What is Glaucoma?
Glaucoma is a disorder associated
with pressure in the eye, and is characterized by
damage to the
optic nerve, with consequent visual
loss, initially peripheral, but potentially blinding
if relentlessly progressive. Unfortunately, glaucoma
is usually a disease in which the patient is
entirely asymptomatic (without symptoms) until late
in the disease. The disorder we refer to as
glaucoma, is not a single disease, but rather a
myriad of diseases with one final common insult,
injury to the optic nerve.Glaucoma affects 2
million Americans, and half of those people are
unaware they have the disease. Approximately 5 to 10
million Americans have elevated eye pressure, which
places them at risk for the development of glaucoma.
Eighty thousand Americans are already blind from the
disease. African-Americans have a five-fold greater
risk of developing glaucoma and, in this population,
it is the single most common cause of irreversible
blindness.
Glaucoma is not usually diagnosed
on the initial exam, and certainly cannot be
determined by measuring eye pressure alone,
regardless of the pressure. In general, the
diagnosis of glaucoma implies optic nerve injury and
loss of peripheral vision. Patients with increased
eye pressures only, are said to have "ocular
hypertension," or possibly are referred to as
"glaucoma suspects". On the initial evaluation, most
ophthalmologists will obtain eye pressure readings
and complete a dilated eye exam in which the optic
nerve is carefully evaluated. An enlarged depression
(called a "cup to disc ratio") in the optic nerve
may be indicative of glaucoma.
If the
ophthalmologist is concerned about the possibility
of glaucoma, the patient is scheduled for a visual
field test. This is a computer-assisted test that
evaluates a patient for subtle peripheral vision
deficits. Some patients believe, when they are told
they need a peripheral vision test, that their
peripheral vision is "fine" because they can see
their waving hand off to the side. In reality, this
kind of testing is so gross as to be entirely
useless except in end-stage glaucoma or certain
stroke patients. If peripheral vision deficits are
found on the visual field test that are consistent
with glaucoma, the patient will be informed and
further evaluation scheduled or a treatment plan
discussed. Many ophthalmologists recommend two or
three baseline pressure readings prior to initiating
treatment. This helps the ophthalmologist to gauge
the pressure reduction once treatment has begun.
Our office also uses Ocular Coherence Tomography
(OCT) to help diagnose early glaucoma. This
instrument measures the thickness of the retinal
nerve fiber layer in very sensitive areas around the
optic nerve. Clinical studies have shown that early
thinning of the nerve fiber layer precedes vision
and visual field loss by 6 years, thus enabling us
to diagnose glaucoma at its earliest presentation! The Carl Zeiss Stratus OCT
 
Glaucoma Treatment
Just because someone has
glaucoma, does not mean they will go blind! Glaucoma
can be treated with drops, lasers and surgery to
lower eye pressure. Once the diagnosis is made, most
patients are given a prescription and started on eye
drops. After a satisfactory eye pressure is
achieved, patients are generally seen back in the
office every 4-6 months.Our office also practice offers
argon laser trabeculoplasty (ALT) using a state of
the art Iridex argon laser to treat glaucoma in the
office. This painless procedure is covered by all
insurances and takes about 15 minutes to perform. If
you are interested in more information regarding ALT
please ask Dr. Serdahl or Dr.Jones for more
information.
Occasionally, drops and laser
treatments are not successful in controlling eye
pressure and a surgery called trabeculectomy is
needed. This is done in the operating room and takes
30-45 minutes under local anesthetic. Because this
surgery increases patient’s risk for future serious
eye infections it is often a last resort for
glaucoma patients with serious pressure problems.
We check you eye pressure
during every eye exam. This is done by placing a
drop of flourescein in your eye (a yellow drop with
anesthetic) and gently touching the eye with a
tonometer. This is the “gold standard” for checking
eye pressure. Since corneal thickness can affect the
accuracy of tonometry, we may also check your
corneal thickness (pachymetry) if we feel that it is
necessary. This easy test takes only minutes and is
painless!
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