Center for Sight

Comprehensive Eye Care Center

Glaucoma Diagnosis, Tests & Treatment

Several diagnostic tests may be performed to make the most precise diagnosis of glaucoma. These include the following:

  • Tonometry: 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.
  • Fundus Lens & Ophthalmoscopy are methods of carefully examining the inside of the eye-especially the optic nerve. Dilating eye drops will be placed in your eyes so that clear and direct observation of the optic nerve is possible.

If either your Intraocular Pressure (IOP) is elevated or your optic nerve appears unusual, additional tests will be necessary to complete the glaucoma examination. These may include the following test procedures:
  • Optic Nerve Stereo Photography: A special camera may be used to obtain stereoscopic photographs of your optic nerves. These provide a useful objective record of your optic nerve appearance against which future comparisons may be made.
  • Visual Field Perimetry: Perimetry or Visual Field testing is an important part of the glaucoma examination where you will be asked to sit in front of a large “bowl like” instrument and a computer program will present a small lights in different positions of your “side” or peripheral vision to see how far your side vision extends in various directions. The computer will then plot an actual map of your field of vision.
  • Gonioscopy: By using a special contact lens, gonioscopy is a quick and painless test that allows us to directly observe the health and condition of the angle where the iris meets the cornea and evaluate your risk for the angle to become closed.
  • Optic Nerve Computer Imaging: Using OCT or Optical Coherence Tomography we capture digital images with special beams of light in order to create a contour map of the optic nerve and measure the retinal nerve fiber thickness.
  • Pachymetry Measurement of Corneal Thickness: Corneal thickness is important because it can alter the accuracy of the measurement of Intraocular Pressure, potentially causing doctors to delay necessary treatment in some cases or causing doctors to treat normal people unnecessarily in other cases. Your actual Intraocular Pressure may be UNDERESTIMATED if you have thin corneas and it may be OVERESTIMATED if you have thicker corneas.

There are three main methods of treating glaucoma: Medical, Laser and Surgical. These treatment options for controlling glaucoma are quite important, as glaucoma has no cure. In almost all cases, glaucoma is treatable, but must be diagnosed as early as possible. The following information is limited to treatment of Primary Open Angle Glaucoma, as it is the most common type of Glaucoma. Primary Open Angle Glaucoma is treated by the three different approaches above depending on the severity of the disease and the ability of each treatment option to slow or halt the disease progression and preserve your vision.

Medical Treatment of Glaucoma
Primary Open Angle Glaucoma is most often treated by prescribing one or more types of eye drops to lower your Intraocular Pressure (IOP). By using a single type of medication or sometimes 2 eye drops in combination, more than 80% of the patients with Open Angle Glaucoma can be successfully treated. These eye drops work by either decreasing the amount of fluid being produced inside your eye or by increasing the rate of drainage of fluid from your eye. For most patients, using the eye drops as prescribed-1-2 times per day it is possible to control the Intraocular Pressure (IOP) and slow or even halt the loss of vision.

Laser Treatment of Glaucoma
The use of laser treatment for glaucoma has become an important treatment option for many patients. In the past, laser treatment for glaucoma was considered a “last resort” before glaucoma surgery. Today, thanks to advances in lasers, using a laser treatment for glaucoma in conjunction with the eye drop treatment or sometimes even using the laser treatment as the primary treatment are excellent options to help maintain control and slow or stop the progression of the disease.

Surgical Treatment of Glaucoma
For a small number of patients, even with the maximum medical therapy and laser treatment, it is still not possible to achieve good stable control of their disease and stop the progression of vision loss. For these patients, there are surgical procedures available to help achieve control of the Intraocular Pressure (IOP) and slow or stop the progression of the disease that include removing a tiny piece of the Trabecular Meshwork, a surgical procedure called “Trabeculectomy”, “Sclerostomy” or “Filtering Procedure”, or even implanting microscopic glaucoma valves, stents such as the iStent®, shunts such as the Ex-PRESS Mini Shunt and tubes to help reduce and stabilize the Intraocular Pressure (IOP) and prevent vision loss.