Glaucoma is third leading cause of blindness in the U.S. Glaucoma is a disease of the optic nerve.
Elevated pressure inside the eye is a risk factor for development of Glaucoma, but eye pressure does not always have to be elevated to have Glaucoma. This is why a comprehensive dilated exam with careful examination of the optic nerve is vital in the diagnosis of glaucoma.
The optic nerve, in the back of the eye, contains approximately one million nerve fibers. These nerve fiber cells provide sensory information to the brain. Glaucoma involves gradual damage to the nerve fiber layer, leading to optic nerve damage and ultimately vision loss, usually in a “tunnel” like fashion. Glaucoma usually developes without pain, and generally can not be prevented, but it can be controlled, and vision loss can be prevented. At least half of people who have glaucoma don’t know they have it.
Our comprehensive examinations include evaluation of intraocular pressure, and more importantly, dilated retinal evaluation and careful binocular ophthalmoscopic examination of the optic nerve. OCT technology is helpful at measuring nerve fiber layer thickness. Often early nerve damage is seen long before functional visual field (peripheral vision) damage is measured. Sometimes this helps guide treatment decisions if progressive nerve fiber loss is detected through serial nerve fiber layer analysis.
There are often no obvious symptoms of glaucoma in its early stages. In an exam, your doctor can look at your eye pressures and optic nerve for signs of glaucoma. If necessary, your doctor can then order further testing to determine whether glaucoma is present. Our clinic uses advanced image capturing technology called optical coherence tomography (OCT) to obtain images of the optic nerve and nerve fibers.
A family history of glaucoma or having high blood pressure or high blood sugar may leave you at a higher risk for developing glaucoma and should be watched very closely with annual exams.
In the early stages of the disease there are no signs or symptoms. Only during your yearly eye health exam in Oklahoma City at our office with full dilation of the pupil can we detect glaucoma when we examine eye pressure and the condition of the optic nerve. If we suspect you could have glaucoma, we will order further tests which will include a visual field test to determine if there has been any subtle loss of peripheral vision.
We will also look at your nerve fiber layer with a special machine called an OCT. The OCT stands for “Optical Coherence Tomography” and we use it to precisely capture an image of the optic nerve and surrounding nerve fibers. Like an ultrasound, the OCT measures the reflection of infrared light, not sound, which is reflected uniquely by different tissues. This test can help detect glaucoma much sooner than other traditional methods.
If needed, we will prescribe eye drops that help to lower eye pressure or discuss a laser treatment called SLT laser, or Selective Laser Trabeculoplasty. If eyedrops are started, after a few weeks of beginning the new medication, we will have you return to repeat pressure measurements and to see how you are tolerating your new medication. We will continue to monitor your eye pressure by asking you to return every three to six months to take another look and to repeat some of the testing looking for any advancement of the disease. We cannot emphasize enough how important these follow-up appointments are to preserving your good vision.
During your follow-up visits, we may prescribe additional medications to help to lower pressure further, and we may suggest more therapeutic treatments like the SLT or Selective Laser Trabeculoplasty. To increase the drainage of the aqueous fluid, a laser is used to help the trabecular meshwork—the normal outflow area for aqueous, to allow more fluid to filter through. Sometimes, the SLT laser helps to reduce the need for additional drops, but please remember to specifically follow our treatment plan and ask questions if you don’t understand.
When we don’t get the pressure down with medications or laser, we may have to resort to surgery to slow the progress of glaucoma. We may suggest a procedure called a Canalaplasty for treatment of advanced glaucoma. Canalaplasty is an effective and proven procedure that uses microcatheter technology to enlarge your drainage system much like with angioplasty. By restoring your natural drainage system, eye pressure is usually lowered. Other types of surgery are available as well if needed
Treatment is guided at reducing the IOP in the eye. Regardless of treatment, they all are ultimately aimed at reducing functional vision loss over your lifetime. Vision that has already been lost secondary to glaucoma cannot be regained. Early detection and treatment are key to limiting vision loss over the course of a patients lifetime.