Glaucoma

Primary Open Angle Glaucoma 
Chronic Narrow Angle Glaucoma 
Acute Narrow Angle Glaucoma 

Glaucoma is a common disease of age, though occasionally you will see it in children and in young adults. There are many sub-varieties of glaucoma and we will be reviewing the main categories: glaucoma suspect, primary open angle glaucoma, normal tension glaucoma, chronic narrow angle glaucoma and acute narrow angle glaucoma. The common mistake patients and technicians make with glaucoma is that they consider it a diagnosis if they have high intraocular pressure (IOP), which is not always the case. By definition, glaucoma is defined as the progressive damage to the optic nerve in the eye. Nowhere in the modern definition of glaucoma is the mention of eye pressure. In fact, many glaucoma cases have low pressures which will be talked about later. It is for this reason that the work-up for glaucoma involves numerous different analyses of the optic nerve and fluid outflow of the eye for proper diagnosis and analysis for progression. Of course, pressure is still an important indicator that is still typically used as a measuring tool for the disease, though definitely not the only measurement used for treatment and management.

Glaucoma Suspect              BACK TO TOP

Definition:  A glaucoma suspect is a patient that presents with one of many possible risk factors and must be worked up to see if they have the disease.  Much like diabetes and high blood pressure, it is sometimes difficult to diagnose a patient immediately with glaucoma.  Studies are needed to confirm the diagnosis or label them a “watch patient”.  It is important that the doctor sees the patient and evaluates them properly as they may not have elevated pressures, family history or any symptoms. 

Work-up:  Standard work-up for a glaucoma suspect involves asking family history (very important), prior eye medical care (has anyone mentioned this to you before or done testing on this?) and getting a proper technician and doctor work-up.  

Testing:  The amount of glaucoma testing is sometimes quite extensive as each test gives us a little look into how the case is doing. 

Gonioscopy will be needed typically on the first visit or soon thereafter to look at the place in the eye where fluid drains out of the eye. Many glaucoma patients do not have normal anatomy here, and this will give the doctor a key to treatment.

Optic nerve photography is also very important as it gives the doctor photographic evidence of what the patient’s optic nerve looked like at that moment in time. Much like following skin lesions for suspicion of cancer, photographs are critically important in looking for change over time.

HRT or Optical Coherence Tomorography (OCT) are the modern technologies that Newsom Eye uses to laser scan the nerve fiber layer of the optic nerve. This not only analyzes against a database for disease, but also stores the findings for future reference with the patient to detect even the slightest progression of the disease.

Pachymetry is used to measure the central corneal thickness which we now know is an important data point of reference for glaucoma risk.

Treatment:  Observation is sometimes done if the patient is only considered a glaucoma suspect. Medical treatment may be initiated (drops which the patient will need to take daily).  However, commonly a laser treatment called selective laser trabelculoplasty or SLT is performed. This is a safe and effective treatment (usually covered by your medical insurance) that is effective at lowering the eye pressure. The treatment usually enables the patient to be kept off of costly medication which can cause side effects.

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