Glaucoma Screening & Treatment

Glaucoma is one the leading causes of blindness in the United States. In glaucoma, the optic nerve (the nerve that connects the eyeball to the brain) deteriorates and is frequently associated with abnormally high eye pressure. Generally speaking, glaucoma becomes more prevalent with age, although glaucoma can affect all age groups. If left untreated, glaucoma can lead to severe loss of vision and in some, to blindness.

Glaucoma comes in two different main types: open-angle glaucoma and angle-closure glaucoma, with open angle glaucoma being more common by far. Angle is part of the eye that drains the fluid from inside the eye out in order to maintain the eye pressure in the normal range. In open-angle glaucoma, as the name implies, the angle of the eye is open, but the eye pressure has become elevated to the point of damaging the optic nerve. In contrast, in angle-closure glaucoma, the angle is closed and the fluid inside the eye cannot be drained, resulting in abnormally high eye pressure. The management of glaucoma depends on its type.

Open-angle Glaucoma

During its early stage, the presentation of open-angle glaucoma is subtle, and patients are completely asymptomatic. At DuPage Ophthalmology, we have the expertise and the diagnostic tools to accurately make the diagnosis of glaucoma. Our tools for evaluating glaucoma includes:

• Goldman tonometry
  • Measures the eye pressure and is considered the gold standard in measuring eye pressure.
  • Routinely performed on routine eye examination to screen for glaucoma.
• Corneal pachymetry
  • Measures the thickness of cornea, which is a prognostic indicator.
  • In open-angle glaucoma eyes with identical pressure, the eye with thinner cornea are more like to progress faster.
• Gonioscopy
  • Gives a direct view of the angle of the eye to check how open the angle is.
  • Is usefully in distinguishing between open-angle and angle-closure glaucomas.
• Automated visual field testing
  • Documents the amount of loss of peripheral (side vision).
  • A computer-driven test. The software can also perform statistical comparison on test results to check for progression of glaucoma.
• Fundus photography
  • Provides high quality digital images of the optic nerve
  • Images are stored in electronic medical records for future comparisons
• High-definition ocular coherent tomography
  • Images the optic nerve in cross-sections at a resolution close to 1/200 mm
  • Provides the most detailed information on the contour (topography) of the optic nerve
  • At DuPage Ophthalmology, we use the RTVue, one the most advanced high-definition ocular coherent topography machines. RTVue was once featured on Good Morning America’s “The Cutting Edge”.

These tests are performed periodically to ensure that patient’s clinical course is stable and there is no progression of open-angle glaucoma. The results of visual field testing and high-definition ocular coherent tomography are analyzed statistically with the aid of the computer. This is particularly helpful in cases where significant changes are subtle and can easily escape detection by direct observation.

Patient’s medical history also provides important information in the evaluation of open-angle glaucoma. The risk factors of open-angle glaucoma include:

• Age: open-angle glaucoma is more prevalent in older patients.
• Race: African Americans are three to four times more likely to develop open-angle glaucoma.
• Family history: patient is more like to develop open-angle glaucoma if she has a immediate family member with open-angle glaucoma.
• Medical conditions: Patients with near-sightedness (myopia), diabetes mellitus, and cardiovascular disease are more prone to develop open-angle glaucoma

The treatment for open-angle glaucoma can be divided into three modalities: eye drop, laser, and surgery. The physicians at DuPage Ophthalmology are highly experienced with all three.

• Eye drops are most frequently employed as the primary treatment in most cases of open-angle glaucoma. There is a large of selection of eye drops available for the treatment of open-angle glaucoma. The modern glaucoma eye drops are generally highly effective and convenient to use. Approximately 90% of patients with open-angle glaucoma are treated with eye drops alone.
• Laser therapy is generally recommended when eye drops are no longer effective or the patient can no longer use the eye drops consistently. Laser trabeculoplasty, the laser therapy for open-angle glaucoma, is performed in office with minimal amount of discomfort. The eye is first anesthetized with eye droops, and a contact lens is used to aim the laser beam. The procedure usually takes about five minutes. After laser trabeculoplasty, most patient can return to their normal daily routines in 24 hours.
• Glaucoma surgery is performed usually when eye drops and laser treatment are no longer effective. At DuPage Ophthalmology we are experienced in performing glaucoma surgery. Glaucoma surgery is performed as outpatient and is highly effective. In modern glaucoma surgery, a shunt (a small metal tube) is usually placed in the eye to enhance the flow of fluid from inside of the eye out. Postoperatively, careful follow-ups are imperative in order to attain the best outcome.

Angle-closure Glaucoma

In contrast to open-angle glaucoma, the onset of angle-closure glaucoma is rapid and dramatic. Patients with angle-closure glaucoma typically experience sudden onset of severe eye pain, unrelenting headache, seeing halos around lights, blurry vision, and frequently with nausea and vomiting. Angle-closure glaucoma is a medical emergency, and patients with symptoms consistent with angle-closure glaucoma should seek medical attention immediately.

Patients with the following risk factors are more prone to develop angle-closure glaucoma:

• Race: Asians and native Americans are more prone to develop angle-closure glaucoma.
• Age: With age, the eye becomes more crowded due to the growth of the natural lens of eye, which continues throughout one’s lifetime. As the lens enlarges, the eye might become crowded to the point that the angle of the eye closes.
• Far-sightedness (hyperopia): Hyperopic eyes are more prone to develop angle-closure glaucoma because they are shorter and have less room to accommodate the growth of the natural lens.
• Family history: having an immediate family member with angle-closure glaucoma makes one more prone to develop the same condition.
• Gender: Women are more prone to develop angle-closure glaucoma than men.

The diagnosis of angle-closure glaucoma is made with clinical examination. The angle of the eye is closed and can be confirmed with gonioscopy, which checks the conformation of the angle of the eye. The treatment modalities for angle-closure glaucoma include:

• Eyedrops are immediately given to constrict the pupil and to lower the eye pressure. Oral and intravenous medications may also be given to lower eye pressure in angle-closure glaucoma
• Laser therapy is the mainstay in treating angle-closure glaucoma. Laser iridotomy is performed to create a small opening in the peripheral (outer) portion of the iris in order to open the closed angle. Laser iridotomy is performed in the office, and the drop in eye pressure after laser is usually dramatic.
• If medical therapy and laser iridotomy are not successful in lowering the eye pressure, then glaucoma surgery is usually performed.

After an angle-closure glaucoma attack, the fellow unaffected eye should also be treated with laser iridotomy in order to prevent developing angle-closure attack. Recently, cataract surgery has been recommended as a preventive measure in patients prone to developed angle-closure glaucoma.