Glaucoma (“silent thief of vision”)

Glaucoma is the leading cause of irreversible blindness in world. 

Glaucoma is often referred to as the “silent thief of vision” because there are typically no signs or symptoms to warn that vision loss is occurring.  Vision loss occurs because of damage to the optic nerve, the connection between the eye and the brain.  As the optic nerve is damaged, vision is first lost in the periphery and then slowly encroaches toward the central vision.

Diagnostic Tests for Glaucoma

• Tonometry - measuring intraocular pressure
• Ophthalmoscopy - visualization of the optic nerve and retina through a dilated eye exam
• Visual Field Testing - measures the peripheral vision of each eye. This is a functional test of the optic nerve.
• Goinoscopy - examination of the drainage angles (where drainage channels are located) of each eye.
• Pachymetry - measurement of the thickness of the cornea
• Optical Coherence Tomography (OCT) - measurement of retinal nerve fiber layer

Treatment Options

The goal of glaucoma treatment is lowering the eye pressure to prevent damage of the optic nerve with minimal side effects.  Damage caused by glaucoma cannot be reversed, so preventing further damage is very important.

Eye Drops (Pharmaceuticals)

Eyedrops are very effective in keeping the eye pressure low in most patients.  The challenge is taking the eyedrops every day since the drops are effective for only a  limited time.  Eyedrops may vary in dosage from once a day up to three times a day.

Learning how to place drops in one’s eyes can be challenging, but most people are able to put their own eyedrops in their eyes with practice.

Six Steps for Using Eyedrops Properly:

1:  Read the Label on the Bottle

Make sure the medication you have is the one prescribed by your eye doctor and it’s not expired.

2:  Wash Your Hands

Thorough hand washing is critical whenever it comes to touching your eyes or handling corrective eyewear. Doing so lowers the risk of hand-eye transmission of germs.

3:  Gently shake the bottle and remove the cap.

You can leave the cap on a clean tissue. Avoid touching the tip of the bottle throughout the process.

4:  Look up to the ceiling

Next, tilt your head back slightly and look up to the ceiling. Use one hand to pull down your lower eyelid, forming a pocket. Hold the bottle with your other hand and place it directly above the pocket.

5:  Apply Eye Drops 

Once everything’s in place, gently squeeze the bottle to release one drop.  Close your eyes and avoid blinking. 

6:  Apply gentle pressure to the inner corner of the eye

Using your finger, apply pressure to the corner of the eye where it meets your nose for two to three minutes. Doing so encourages proper absorption of the medication. Blot any excess solution with a clean tissue before opening your eyes.

Laser

Lasers can be used in certain types of glaucoma to create increase outflow of fluid from the eye and thus lower the eye pressure.

These laser procedures are used in office and patients tolerate them well.  Patients can drive themselves to and from the laser appointment.  Patients can usually return to work or other activities the same day as the procedure.

• Laser Peripheral Iridotomy: used to treat closed-angle glaucoma.
• Selective Laser Trabeculopasty: Used to reduce the eye pressure in all types of glaucoma.

Surgery

Eye surgery designed to improve existing or create new drainage pathways for lowering the eye pressure is sometimes required when eyedrops and laser treatment is not provide adequate pressure control.

Sometimes glaucoma surgery is paired with cataract surgery if a cataract is present.