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Home » Eye Care Services » Management of Ocular Diseases » Glaucoma Testing & Treatment

Glaucoma Testing & Treatment

Glaucoma is a leading cause of preventable vision loss and blindness in adults in the United States and Canada and the second leading cause of blindness in the World.

What is Glaucoma?

Glaucoma is actually a group of eye diseases that cause damage to the optic nerve due to an increase in pressure inside the eye or intraocular pressure (IOP). When detected in the early stages, glaucoma can often be controlled, preventing severe vision loss and blindness. However, symptoms of noticeable vision loss often only occur once the disease has progressed. This is why glaucoma is called “the sneak thief of sight”. Unfortunately, once vision is lost from the disease, it usually can’t be restored.

Treatments include medication or surgery that can regulate the IOP and slow down the progression of the disease to prevent further vision loss. The type of treatment depends on the type and the cause of the glaucoma.

Risk Factors

Prevention is possible only with early detection and treatment. Since symptoms are often absent, regular eye exams which include a glaucoma screening are essential, particularly for individuals at risk of the disease. While anyone can get glaucoma, the following traits put you at a higher risk:

  • Age over 60
  • Hispanic or Latino descent, Asian descent
  • African Americans over the age of 40 (glaucoma is the leading cause of blindness in African Americans, 6-8 times more common than in Caucasians.)
  • Family history of glaucoma
  • Diabetics
  • People with severe nearsightedness
  • Certain medications (e.g. steroids)
  • Significant eye injury (even if it occurred in childhood)

Signs and Symptoms of Glaucoma: Due to a buildup of pressure in the eye, glaucoma causes damage to the optic nerve which is responsible for transmitting visual information from the eye to the brain. How does glaucoma affect your vision?

Types of Glaucoma: There are a number of types of glaucoma, some more acute than others. Learn about the common types of glaucoma and the differences between them.

Diagnosis and Treatment of Glaucoma: Early detection and treatment of glaucoma is essential to stopping or slowing the disease progression and saving vision. Treatment can include medicated eye drops, pills, laser procedures and minor surgical procedures depending on the type and stage of glaucoma.

Signs and Symptoms of Glaucoma

The intraocular pressure caused by glaucoma can slowly damage the optic nerve, causing a gradual loss in vision. Vision loss begins with peripheral (side) vision, resulting in limited tunnel vision. Over time if left untreated, central vision will also be affected which will increase until it eventually causes total blindness. Unfortunately any vision that is lost from the optic nerve damage cannot be restored.

What are the Symptoms?

Typically, glaucoma sets in without any symptoms. At the early onset of the most common type of glaucoma “open angle” glaucoma, vision remains normal and there is no pain or discomfort. This is why the disease is nicknamed the “sneak thief of sight”.

An acute type of glaucoma, called angle-closure glaucoma, can present sudden symptoms such as foggy, blurred vision, halos around lights, eye pain, headache and even nausea. This is a medical emergency and should be assessed immediately as the intraocular pressure can become extremely high and cause permanent damage within hours.

Types of Glaucoma

The primary forms of glaucoma are open-angle and narrow-angle, with open-angle being the most common type.

Primary open-angle glaucoma (POAG) gradually progresses without pain or noticeable vision loss initially affecting peripheral vision. By the time visual symptoms appear, irreparable damage has usually occurred, however the sooner treatment starts the more further vision loss can be prevented. When untreated, vision loss will eventually result in total loss of side vision (or tunnel vision) and eventually total vision loss.

Normal-tension glaucoma or low-tension glaucoma is another form of open-angle glaucoma in which the intraocular pressure remains within the normal level. The cause of this form of glaucoma is not known, but it is believed to have something to do with insufficient blood flow to the optic nerve, causing damage. Individuals of Japanese descent, women and those with a history of vascular disease or low blood pressure are at higher risk.

Angle-closure glaucoma can be a sudden increase in eye pressure causing severe pain, blurred vision, halos, nausea and headaches. The pressure is caused by a blockage in fluid at the front of the eye which is a medical emergency and should be treated immediately. Without prompt treatment to clear the blockage vision can be permanently lost.

Congenital glaucoma is an inherited form of the disease that is present at birth. The babies are born with a defect that slows the normal drainage of fluid out of the eye and are usually diagnosed by the time they turn one. In these cases there are typically some noticeable symptoms such as excessive tearing, cloudiness or haziness of the eyes, large or protruding eyes or light sensitivity. Surgery is usually performed with a very high success rate of restoring full vision.

Secondary glaucomas are complications that develop from eye surgeries, injuries or other medical conditions such as cataracts, tumors, or a condition called uveitis which causes inflammation. Uncontrolled high blood pressure or diabetes can result of another serious form called neovascular glaucoma.

Pigmentary glaucoma is a rare form in which pigment from the iris sheds and clogs the drainage of fluid from the eye resulting in inflammation and damage to the eye and drainage system. .

Treatment of glaucoma is dependant upon the severity and type of glaucoma present.

Glaucoma Diagnosis and Treatment

Detecting Glaucoma

During a routine comprehensive eye exam to check for glaucoma, your eye doctor will dilate your eye to examine the optic nerve for signs of glaucoma and will also measure the intraocular pressure (IOP) with an instrument called a tonometer. Tonometry involves numbing the eye with drops and then gently pressing on the surface of the eye to measure the pressure. Since your IOP can fluctuate throughout the day and glaucoma can exist without elevated IOP this is not enough to rule out the disease. If there are signs of the disease, further testing will be performed.

Visual Field Test

A visual field test is designed to detect any blind spots in your peripheral or side field of vision. You will be asked to place your head in front of a machine while looking ahead and indicate when you see a signal in your peripheral field of view.

Your doctor may also measure the thickness of the cornea with an ultrasonic wave instrument in a test called pachymetry or use imaging techniques such as digital retina scanning or optical coherence tomography (OCT) to create an image of your optic nerve to look for glaucoma damage.

Treating Glaucoma

Treatment for glaucoma depends on the type and severity of the disease and can include medication such as eye drops or pills or laser or traditional surgery.

Medication and drops to lower IOP are often the first resort for controlling pressure-related glaucoma. These drops may have some uncomfortable side effects, but compliance with the treatment plan is essential for preserving vision and halting the progression of the disease.

Surgical procedures are designed to control the flow of fluids through the eye by either decreasing the amount of fluid produced or improving the drainage. Your doctor may decide that a combination of surgery and medication will be the most effective in many cases.

It cannot be stressed enough that the most effective treatment for glaucoma happens when the disease is detected and treated early before significant vision loss occurs. Any vision that is lost can not be restored. This is why the best prevention is awareness by knowing your risks and taking responsibility by having your eyes examined on a regular basis.

Dear Patients,

We will be reopening our office Monday, May 18, 2020, and would like to bring you up to date with the many very important physical and procedural changes we have made to our office to assure the highest level of health and safety for our patients and staff during these very challenging times.

We have consulted with our county, state and federal officials, as well as the CDC and other healthcare professionals, to incorporate the recommended and required safety measures throughout our office.

We sincerely apologize for any inconvenience we may have caused by rescheduling or postponing your earlier appointments.

To assure the health and safety of our staff and patients, as well as minimize any exposure, we have instituted the following changes. Please read through this entire document and print a copy so you are familiar with them.

1. Any and ALL appointments and visits will need to be scheduled. This includes the pickup of eyeglasses or trial contact lenses, frame selection, eyeglass repairs, and eyeglass adjustments.

2. Contact lenses will be shipped to all patients at no charge

3. To maintain social distancing and minimize any possible exposure, we have spread out our patient schedule.

4. 24-48 hours before your appointment, one of our staff will be calling to remind you of your appointment and discuss your ocular and medical history. In addition, they will ask you standard COVID19 screening questions and answer any questions regarding your upcoming exam. This will take 5 – 10 minutes but this initial call is important to allow you ample time in our office.

Please look for and answer this call.

5. In order to save time and keep everyone on schedule, any and all medications you are taking should be listed in as much detail as possible on a separate piece of paper, emailed to our secure site: DROXENBERG@COMCAST.NET, or entered on the patient registration form on our website: WWW.DROXENBERG.COM. This needs to be completed prior to your appointment and should include all systemic medications (diabetes, hypertension, etc.) and ocular medications (eye drops, glaucoma medicine, etc.).

6. On the day of your appointment please plan to arrive 15 minutes early and call us at (717) 394-3798 when you arrive. We will return your call when you will be allowed to enter. Entry will be through the front door only unless previously discussed with our staff. Only the person with the appointment will be allowed in the office with the exception of minor children who have the appointment. NOTE: Family members and/or friends will need to wait outside.

7. We will be taking your temperature in the vestibule and anyone with a temperature of 100 degrees or higher or who is sick will be rescheduled. If you feel ill, please reschedule your appointment.

8. All staff will have their temperatures checked 2 times daily for your safety.

9. All staff will wear a facemask while in the office. In addition, all patients must wear a facemask while in the office as mandated by Governor Wolf for all PA businesses. If you do not wear a facemask, one will be provided to you.

10. There are hand sanitizing stations strategically placed throughout the office. Please use them.

11. All frames will be disinfected before and after being handled by patients and staff. Frames will not be returned to the frame display until they are appropriately disinfected.

12. All exam room equipment will be cleaned and disinfected before and after each use according to the CDC guidelines.

13. Cleaning and disinfection of our office have always been a priority and this will continue in earnest.

14. Preferred payment is by credit card or checks at the time of services but cash will be accepted.

15. We have installed a plexiglass barrier on our front desk to comply with the CDC and state guidance.

16. Reception area chairs have been separated to maintain social distancing.

17. Patients who are physically disabled will be allowed entry through the rear door, with prior approval, following a temperature check and COVID19 screening. All other patients must enter through the front door and screening vestibule.

18. Above all else, your safety and health are our top priorities. We take this responsibility very seriously and have implemented these changes in procedures to achieve this.

Dr. Oxenberg has been providing eye care to you and your family since 1990 and expects to continue for many years to come.

If you have any questions and /or concerns, please feel free to email our office at droxenberg@comcast.net or call (717) 394-3798.

We look forward to seeing you all again!

Sincerely,

Dr. Larry Oxenberg