Glaucoma Care at Tri-County Eye

Glaucoma is a chronic degenerative disease which can cause permanent damage to the optic nerve, resulting in gradual vision loss. Left untreated glaucoma can lead to blindness.  At Tri-County Eye, we are committed to ensuring the health of your eye.  Every routine eye health exam includes detailed examination of the optic nerve to check for signs of glaucoma.  Our comprehensive ophthalmologists and optometrists closely monitor glaucoma problems when they arise, and provide treatment as needed.  Glaucoma care treatment options include topical eye drop medications, laser treatments and sometimes surgery.

What is Glaucoma?

Glaucoma is typically a silent, chronic condition with elevated eye pressure that can lead to vision loss. Fortunately, most patients have the chronic open angle form of glaucoma which may take years to affect your vision. Once damaged, the vision cannot be restored. As a result, it is always a good idea to have regular eye health exams as an adult to ensure everything is healthy. Glaucoma, untreated, is among the leading causes of blindness in the USA. Early diagnosis and treatment can usually prevent vision-threatening damage. Heredity plays an important role in who develops glaucoma. If you have glaucoma or are being followed as a suspect, you should advise your blood relatives to be examined. Damage to the optic nerve due to glaucoma is usually caused by elevated intraocular pressure (IOP). Clear fluid called aqueous humor is secreted by ciliary body cells. Aqueous humor circulates through the eye providing nourishment to the ocular tissues and sustaining normal levels of IOP to help maintain the shape of the eyeball. Elevated IOP can occur when there is an abnormal increase in fluid production and/or a decrease in the ease of fluid drainage.

Types of Glaucoma?

Glaucoma is a chronic disease in which high fluid pressure within the eye can cause progressive damage to the nerve which transmits visual signals from the eye to the brain. There are two main forms of glaucoma: open angle (the more common) and closed angle.  Other types include normal or low tension glaucoma (NTG),  when a patient sustains optic nerve damage in both eyes despite having “normal” eye pressures.  This type of glaucoma is diagnosed by ruling out other conditions such as other types of glaucoma, systemic disease or processes.   Secondary glaucoma is when the cause is known and may present like angle closure glaucoma or open angle glaucoma.  Traumatic glaucoma caused by trauma to the eye is an example of secondary glaucoma.  Other types of glaucoma include ICE (Irido Corneal Endothelial) syndrome, neovascular glaucoma, pigmentary glaucoma, and pseudoexfoliative glaucoma.

Glaucoma Testing
  • Intraocular pressure measures the fluid pressure in the eyeball
  • Visual field test evaluates the patient’s field of vision to find defects in the peripheral and central vision caused by glaucoma and other neurological conditions
  • OCT (Optical Coherence Tomography) is used to image optic nerve fiber layer thickness and diseases of the optic nerve
  • Fundus Photography is high resolution imaging of the back of the eye to include retina, optic nerve head, and macula
  • Pachymetry is the measurement of corneal thickness
Risk Factors for Glaucoma

A risk factor means your chance of being diagnosed with glaucoma in your lifetime is greater than average.  Risk factors include age, increased intraocular pressure, myopia, family history, race, hyperopia (increased risk for angle closure glaucoma), abnormal eye anatomy, medical conditions – diabetes, hypertension (elevated blood pressure), heart disease, injury to the eye and corticosteroid usage.

Glaucoma Treatments

Glaucoma Medical Treatments

Eye drops are commonly used to control open angle glaucoma – some reducing aqueous humor production and others promoting aqueous humor drainage. Oral medications, less commonly utilized, generally reduce the production of aqueous humor. Medications can be very expensive, and may have certain unwanted side effects. All require faithful compliance with a strict treatment schedule. Furthermore, medications may need to be taken for the rest of one’s life.

Glaucoma Surgical Treatments

If medical treatment fails to adequately lower IOP (intraocular pressure), surgery may be required to create an alternative path for drainage of the aqueous humor.  Aqueous humor is the fluid between the iris and the cornea.  Filtration surgery is designed to relieve elevated IOP by either removing tissue in order to create a new drainage channel or by inserting drainage implants within the eye, or a combination of both.

Laser Treatments for Glaucoma

Open angle glaucoma, a painless disease, does not cause visual symptoms until significant damage has occurred. Diagnosing open angle glaucoma early, through periodic eye health exams, is crucial. High eye pressure in open angle glaucoma is usually treated initially with eyedrops. More recently, laser surgery (SLT-Selective Laser Trabecuolpasty) has been shown to be an effective first line treatment as well. Laser trabeculoplasty is a safe, painless, outpatient procedure that effectively lowers eye pressure. Even so, eye drops may still be necessary as a supplement to laser trabeculoplasty to effectively lower the intra-ocular pressure to safe levels.

Angle closure glaucoma, by contrast, is an eye emergency that causes severe pain and blurred vision. It requires immediate treatment to prevent blindness. In angle closure glaucoma, laser treatment called peripheral iridotomy lowers eye pressure by opening the closed internal drainage channel. Fortunately, angle closure glaucoma is not only treatable but also preventable. In patients who are at risk (as determined by examination) for developing angle closure, preventative laser treatment effectively eliminates this risk. The laser is truly a remarkable tool which, when used by a skilled ophthalmologist, can help to prevent loss of vision due to glaucoma.

Glaucoma Risks with Use of Over-the-Counter (OTC) Medications

The package warning label accompanying many commonly used medications – including nasal decongestants and stomach remedies – cautions “contraindicated in patients with glaucoma.” In fact, this warning refers to those with narrow anterior chamber angles. These medications often dilate the pupils, risking an acute angle closure attack. Ironically, most such individuals for whom the warning is intended have neither been diagnosed with nor treated for narrow anterior chamber angles and are therefore not at all aware of their own heightened risk.

Patients followed and treated for open angle glaucoma are not normally subject to this contraindication warning.