image8
Welcome First Time Patients:

Steps to your 1St glaucoma visit

  1. Schedule your appointment by calling us (907)274-7825
  2. Provide us with all your information needed for MEDICAL insurance billing prior to visit!  We will need to verify all benefits PRIOR to your visit.
  3. Your visit will last about 90 minutes.  Please be prepare to spend this time with us as we are performing many tests .

WHAT IS GLAUCOMA testing?

image9

OUR GLAUCOMA TESTINGS

  • Early detection, through regular and complete eye exams, is the key to protecting your vision from damage caused by glaucoma. 
  • A complete eye exam includes six these common tests to detect glaucoma.


A Comprehensive Glaucoma Exam

  • Optical Coherence Tomography (OCT)
  • Perimetry Visual Fields (VF)
  • Pachymetry
  • Tonometry
  • Ophthalmoscopy/Retina Scan
  •  Visual electrophysiology  (VEP & ERG)
  • Gonioscopy


Optical Coherence Tomography (OCT)

  • Optical Coherence Tomography (OCT) is a non-invasive diagnostic instrument used for imaging the retina. It is the technology for the future because it can enhance patient care. It has the ability to detect problems in the eye prior to any symptoms being present in the patient 


Perimetry Visual Fields (VF)

  • Perimetry is a visual field test that produce your complete field of vision. This test will help a doctor determine whether your vision has been affected by glaucoma. During this test, you will be asked to look straight ahead and then indicate when a moving light passes your peripheral (or side) vision. This helps draw a "map" of your vision.
  • Do not be concerned if there is a delay in seeing the light as it moves in or around your blind spot. This is perfectly normal and does not necessarily mean that your field of vision is damaged. Try to relax and respond as accurately as possible during the test.
  • Your doctor may want you to repeat the test to see if the results are the same the next time you take it. After glaucoma has been diagnosed, visual field tests are usually done one to two times a year to check for any changes in your vision. 


Pachymetry

  • Pachymetry is a simple, painless test to measure the thickness of your cornea -- the clear window at the front of the eye. A probe called a pachymetery is gently placed on the front of the eye (the cornea) to measure its thickness. Pachymetry can help your diagnosis, because corneal thickness has the potential to influence eye pressure readings. With this measurement, your doctor can better understand your IOP reading and develop a treatment plan that is right for you. The procedure takes only about a minute to measure both eyes.


Tonometry

  • Tonometry measures the pressure within your eye. During tonometry, eye drops are used to numb the eye. Then a doctor or technician uses a device called a tonometer to measure the inner pressure of the eye. A small amount of pressure is applied to the eye by a tiny device or by a warm puff of air.
  • The range for normal pressure is 12-22 mm Hg (“mm Hg” refers to millimeters of mercury, a scale used to record eye pressure). Most glaucoma cases are diagnosed with pressure exceeding 20mm Hg. However, some people can have glaucoma at pressures between 12 -22mm Hg. Eye pressure is unique to each person.


Ophthalmoscopy/Retina Scan

  • This diagnostic procedure helps the doctor examine your optic nerve for glaucoma damage. Eye drops are used to dilate the pupil so that the doctor can see through your eye to examine the shape and color of the optic nerve.
  • The doctor will then use a small device with a light on the end to light and magnify the optic nerve. If your intraocular pressure (IOP) is not within the normal range or if the optic nerve looks unusual, your doctor may ask you to have one or two more glaucoma exams: perimetry and gonioscopy.

 

 Visual electrophysiology  (VEP & ERG)

  • Diopsys® Light Induced Visual-response (LIV)™ tests are painless, non-invasive, and provide your doctor with comprehensive information on the function of your vision.
  • Like an electrocardiogram (EKG) which tests heart function, LIV tests work by evaluating how the cells within your vision system are functioning. Eye disease disrupts that function as cells become unhealthy. By catching this dysfunction before the cells die, your doctor may be able to prescribe treatment to make the cells healthy again. Additionally, your doctor can use the tests to help determine if your treatment is working.


Gonioscopy

  • This diagnostic exam helps determine whether the angle where the iris meets the cornea is open and wide or narrow and closed. During the exam, eye drops are used to numb the eye. A hand-held contact lens is gently placed on the eye. This contact lens has a mirror that shows the doctor if the angle between the iris and cornea is closed and blocked (a possible sign of angle-closure or acute glaucoma) or wide and open (a possible sign of open-angle, chronic glaucoma).


Why Are There So Many Diagnostic Exams?

  • Diagnosing glaucoma is not always easy, and careful evaluation of the optic nerve continues to be essential to diagnosis and treatment. The most important concern is protecting your sight. Doctors look at many factors before making decisions about your treatment. If your condition is particularly difficult to diagnose or treat, you may be referred to a glaucoma specialist. A second opinion is always wise if you or your doctor become concerned about your diagnosis or your progress.

glaucoma

image10

WHAT IS GLAUCOMA ?

  • Glaucoma is an eye disease that gradually steals vision. There are typically no early warning signs or painful symptoms of open-angle glaucoma. It develops slowly and sometimes without noticeable sight loss for many years.
  • Most people who have open-angle glaucoma feel fine and do not notice a change in their vision at first because the initial loss of vision is of side or peripheral vision, and the visual acuity or sharpness of vision is maintained until late in the disease.
  • By the time a patient is aware of vision loss, the disease is usually quite advanced. Without proper treatment, glaucoma can lead to blindness. The good news is that with regular eye exams, early detection, and treatment, you can preserve your vision.

Eye Exams

  • Because open-angle glaucoma has few warning signs or symptoms before damage has occurred, it is important to see a doctor for regular eye examinations. If glaucoma is detected during an eye exam, your eye doctor can prescribe a preventative treatment to help protect your vision.

Optic Nerve Damage

  • In open-angle glaucoma, the angle in your eye where the iris meets the cornea is as wide and open as it should be, but the eye’s drainage canals become clogged over time, causing an increase in internal eye pressure and subsequent damage to the optic nerve. It is the most common type of glaucoma, affecting about four million Americans, many of whom do not know they have the disease.


WHAT ARE THE TYPES OF GLAUCOMA

  •  There are many different types of glaucoma, but the most common type in the United States is called open-angle glaucoma — that’s what most people mean when they talk about glaucoma. Other types of glaucoma are less common, like angle-closure glaucoma and congenital glaucoma. 


 Angle-closure glaucoma can cause these sudden symptoms:

  • Intense eye pain
  • Upset stomach (nausea)
  • Red eye
  • Blurry vision

If you have these symptoms, go to your doctor or an emergency room now

WHAT ARE THE SYMPTOMS OF GLAUCOMA

  • At first, glaucoma doesn’t usually have any symptoms. That’s why half of people with glaucoma don’t even know they have it.  
  • Over time, you may slowly lose vision, usually starting with your side (peripheral) vision — especially the part of your vision that’s closest to your nose. Because it happens so slowly, many people can’t tell that their vision is changing, especially at first. 
  • But as the disease gets worse, you may start to notice that you can’t see things off to the side anymore. Without treatment, glaucoma can eventually cause blindness. 

AM I AT RISK OF GLAUCOMA?

 Anyone can get glaucoma, but some people are at higher risk. You’re at higher risk if you: 

  • Are over age 40
  • Are African American or Hispanic/Latino and over age 40 
  • Have a family history of glaucoma 
  • Are Diabetic
  • Are  Using steriod medication or drops
  • Have enlarge optic nerve or large cup-disc ration ( Large C/D)
  • Have higher intra-ocular pressure (IOP)
  • Are very nearsighted
  • Have high blood pressure


 It is important to have your eyes examined regularly. Your eyes should be tested:

  • before age 40, every two to four years
  • from age 40 to age 54, every one to two years
  • from age 55 to 64, every year
  • after age 65, every six to 12 months

REASONS WHY YOU MIGHT NEED A COMPREHENSIVE GLAUCOMA EXAM

  • Glaucoma Suspect due to Large cupping ( Large C/D)
  • Glaucoma Suspect due to different C/D ratio 
  • Glaucoma Suspect due to higher IOP's
  • See Risks factor above

image11

WHAT CAUSES GLAUCOMA?

  • Scientists aren’t sure what causes the most common types of glaucoma, but many people with glaucoma have high eye pressure (intraocular pressure) — and treatments that lower eye pressure help to slow the disease. 

  • There’s no way to prevent glaucoma. That’s why eye exams are so important — so you and your doctor can find it before it affects your vision.

DID YOU KNOW?

  • Glaucoma can happen in one eye or both eyes
  • Some people with high eye pressure don’t get glaucoma — and there’s a type of glaucoma that happens in people with normal eye pressure
  • The amount of eye pressure that’s normal varies by person — what’s normal for one person could be high for another

WHAT'S THE TREATMENT FOR GLAUCOMA?

  • Doctors use a few different types of treatment for glaucoma, including medicines (usually eye drops), laser treatment, and surgery.  
  • If you have glaucoma, it’s important to start treatment right away. While it won’t undo any damage to your vision, treatment can stop it from getting worse. 


  • Medicines. Prescription eye drops are the most common treatment. They lower the pressure in your eye and prevent damage to your optic nerve.
  • Learn more about glaucoma medicines


  • Laser treatment. To lower pressure in your eye, doctors can use lasers to help the fluid drain out of your eye. It’s a simple procedure that your doctor can do in the office.


  • Surgery. If medicines and laser treatment don’t work, your doctor might suggest surgery. There are several different types of surgery that What’s the treatment for glaucoma? help the fluid drain out of your eye.


  • Talk over your options with your doctor. While glaucoma is a serious disease, treatment works well. 


Remember these tips: 

  • If your doctor prescribes medicine, be sure to take it every day 
  • Tell your doctor if your treatment causes side effects 
  • See your doctor for regular check-ups 
  • If you’re having trouble with everyday activities because of your vision loss, ask your doctor about low vision services or devices that could help 
  • Encourage family members to get checked for glaucoma, since it can run in families 

OPTIC NERVE CUPPING

image12

What is optic nerve cupping or C/D ratio?

  • The optic nerve carries impulses for sight from the retina in the eye to the brain. It is composed of millions of retinal nerve fibers that bundle together and exit to the brain through the optic disc located at the back of the eye. The optic disc has a center portion called the "cup" which is normally quite small in comparison to the entire optic disc.
  • In people with glaucoma damage, because of increased pressure in the eye and/or loss of blood flow to the optic nerve, these nerve fibers begin to die. This causes the cup to become larger in comparison to the optic disc, since the support structure is not there. Optic nerve cupping progresses as the cup becomes larger in comparison to the optic disc.
  • Both people with and without optic nerve damage have optic nerve cupping, although those with glaucoma tend to have a greater cup-to-disc ratio. A cup to disc ratio greater than six-tenths is generally considered to be suspicious for glaucoma.
  • Through periodic photographs of the optic nerve, the ratio of the cup to the disc can be monitored. This helps the doctor determine whether or not damage is still occurring to the nerve fibers with current treatment and/or if treatment should be modified.

Article by Scott Burk, MD, PhD, Associate Ophthalmologist, John S. Cohen, MD, Chief of Glaucoma Services, Cincinnati Eye Institute, Cincinnati, OH, and Harry Quigley, MD, Director of the Glaucoma Service, Wilmer Ophthalmology Institute, Johns Hopkins Hospital, Baltimore,

If I have a large optic nerve cup, does that mean I have glaucoma ?

The second most significant risk factor for the development of chronic open-angle glaucoma is the size of the central cup "cupping" of the optic nerve head. 

Cupped disc

  • The cupping of the optic nerve means the size of the depression in the middle of the nerve when viewed from the front of the eye. When there is damage to the optic nerve, the cupping increases. When a person is shown to have large optic nerve cups, it could be an indicator of damage unless it can be determined that the cup size is considered normal for that individual.  
  • Through periodic photographs of the optic nerve, the ratio of the cup to the disc can be monitored. This helps your eye doctor determine a baseline and to see whether or not damage is still occurring to the nerve fibers with current treatment and/or if treatment should be modified.
  • Ultimately, it is through a combination of eye exams and observations that your eye doctor will determine whether you have glaucoma.