Glaucoma’s effect on your Vision, Part 2.

Normal Optic Nerve vs Glaucoma

How is Glaucoma treated?

There is no cure for glaucoma, but there is treatment and management.  First line treatment involves the use of eye drops.  The eye drops involves decreasing production of aqueous fluid or increasing outflow of aqueous fluid.  Should eye drops prove ineffective, or poor patient compliance, surgery is a consideration.  Surgery is not a first line treatment as some surgeries cause side effects of light sensitivity and increased glare.

How do you monitor glaucoma?

Standard of care involves measurement of eye pressures with an anesthetic and fluorescein, and evaluation of the optic nerve.  Supplemental testing of retinal imaging, visual fields, optical coherence tomography (OCT), gonioscopy and pachymetry.

Retina diagram
Structures of the retina (the back layer of the eyes).

Eye pressures of 21mmHg and under is considered within normal limits, however the results of the above tests must also be considered.  The optic nerve is judged by the appearance (color and symmetry) and the cup-to-disc ratio (the central hole).  Think of the optic nerve as a doughnut.  Different people will have different sized doughnuts and the hole in the middle is crucial.  If the hole progressively increases, there is less and less doughnut over time, this is what glaucoma is in a nutshell, a loss of the optic nerve tissue over time with the central hole expanding.

Normal Optic Nerve vs Glaucoma
Note the small hole in the normal optic nerve vs the large hole in the glaucoma optic nerve.

Retinal imaging – is a picture of the retina, including the optic nerve.  This allows your eye care provider to study and monitor your optic nerve over time.

Visual fields – maps your peripheral vision, compares your results to your “normal” population (people of the same gender, age group and ethnicity).

OCT (Anterior) – allows measurement of the thickness of your cornea and evaluation of the angle of your eyes (using light technology.)  Cornea thickness plays a factor in determining your eye pressure, while the angle is involved in aqueous fluid drainage.

OCT (Optic nerve) – allows a mapping of your optic nerve through light technology, the thickness of your optic nerve is then compared to your “normal” population.

Gonioscopy – evaluation of the angle of your eyes using an optical lens.

Pachymetry – measurement of the thickness of your cornea using a digital pressure gauge.

I have glaucoma, what can help me?

First, you need to see your eye care provider, who will likely start with a dilated eye exam to get a 3D view of your retina.  Also expect your eye pressures to be measured at this visit.  The some of the supplemental tests may be performed on the same day, depending on the coverage of your insurance carrier.

Should you have moderate, advanced or a visual impairment from glaucoma, you also need a low vision evaluation from a low vision specialist.

Both Dr. Anthony Huynh and Dr. Anh Do can treat glaucoma.  Dr. Anthony Huynh is also a low vision specialist who can help you with your functional vision needs.

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