Glaucoma is a disease that damages the optic nerve. This is typically caused by fluid buildup in the eye that leads to high pressure. There are several different types of glaucoma, some that can cause a very slow loss of vision, and other types can cause changes in vision very quickly. Typically the peripheral vision is affected first in glaucoma, which is why it has often been called the silent blinding disease as we tend not to realize the loss of peripheral vision immediately.
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There may be no warning signs in the early to mid stages of glaucoma, and that is why it is very important to have routine eye exams to monitor your eye pressure and to look for other signs of glaucoma in the eye. There are many treatment options for patients who are diagnosed with glaucoma. These may include eye drops, oral medications, laser or surgery. Glaucoma vision loss is permanent but can be prevented if diagnosed early and treated.
Monitoring For Glaucoma
Most patients will have several baseline tests done to monitor for glaucoma and determine if a patient has glaucoma. These tests include a complete ophthalmologic exam and history, visual field testing, gonioscopy, pachymetry, and OCT images of the optic nerve. Visual field testing is a way to formally test an individual’s peripheral vision, which is often affected first in glaucoma. Gonioscopy is the use of a special lens to examine the drainage system of the eye to make sure that there is not a blockage that is causing the eye pressure to be elevated. Pachymetry is a measurement of the thickness of one’s cornea, as individual’s with thinner corneas are at a higher risk for glaucoma. OCT (optical coherence tomography) is a sophisticated imaging machine that captures high resolution maps and images of the optic nerve to measure its thickness and compare it to normal thickness for an individual.
Treatment For Glaucoma
For patients who are at risk for glaucoma or who have the early stages of glaucoma, eye drops are often initiated to lower the pressure inside the eye. Lowering eye pressure has been shown to significantly slow or stop the progression of glaucoma. These days there are many different options for glaucoma drops that require a discussion between you and your eye doctor. Each glaucoma drop has some advantages and disadvantages, depending on the individual patient and insurance coverage. Some patients require 2 or 3 different glaucoma drops to keep the eye pressure down. The target eye pressure also can vary from individual to individual, depending on the baseline eye pressure and other variables.
Selective Laser Trabeculoplasty (SLT) is a very safe laser option to lower eye pressure and is an alternative for some patients who cannot tolerate eye drops or have difficulty remembering to take eye drops or other reasons for not wanting to take eye drops. It can also be used in some patients already on one glaucoma drop as a way to lower eye pressure further instead of adding an additional eye drop. SLT lowers eye pressure in the majority of patients but does not work for everyone. For those individuals where it does not work initially, a second treatment can often be effective. Talk to your eye doctor further to see if SLT is an option for you.
MIGS (Minimally Invasive Glaucoma Surgery)
For patients with mild to moderate glaucoma who are undergoing cataract surgery, MIGS is now an option to help lower eye pressure at the time of cataract surgery. There are now several MIGS devices that are approved for patients with mild to moderate glaucoma that can be implanted at the time of cataract surgery in the hopes of lowering eye pressure so that many patients will no longer require glaucoma drops after surgery. Talk to your eye surgeon to see if MIGS is an option for you.
Tube / Shunt / Trabeculectomy
For patients with moderate to severe glaucoma, glaucoma surgery may be necessary. Most patients who require surgery have eye pressures that are too high despite attempts to lower the pressure with multiple eye drops or laser. Some patients may be offered a glaucoma tube or a glaucoma shunt, which are drainage devices that are implanted to lower eye pressure more substantially than most glaucoma drops or SLT laser. A trabeculectomy (trab) is a type of glaucoma surgery that also lowers eye pressure without implanting a shunt. At Eye Consultants of Fargo, Dr. Grosz performs trabeculectomies. Some patients may need to be referred to a glaucoma specialist and this would be coordinated through Eye Consultants of Fargo when indicated.