Glaucoma being high pressure of the eye, generally greater than 21 mm/Hg, is the leading cause of blindness throughout the world, but fortunately is treatable with prevention. Those that are most at risk are diabetics, senior citizens, Afro-Americans, and those who are short-sighted with additionally a family history of glaucoma.

Most people think that glaucoma is a condition that is painful with red eyes that has something to do with tears. Nothing could be further from the truth, because typically the most common form of glaucoma is not painful, and does not cause redness to the eye. This is why prevention is so important for early detection and proper treatment.

Recently, Kirby Puckett, a multi-million dollar professional baseball player for the Minnesota Twins, lost his eyesight in one eye due, in part, to glaucoma. This Afro-American was only 37 years old when this occurred, therefore having to retire prematurely from professional sports. This is why the American Academy of Ophthalmology recommends your first eye examination to screen for glaucoma to occur in the early thirties, every couple of years in the forties and fifties, and annually beyond the age of sixty.

More goes into a glaucoma eye exam than just checking the eye pressure with a little blue circular light. In other words, a normal eye pressure doesn't rule out evidence of glaucoma, because eye pressure can go up and down all the time, mostly the highest in the morning and the evening.

Also, another unusual type of glaucoma is where damage to the optic nerve can occur at even normal pressures of the low teens. Therefore, visualization of the optic nerve, which is like a teacup on a saucer, is very important. The greater the cupping, the more glaucoma that could be present.

With more severe glaucoma, the lower the pressure must be to prevent further loss of side vision. Side vision can be regularly checked by a computerized test called a visual field test as well. So, vision, eye pressure, optic nerve visualization, and side vision testing regularly are all important to decide what is a normal eye pressure for a patient at the Eye Care Center.

In the last couple of years, a new photographic modality has become quite useful and even indispensable in diagnosing early glaucoma and following it through its early stages.  It is the OCT or optical coherence tomography of the retinal nerve fiber layer (RNFL).  This photographic test is very easy and only requires a few minutes of fixation when the picture is taken after dilation of the patient in the Eye Care Center.  This photograph is quite accurate down to even as small as 7 microns and diagnosing thinning of the nerve layer caused by glaucoma.  In some situations, this photograph can be used in concert or stand independently from a visual field test to diagnosing early glaucoma to managing it in its earlier stages.  However, the visual field test becomes more useful later in the disease process when the nerve fiber layer has already thinned out to some degree. 

Starting treatment of high eye pressure without evidence of loss of side vision can be a very difficult decision, because eye drops can be expensive and have side effects. Ongoing studies will tell the ophthalmologist when to treat what level of eye pressure in order to prevent even the earliest evidence of glaucoma. There are six families of eye drops to help lower the eye pressure, and beyond this there is laser treatment as well. But once again, eye drops and laser are only treatment and are not curable for glaucoma. Recently the genetic cause has been identified so a cure may be forthcoming in the future.

If the eye pressure must be lower despite eye drops and laser, then special surgically created valves called filters with an anti-scarring medication applied can be performed in a hospital setting. This cutting form of surgery can achieve eye pressures as low as single digits without the prolonged use of anti-glaucoma eye drops. However, it is very involved and when done correctly, can take several weeks for vision to clear and pressure to stabilize.

Once again, glaucoma is treatable and preventable, but not curable or reversible once damage occurs. Therefore, it is certainly important to get to the very best eye doctor possible for even routine checks. Such is offered at the Eye Care Center.


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