GLAUCOMA DIAGNOSIS AND TREATMENT

Glaucoma is damage to the optic nerve leading to vision loss. Glaucoma is a disease that can steal sight without warning or symptoms. Three million Americans have glaucoma, but only half of them know it. Screening for glaucoma is important in aging patients since early detection and treatment can often stop the vision loss associated with this disease. People over the age of sixty are six times more likely to develop this disease.

Who is at risk?

Everyone is at risk for glaucoma. However, certain groups are at higher risk than others. If you have a family history of glaucoma, high intraocular pressure, suspicious findings on your eye exam. Your risk of glaucoma is much higher as you get older. Race can also be a risk factor. Glaucoma is more prevalent in African and Hispanic Americans, but is present at a high rate in Caucasians as well. People at high risk should have a dilated eye exam and visual field testing every one to two years.

When should my eyes be tested to screen for eye diseases like glaucoma and macular degeneration?

Age 35, 40, and every two to four years until age 60.
After age 60, every one to two years. Anyone with high risk for glaucoma should be tested every one to two years after age 35.

What are common tests for glaucoma?

Tonometry to check the eye pressure.
Ophthalmoscopy to look at the optic nerve.
Pachymetry to determine cornea thickness.
Perimetry (visual field testing).
Photos of the optic nerve are often needed to make sure it is not losing density on subsequent visits.
Gonioscopy helps the eye physician gain information about the part of the eye where fluid is drained.

What types of treatment are available for glaucoma?

Your doctor may start you on any of a number of eye drops to lower the pressure in the eye. Several types of laser may be used. Surgery for glaucoma is sometimes necessary, but in this modern age, surgery should be used as a last resort. Both Dr’s John and Patrick Costello perform all of these procedure and treat thousands of patients with this disease. Your doctor should have extensive experience with the medications, lasers, and surgeries necessary to treat glaucoma before advising you.

SLT: Selective Laser Trabeculoplasty

A recent advance in open angle glaucoma therapy is the Selective Laser Trabeculoplasty. This is a laser modality which is excites only the pigmented cells of the eye’s drainage system (the trabecular meshwork). These pigmented cells ‘melanocytes’ are then triggered to secrete a prostaglandin which causes increased filtration of fluid from the eye and thus lowers the intraocular pressure to treat glaucoma.

SLT is gradually replacing ALT or ‘Argon Laser Trabeculoplasty’ as the laser treatment of choice for open angle glaucoma. At Costello Eye Physicians and Surgeons, we are now offering this laser as a primary treatment modality for open angle glaucoma. The advantages over its predecessor (ALT) are that it does not ablate and destroy tissue. ALT can be performed effectively and safely only twice per eye in a patient’s lifetime because of the damage that it does to tissues inside the eye. ALT works well in many patients. Studies show that SLT can be repeated as many times as is necessary, although if an individual does not respond to laser the first time, the laser typically need not be repeated since it is likely not effective for that particular patient.

Best candidates for SLT: Patients who are over 65 or have pseudoexfoliation glaucoma or pigmentary glaucoma have the highest percentage of responders, but in our practice we have seen a response to this laser in almost all demographics of our patient population.

This laser as been an excellent adjunct to the care of our glaucoma patients. Because glaucoma drops can sometimes irritate patients’ eyes, be difficult to remember, and in some cases have serious side effects, this laser has helped many patients stay off one or more medications.

To read more about this procedure, see the website of the laser’s designers and manufacturer. http://www.glaucomaslt.com/wt/page/index (LUMENIS)

Are there different types of glaucoma?

There are over twenty types of glaucoma. All of them can be divided into the broad categories of Open Angle Glaucoma (the most common), and Closed or Narrow Angle Glaucoma. Open Angle Glaucoma is often slow to develop. Closed Angle Glaucoma can develop suddenly causing pain and taking sight very quickly.

Living with Glaucoma

A diagnosis of glaucoma need not prevent you from enjoying your life and your normal routine. When you have the facts, you can take control of your health with just a few adjustments to your routine. Remember, most cases of glaucoma are managed through medication, surgery, or a combination of treatments. With an early diagnosis, most people with glaucoma do not go blind.

For more information, please visit the Glaucoma Research Foundation website at: www.glaucoma.org

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