Diagnosis & Treatment
Diagnosis of Glaucoma
The best way to maintain eye health and preserve your vision is to have regular and complete eye examinations with the appropriate level of diagnostic testing for glaucoma as recommended by the Ophthalmologists at The Eye Care & Surgery Center in New Jersey. During your examination, our eye doctors and staff may perform a number of tests in order to make the most accurate diagnosis of Glaucoma. These include the following testing procedures:
The Tonometry Test is a method of measuring your Intraocular Pressure (IOP). This test involves first placing some eye drops into your eyes to numb them and then lightly touching the surface of the cornea with a specialized measuring instrument. There is no discomfort involved. The test is quick and gives the eye physicians the first piece of important information in determining whether you have glaucoma.
Ophthalmoscopy is a method of carefully examining the inside of the eye-especially the optic nerve-in order to detect glaucoma. Some eye drops will be placed in your eyes in order to dilate your pupils so that the doctors can make a clear and direct observation of the optic nerve. The examination will take place in a darkened room using different types of ophthalmoscopes in order to examine the shape and color of your optic nerve. If either the Intraocular Pressure (IOP) is elevated or the optic nerve appears unusual, additional tests will be necessary in order to complete the glaucoma examination. These may include the following test procedures:
Visual Field Perimetry
Perimetry or Visual Field testing is an important part of the glaucoma examination. During this test you will be asked to sit in front of a large “bowl like” instrument and look directly straight ahead. A computer program will present a number of lights in different positions of their “side” or peripheral vision to see how sensitive your side vision is in various directions. The computer will then plot an actual map of the field of vision so that your doctor can interpret this map in conjunction with other examination tests in order to understand how well the optic nerve is functioning. Glaucoma usually affects your side vision before your central vision, so visual field testing can often show any problems from glaucoma before you can notice them.
Gonioscopy is a quick and painless test that allows the doctors to directly observe the health and condition of the angle where the iris meets the cornea. By directly observing the angle and its status your eye doctor will be know more about whether you are at risk for the angle to become closed or whether the Trabecular Meshwork appears to have a normal anatomical structure.
Optic Nerve Computer Imaging
At The Eye Care & Surgery Center, we use the most advanced computer imaging technology in order to make the earliest and most accurate diagnosis of glaucoma. The doctors at The Eyecare & Surgery Center use OCT or Optical Coherence Tomography, a method that is capable of creating digital images through the use of special beams of light in order to create a contour map of the optic nerve and measure the retinal nerve fiber thickness. In many regards this is similar to the CT Scans used to study organ systems and tissues throughout your body. The goal of OCT Optic Nerve Computer Imaging is to give our eye doctors the ability to detect the slightest loss of optic nerve fibers, at the first possible moment, in order to diagnose glaucoma at the earliest possible stage in order to stop the progression of the disease and preserve your vision. These tests are also useful in monitoring for the possibility of progression by comparing tests over time. We perform OCT Optic Nerve Computer Imaging right in the comfort and convenience of our office at The Eye Care & Surgery Center.
Pachymetry Measurement of Corneal Thickness
The National Eye Institute of the National Institutes of Health released a key study in 2002, called the Ocular Hypertension Study (OHTS). In this study an important finding was made regarding corneal thickness and its role in Intraocular Pressure and the development of Glaucoma. The OHTS study found that corneal thickness is important because it can alter the accuracy of the measurement of Intraocular Pressure, potentially causing doctors to treat you for a condition that may not actually exist or to treat you unnecessarily when you are normal. Your actual Intraocular Pressure may be UNDERESTIMATED if you have thin corneas and it may be OVERESTIMATED if you have thicker corneas. In addition, it appears that patients with thin corneas may be inherently more likely to develop glaucoma apart from its influence on the measurement of intraocular pressure. During a glaucoma examination, your doctor or a staff member may perform a Pachymetry Test to measure your corneal thickness as part of your examination and consider this finding in conjunction with the other glaucoma testing in order to make the most accurate diagnosis. The Pachymetry Test is a simple, quick and painless way of accurately measuring your corneal thickness that we do right in our office. The test is performed by first placing some drops in your eyes to make them numb and then lightly touching the cornea with a “pencil like” probe that uses sound waves to precisely measure your corneal thickness.
Treatment of Glaucoma
Medical, Laser & Surgical Glaucoma Treatment
The goal of glaucoma treatment is to stabilize and control your eye pressure in order to provide the best chance of preserving your vision. The three main glaucoma treatments are medical-using eye drops, glaucoma laser treatment & glaucoma surgery, most often minimally invasive glaucoma surgery (MIGS).
Medical Treatment of Glaucoma
Primary Open Angle Glaucoma has most often been treated with eye drops. By using one or two types of glaucoma eye drops most patients are able to achieve a stable and lowered eye pressure. Some patients are unable to achieve adequate control with eye drops alone, or may experience intolerable side effects from the eye drops, and do better with an in office glaucoma laser treatment to maintain control as a first choice of treatment.
Laser Treatment of Glaucoma
Selective Laser Trabeculoplasty (SLT) is a type of glaucoma laser treatment for Primary Open Angle Glaucoma that helps to reduce the Intraocular Pressure (IOP) by creating more effective drainage of fluid through the trabecular meshwork. We perform this painless procedure in the comfort of our office and often patients are able to obtain good stability and also reduce the number or frequency of eye drops they need to use. Laser Peripheral Iridotomy (LPI) is a type of glaucoma laser treatment for Angle Closure Glaucoma that creates a hole on the outer edge, or rim, of the iris, the colored part of the eye which allows the aqueous humor fluid to easily flow between the anterior chamber, the front part of the eye, and the area behind the iris, the posterior chamber. This is performed for patients with narrow chamber angles or those patients experiencing angle closure to prevent sudden buildup of pressure within the eye, which occurs during an episode of acute closed-angle glaucoma. Endocylcophotocoagulation, ECP, or Endo Laser may be helpful for patients having cataract surgery who have glaucoma. Your cataract surgeon and glaucoma specialist can place a very tiny fiber optic probe through the same incision that is used to remove the cataract so gentle laser energy can be delivered to the internal structures of the eye-called ciliary processes-that are responsible for producing the eye’s fluid. By reducing the amount fluid being produced inside the eye it is often possible to reduce the Intraocular Pressure (IOP) resulting in patients being able to reduce their glaucoma eye drops and medication and sometimes even eliminate them totally.
Surgical Treatment of Glaucoma
Even with the maximum eye drop medical therapy and glaucoma laser treatment, for some patients it is still not possible to achieve good stable control of their disease and stop the progression of vision loss. Our glaucoma specialist is able to perform Minimally Invasive Glaucoma Surgery (MIGS) for most patients. Sometimes traditional glaucoma surgery may be an option and may include removing a tiny piece of the trabecular meshwork-called Trabeculectomy or a MIGS procedure called GATT (Gonioscopy Assisted Transluminal Trabeculotomy) might be recommended. Our glaucoma specialist is able to implant microscopic tubes, shunts, valves or stents such as the XEN Gel Stent, or iStent® or Hydrus MicroStent for cataract patients and ABiC™ – iTrack™ Ab Interno Canaloplasty Glaucoma Surgery which can be performed for patients needing glaucoma surgery combined with cataract surgery as well as those only requiring glaucoma surgery.