Glaucoma Evaluation and Treatment

Glaucoma is an eye disease in which pressure inside the eye (intraocular pressure) rises dangerously high, damaging the optic nerve and causing vision loss. In a healthy eye, aqueous (watery) fluid is produced inside the eye to nutrify and sustain the inside health of some of the eye structures. This fluid circulates within the eye compartments and then drains through tiny passages called the trabecular meshwork. Normally there is a delicate balance between this fluid production and its drainage so the nerve does no get compromised. In people with glaucoma, the balance is disrupted and the pressure rises to a point where the optical nerve suffers damage.

Types of Glaucoma:

The most common types of glaucoma are primary open angle (POAG) and narrow angle glaucoma (NAG). The more frequent of these two is the primary open angle variety where the drainage structures are openly in contact with the aqueous fluid but trabecular meshwork is overwrought with the draining the aqueous fluid from the eye resulting in the pressure drop.

The second most common glaucoma is the narrow angle glaucoma which is also known as pupillary block glaucoma. In this variety the trabecular meshwork is not necessarily impaired but there is an anatomical misplacement of the pupil (the colored part of the eye) which seals off the access to the trabecular meshwork resulting in the pressure rise.

In very unusual cases both types of glaucoma can exist in the same eye. This uncommon variety is called combined mechanism glaucoma.

How Is Glaucoma Detected?
A thorough eye examination is necessary to diagnose glaucoma. Glaucoma is usually painless and the vision changes are difficult to detect in early cases. Close monitoring of the eye is necessary to prevent glaucoma vision damage. With proper medical care, glaucoma may be treated and controlled. An eye examination for glaucoma, including specialized testing, is the most important tool in preventing vision loss. During your exam, your doctors may determine that the Heidelberg Retinal Tomography test (HRT) and/or automated visual field testing is needed.

Zeiss/Humphrey Automated Visual Field Analyzer

Zeiss/Humphrey Automated Visual Field Analyzer Glaucoma usually affects peripheral vision (side vision) before it damages central (reading) vision. Proper glaucoma care involves periodic analysis of the peripheral vision. We use the Zeiss/Humphrey visual field analyzer a fast and reliable way to measure side vision

Back to Top Heidelberg Retinal Tomographer Heidelberg Retinal Tomographer The Heidelberg Retinal Tomography is a system that combines a laser-scanning camera and specialized software that evaluates the optic nerve. The HRT may diagnose glaucoma years before symptoms become apparent to the patient. The HRT is especially useful at detecting small changes over time. The HRT II is a confocal scanning laser ophthalmoscope that provides objective measurements of the optic nerve head and surrounding RNFL. Clinical research has shown that the automated results are comparable or better than expert interpretation of high quality stereo photographs of the optic disk. It is the only advanced imaging device to quantitatively measure the three vital structures, cup, rim, and RNFL, needed to make a complete assessment of glaucoma. This is important because glaucomatous damage can be detected at one or more of these locations depending on individual patient anatomy and susceptibility. CUP CUP/RIM Classic RNFL RNFL Treatments for glaucoma Most cases of glaucoma can be treated with eyedrop medications. For others, laser or traditional surgery is required to lower eye pressure. Common surgeries include: Argon Laser Trabeculoplasty (ALT) - For patients with certain forms of glaucoma the trabecular passages are opened to increase fluid drainage. Laser Peripheral Iridotomy (LPI) - For patients with narrow-angle glaucoma a small hole is made in the iris to increase the angle between the iris and cornea and encourage fluid drainage. Ocular minishunt valve surgery - May be recommended for patients not responding to other measures. The shunt acts like a stent that allows for easier exit of fluid from the eye. Click image to enlarge Click image to enlarge Click image to enlarge Filtering Microsurgery (Trabeculectomy) - For patients who have not been helped with laser surgery or medications. A new drainage passage is created by cutting a small hole in the sclera (the white part of the eye) and creating a collection pouch between the sclera and conjunctiva (the outer covering of the eye). Tube Shunt Surgery - May be recommended for patients with neovascular glaucoma, failed trabeculectomy, or susceptibility to developing scar tissue. A thin, flexible tube (a shunt) with a silicone pouch is inserted in the eye to facilitate drainage.