| oma is a disease that damages the optic nerve | | | | Confirmation of the disease is made with a GDX, |
| inside the eye resulting in blindness if untreated. | | | | which is an instrument that actually maps out the |
| There is a genetic predisposition for the disorder, | | | | optic nerve changes and spots areas that are in |
| but there are other factors that contribute to the | | | | danger. |
| type of Glaucoma and severity of the disease. | | | | There are several types of Glaucoma, the most |
| Routine eye exams should always include a | | | | common type being Chronic Open Angle. There is |
| pressure check which is the basic Glaucoma test. | | | | also a Narrow Angle type which is most common |
| The most accurate way of evaluating the | | | | in farsighted patients. Diseases like Diabetes can |
| intraocular pressure is with the Goldman | | | | cause the disorder as well by increasing blood |
| Applanation method. That requires eye drops and | | | | vessel growth into the angle that drains the fluid |
| the use of an applanator with a cobalt blue light. | | | | from the eye. That is most dangerous and is |
| The most common method is the non-contact | | | | called Neovascular Glaucoma and follows Rubeosis |
| tonometer which is the ” air puff” | | | | which is blood vessel growth in the iris of the eye. |
| test. It is easy and quick, but not as accurate as | | | | Trauma can cause the disease by recessing the |
| the applanation. If the pressure is close to or | | | | iris resulting in scar tissue. That is called Angle |
| above 21 mm, then a closer look is indicated | | | | Recession Glaucoma. Finally, there is Pigmentary |
| because there is an increased chance that there | | | | Glaucoma which results from pigment leaching out |
| may be a problem. | | | | of the iris and blocking the drainage area. This has |
| The next part of the exam is to look at the optic | | | | a very strong genetic component and is the most |
| nerve. Normal nerves should have a yellowish | | | | difficult to treat. |
| pinkish appearance and the central cup part should | | | | The key issue with Glaucoma evaluation is to |
| not be more then 30% of the overall optic nerve. | | | | know the signs of early disease and treating it |
| If it is and there is a vertical elongation to the | | | | appropriately. All too often the early signals are |
| cup, then additional testing must be done. Next up | | | | missed and damage to the nerve occurs. The |
| would be a visual field test. This involves following | | | | increase in pressure results in a decrease in blood |
| a light and using ones’ peripheral vision to | | | | flow to the nerve resulting in death to the tissue. |
| see other spots. This evaluates the neurological | | | | Thus, the new treatment methods focus on |
| integrity of the nerve. If there are glaucomatous | | | | vascular sparing to keep the blood flowing to the |
| field and nerve changes then there will first be an | | | | nerve. As a practitioner, even questionable |
| increase in the natural blind spot followed by | | | | pressures or optic nerves should be tested |
| arcuate “scotomas” or blind areas | | | | further and we must not assume that things are |
| surrounding the central vision. These are clear | | | | normal. Proper follow up is a must and patient |
| indications of a positive diagnosis of Glaucoma. | | | | compliance must be carefully evaluated. |