma patients, is chronic open-angle glaucoma. Chronic open-angle glaucoma causes a chronic, slow loss of visual field.
Another type of glaucoma is angle-closure glaucoma, in which a sharp rise in pressure occurs suddenly.  Symptoms of angle-closure glaucoma include severe pain in the eye, headaches, nausea and vomiting, blurred vision and seeing rainbow halos around lights.  This type of glaucoma can occur in only a few hours and cause severe visual loss which is irreversible.  It is essential to see an eye doctor for treatment upon experiencing the symptoms of angle-closure glaucoma or blindness can result.

How is glaucoma detected?

Vision loss from glaucoma is permanent but can usually be prevented with early detection and treatment.  Glaucoma management is usually a lifelong process that requires frequent monitoring and constant treatment.  Since there is no way to determine of glaucoma is under control based on how a person feels, regular doctor visits are critical. The glaucoma exam is painless and includes measuring intraocular pressure, inspecting the drainage angle of your eye, evaluating the optic nerve for signs of damage and testing the visual field in both eyes. We offer state-of-the art equipment to detect glaucoma, and to manage the course of treatment for each individual patient.  Our testing is discussed below. 

We routinely scan your optic nerves using the most sophisticated imaging technology available, the Zeiss OCT (optical coherence tomography). The optic nerve laser scanner is emerging as the state of the art of glaucoma care.  Our precision equipment, which includes a computerized visual field machine and stereo optic nerve cameras permits us to offer our glaucoma patients the gold standard in glaucoma care.  Fortunately, routine eye exams detect the vast majority of glaucoma conditions before any damage to vision occurs. SEE OUR SPECIALTY TESTING HERE

 

What are the risk factors for glaucoma?

There are several risk factors for glaucoma, which include a family history of glaucoma, African descent, high myopia, age, and trauma to the eye. Your ophthalmologist will consider these factors in determining whether and what type of treatment is most suitable for each patient and whether further monitoring is required.

How do you treat glaucoma? 

The most common forms of treatment for glaucoma are eye drops which act to reduce intraocular pressure or laser treatment.  Eye drops are usually very effective, however, they can be expensive and are often not covered by medical insurance.  Glaucoma drops may also unintended side effects, especially since they are usually taken every day for the rest of your life.  Surgery is more definitive than drops and can be very effective; however, it has a much higher risk of complications and is only used as a last resort.  Another option (discussed below) is SLT laser which is much easier and safer than surgery, and often has the same pressure lowering effect as eye drops. It is important to understand that treatment of any kind does not reverse previous damage but it can stop further damage to the optic nerve or vision.  In addition to treatment, monitoring visits with your eye doctor will usually occur every three to four months and include diagnostic tests to follow the progress of the glaucoma.

 

SLT laser

 

Selective Laser Trabeculoplast, or SLT, is a laser treatment used to lower intraocular pressure in open angle glaucoma.  It targets only specific cells of the eye, located in the drainage meshwork.  This allows for only those cells to be affected, leaaving surrounding tissue intact.  SLT uses extremely rapid laser pulses with minimal heat absorption by tissues.  For this reason it is sometimes referred to as “cold laser” because it does not cause thermal damage or tissue scarring.  The main goal of the laser is to disrupt the blockage of fluid outflow from the eye which eventually results in lowering of intraocular pressure. SLT is performed in the office and only takes a few minutes. The laser is applied through a special microscope, similar to the one used for eye examinations.  It is rare to experience pain.  When used as initial treatment it will lower the intraocular pressure significantly in about 75% of patients, freeing them from the inconvenience, cost and side effects of glaucoma drops. The pressure lowering effect usually lasts for several years and can be repeated if needed.  Side effects to the laser are quite limited and, in most cases, can be easily treated with anti-inflammatory drops.  SLT is reimbursed by almost all insurance plans.