Glaucoma is a disease of the eye where the fluid pressure is elevated. Over time that pressure can cause damage to the back of the nerve causing vision damage, first peripherally, and then closing in on the central vision. Glaucoma is a slow progressive disease; the big issue with glaucoma is detection. There are no signs or symptoms of glaucoma until the really late stages. By having yearly comprehensive eye exams, we can definitely catch glaucoma at an early stage and treat it if necessary.
In order to detect glaucoma during an eye exam, we measure the pressure at the back of the eye. The most famous – or perhaps infamous – test for glaucoma is the puff of air. While not very patient-friendly, it gives us a good baseline reading as a glaucoma screening device. A high reading would be followed by another test, also performed in our office, called a tonometry test, which is the gold standard for glaucoma diagnosis. Since some of the newer studies on glaucoma have shown that the thickness of the cornea plays a role in the outcome of that pressure reading, we also measure corneal thickness using a machine called a pachometer.
A visual field test is performed to map the patient’s peripheral vision. A person with really severe glaucoma might still have 20/20 vision, yet their peripheral vision could be completely deteriorated.
Everyone should be coming in for glaucoma screenings every year, but there are certain people that we would screen more vigorously than others. Risk factors that are associated with glaucoma include:
- Age
- Race
- Family history
Glaucoma can affect both men and women equally. If you do have risk factors for glaucoma, it is important mention them to your doctor.
Again, there are no signs or symptoms for glaucoma, so you will not know you have it at the early stages. It’s not like you can say “Hey Doc, I think my glaucoma is high today.” Sometimes, people think they feel eye pressure, but their complaints are not related to the intraocular pressure of glaucoma; usually, what they feel is due to something else, like eye strain. High fluid pressure in your eye from glaucoma can go undetected forever. Glaucoma screening tests really the only way to catch it early enough to prevent vision loss from glaucoma.
Glaucoma only affects your vision in the very late stages of the disease, so people who don’t come in for their yearly eye check-up, perhaps because they don’t feel they need glasses or a new prescription, are at risk for developing “the silent thief of sight”. Early detection is the key to treating glaucoma.
The treatment options for glaucoma are actually very good. Over the last couple of decades, some new medications that have come out that have been phenomenal, basically in the form of eye drops. Most of the drops nowadays are single-dose units, so you just put a drop in before you go to bed at night. There are different types of glaucoma, so that method won’t work for everybody, but I would say these drops treat glaucoma for about ninety-five percent (95%) of the folks that we diagnose in our office.
Are there any patients in our practice who we diagnose glaucoma and treat it, saving them from partial blindness? Oh yeah, we see them almost on a daily basis. Unfortunately, sometimes we get patients that have not been had their eyes checked in years, and now they’re coming to us because they can’t see as well as they used to, and in that routine checkup we find that they have high pressure. When we do the further work-up for glaucoma, we check their visual fields, their peripheral vision; we sometimes find that they have significant damage. Often, at that point, all we can do is to try to inhibit further damage. Although we are able to treat those patients from that point forward, the damage that has already been done by glaucoma is not reversible.
That’s why we want to catch glaucoma as early as possible. There are glaucoma cases that we detect early on and we watch it for years, and then one time we’ll say, “Hey listen, your pressures are a little high today, and we are starting to see damage. We need to go ahead and start treatment.” So those are the patients that we are grateful for, because we watch them on the annual basis, and are able to follow their glaucoma progress and prevent damage to their vision from glaucoma.
The take-home message is: Get an annual comprehensive eye exam!