Saturday, 6 January 2018

Recommended Treatments For Glaucoma + Diagnosis


Glaucoma is a disease of the eye in which fluid pressure within the eye rises; if left untreated, the patient may lose vision and even become blind.


There is no known way to prevent glaucoma, but catching it early means it can be treated more effectively and vision loss can be minimized. Because, often, there are no symptoms, getting your eyes regularly checked is important; especially for people with a greater risk. So, older adults, people of African descent, and individuals with diabetes should be tested every year or 2 after the age of 35. Ask a doctor how often you should have a check up.
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During routine eye exams , a tonometer is used to measure your intraocular pressure, or IOP. Your eye typically is numbed with eye drops, and a small probe gently rests against your eye's surface. Other tonometers send a puff of air onto your eye's surface.
An abnormally high IOP reading indicates a problem with the amount of fluid ( aqueous humor) in the eye. Either the eye is producing too much fluid, or it's not draining properly.
Normally, IOP should be below 21 mmHg (millimeters of mercury) a unit of measurement based on how much force is exerted within a certain defined area.

Ways Glaucoma Can Be Diagnosed 

◾Tonometry determines the pressure in the eye by measuring the tone or firmness of its surface. Several types of tonometers are available for this test, the most common being the applanation tonometer. After the eye has been numbed with anesthetic eyedrops, the tonometer's sensor is placed against the front surface of the eye. The firmer the tone of the surface of the eye, the higher the pressure reading.

◾Visual field testing : This is a way for your eye doctor to determine if you are experiencing vision loss from glaucoma. Visual field testing involves staring straight ahead into a machine and clicking a button when you notice a blinking light in your peripheral vision. The visual field test may be repeated at regular intervals to make sure you are not developing blind spots from damage to the optic nerve or to determine the extent or progression of vision loss from glaucoma.

◾Gonioscopy is done by numbing the eye with anesthetic drops and placing a special type of contact lens with mirrors onto the surface of the eye. The mirrors enable the doctor to view the interior of the eye from different directions. The purpose of this test is to examine the drainage angle and drainage area of the eye. In this procedure, the doctor can determine whether the angle is open or narrow and find any other abnormalities, such as increased pigment in the angle or long-standing damage to the angle from prior inflammation or injury. As indicated earlier, individuals with narrow angles have an increased risk for a sudden closure of the angle, which can cause an acute angle-closure glaucomatous attack. Gonioscopy can also determine whether the eye is subject to chronic angle closure, whether blood vessels are abnormal, or whether hidden tumors might be blocking the drainage of the aqueous fluid out of the eye.


◾Pachymetry measures the thickness of the cornea. After the eye has been numbed with anesthetic eyedrops, the pachymeter tip is touched lightly to the front surface of the eye (cornea). Studies have shown that corneal thickness can affect the measurement of intraocular pressure. Thicker corneas may give falsely high eye pressure readings and thinner corneas may give falsely low pressure readings. Furthermore, thin corneas may be an additional risk factor for glaucoma. Once a doctor knows the thickness of a patient's cornea, he or she can more accurately interpret the patient's
tonometry .

Treatments For Glaucoma
Treatment can involve glaucoma surgery, lasers or medication, depending on the severity. Eye drops with medication aimed at lowering IOP usually are tried first to control glaucoma.

  • Eye drops : These either reduce the formation of fluid in the eye or increase its outflow. Side effects may include allergies , redness, stinging, blurred vision, and irritated eyes. Some glaucoma drugs may affect your heart and lungs . Medications commonly come as eyedrops. Beta-blocker medications slow the eye’s fluid production, and steroids such as timolol work quickly reduce inflammation. Eyedrops containing prostaglandins work to relax the eye muscles, push the iris away from the trabecular meshwork, and open up the interior structure to alleviate extreme eye pressure.
◾Epinephrines decrease the fluid production rate while increasing outflow from the eye itself. If immediate pressure relief of the optic nerve is needed, a you may need to take hyperosmotic agents.
◾Alpha-adrenergic agonists, parasympathomimetics, and carbonic anhydrase inhibitors all work by decreasing the aqueous humor’s production rate. Carbonic anhydrase inhibitors such as Diamox and Neptazane are also available in pill form.

Open-angle glaucoma is most often treated with various combinations of eye drops, laser trabeculoplasty, and microsurgery. Doctors in the U.S. tend to start with medications, but there’s evidence that early laser surgery or microsurgery could work better for some people.


Author: Richard Smith