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.