GLAUCOMA
OVERVIEW | DIAGNOSIS | TREATMENT

Overview
Glaucoma is one of the leading causes of blindness in the United States. It is a condition in which the nerve of the eye is damaged due to uncontrolled pressures from within the eye. The damage could result in a painful eye (seen in acute angle closure glaucoma), but more often, results in slowly progressive, painless loss of vision (seen in the more common open angle glaucoma). Glaucoma damages the peripheral vision, so patients may develop significant damage to the nerve without noticing a change in their central vision. This damage from glaucoma is irreversible. However, if diagnosed early, the vision can be maintained and glaucoma progression, halted.
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Diagnosis
The diagnosis of glaucoma has changed over the years. Historically, any intraocular pressure above 21 mmHg was considered to be the definition of glaucoma. Today, it is clear that an elevated intraocular pressure is just a risk factor for glaucoma. An elevated intraocular pressure may be seen in normal patients and a low intraocular pressure may be seen in glaucoma patients.

The Visual Field Test is currently the gold standard for evaluating the status and progression of glaucoma. It evaluates the peripheral vision by having patients respond each time they see a projected light in the peripheral visual field. Both the diagnosis and the evaluation of progression of glaucoma can be made with this test.

The GDx VCC Nerve Fiber Layer is the newest technology for evaluating the status of the optic nerve. It uses polarized light to measure the thickness of the nerve fiber layer emerging from the optic nerve. It is thought that this instrument may help to catch glaucoma years earlier, before vision loss actually occurs. Every patient evaluated by either Dr. Decker or Dr. Yang will receive a GDx analysis to help refine their ocular assessment.

In a landmark study published in Archives of Ophthalmology (June 2002), the thickness of the cornea was found to play a vital role in glaucoma. Having a thin cornea puts a patient at much higher risk for developing glaucoma. As a result of this study, patients with glaucoma as well as patients suspected of having glaucoma should have corneal pachymetry performed in order to determine their corneal thickness.

Lastly, both Dr. Decker and Dr. Yang use 3-dimensional photography to document the optic nerves. This captures not only the appearance, but also the contour and shape of the optic nerve. These elements are critical in following the stability of the nerve.
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Treatment
There are many treatment options available for glaucoma patients. For
most patients, eye drops are the first treatment of choice. There are
numerous, excellent medications available and both Dr. Decker and Dr.
Yang are well versed in the nuiances of each medication as well as their
potential side-effects.

Some patients will require laser treatment. There are different types of laser treatment for the different types of glaucoma. This includes laser peripheral iridotomy, argon laser trabeculoplasty, and selective laser trabeculplasty.

In the more advanced cases, where the glaucoma is not well-controlled with either medications or laser treatment, there are various surgical options available. At this stage, Dr. Decker or Dr. Yang can discuss with each patient the options best-suited for each individual's needs.
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