What is Glaucoma?

Glaucoma is a serious eye disease where damage to the optic nerve causes vision loss that is not reversible.  It often happens when fluid builds up in your eye and may be related to eye pressure .  This extra fluid can damage your optic nerve and cause loss of vision.  You will often not notice vision loss from the earlier or even moderate stages.  There is usually no pain or other symptoms associated.

Glaucoma is one of the leading causes of preventable blindness.  The vision loss can often be prevented with early diagnosis and treatment.  There are often no symptoms in the earlier stages.  The vision loss is usually first in the periphery.  Later more advanced stages of glaucoma can cause total blindness.

Risk factors for this blinding disease include family history, age and race.

How is it Diagnosed?

Glaucoma is diagnosed with a comprehensive eye examination.  Dr. Stanley Grandon, Dr. Cindy Wang and I may suspect glaucoma if your intraocular pressure is elevated and/or if your optic nerve looks as though it may have damage.  Up to half of patients with glaucoma do not have an elevated intraocular pressure when examined.  If we have a high enough suspicion, extra tests such as a peripheral vision test (a visual field), a picture of the optic nerve and checking the thickness of your cornea (pachymetry) may be recommended.  Depending on the level of suspicion, we may decide to observe you or choose to initiate treatment.

What Happens if I Have Glaucoma?

Although this eye disease is not curable, it is often treatable by various methods.  Dr. Stanley Grandon, Dr. Cindy Wang and I often initially start treatment with eyedrops.  There are several eye drops available that work in different ways.  We will often start you on a once daily drop.  Sometimes, other drops are added as well.   We will monitor your intraocular pressure, optic nerve and visual field tests to ensure your disease is not progressing.  As of today, there are no dietary supplements that have shown to be effective for glaucoma.

Laser treatments are another method of treatment.  Laser is often performed in the office and can lower intraocular pressure.  Laser does not cure glaucoma.

If we are unable to manage your disease with drops and /or laser surgery in the operating room may be required .  If necessary, there are various types of surgical procedures.  No matter what treatment is iniated, it is important to maintain regular examinations to ensure it continues to be under control.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126

How to Diagnose and Treat Glaucoma

How do I diagnose and treat glaucoma?  Glaucoma has no symptoms.  Patients who come into my office for an eye examination or urgent eye problem are always tested for glaucoma.  To diagnose glaucoma, I check the patient’s intraocular pressure (IOP) and look into the back of their eye at their optic nerve during a dilated eye examination.

Diagnosis of Glaucoma

Many patients with glaucoma have a normal eye pressure but have an optic nerve that looks suspicious for glaucoma.  If you have either an elevated eye pressure or a suspicious looking optic nerve, I will recommend more detailed testing including a visual field test, a picture of the optic nerve and checking the thickness of the cornea (pachymetry).

I may ask you to return to my office on another day to recheck the intraocular pressure, often at a different time of the day.  Eye pressure can vary day to day and different times of the day.

Treatment of Glaucoma

Depending on your intraocular eye pressure, appearance of the optic nerve and glaucoma testing, I may opt to treat you for glaucoma.  The initial treatment for glaucoma is often a once daily drop from the class of medications called prostaglandin analogs.  These drops are typically used at nighttime.  I will usually bring you back to the office a few weeks later to assess if the medication is working properly.

Some patients may need more than one drop to sufficiently lower their intraocular pressure.  Drops are usually added one at a time to assess their response.  Many patients may prefer to not take more than one medication, have difficulty affording or instilling the medications or the medications are not working enough.  For these patients, an in office laser procedure can be considered.

After the intraocular pressure has been sufficiently lowered, I will often recommend follow up in 3-4 months depending on the severity of the disease.  I will monitor the intraocular pressure and the testing will be repeated usually yearly.  If I feel the disease is progressing, I will add or change the treatment plan.

If your glaucoma cannot be sufficiently controlled with medical therapy or laser treatment, surgery is often considered.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126