Glaucoma
Glaucoma is easy to treat in most cases. If not treated, however, it can result in blindness, with no warning. Dr. D and SEECA offer a wide array of treatment options for this condition and we take pride in the hundreds of patients we have successfully managed with this condition.
Glaucoma, the 2nd leading cause of blindness, is characterized by:
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Optic Nerve Damage
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Visual Field loss
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Increased Intra Ocular Pressure (in most cases)
No single test can diagnose glaucoma, so we use 6 tests, as recommended by the American Academy of Ophthalmology.
The 6 tests used at SEECA to determine glaucoma are interpreted as a group
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IOP - Intra ocular pressure
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DFE - Dilated fundus exam with Optic nerve assessment
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DISC PHOTOS – Used to visually track Optic nerve anatomy
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SVF - Synemed visual field
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HRT – Computerized 3-D imaging of the Optic Nerve Head.
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GONIO - Gonioscopy to determine the angle anatomy
This series of tests is the best way to diagnose and manage glaucoma according to the American Academy of Ophthalmology. As a Board Certified Specialist, Dr. D gives patients the best care possible by following the guidelines set forth above and our results have been excellent, in terms of preventing vision loss from glaucoma. Each of the tests above is usually performed once a year over a span of 3 visits. After the results are in, the tests are analyzed by Dr. D and are used as a baseline which will be compared to next year’s tests. By comparing results year to year, we can precisely determine if you are getting better or worse.
The 6 tests for glaucoma are also used to set the most important parameter of your glaucoma management. This number is called the TARGET PRESSURE.
The target pressure is the estimated pressure your eye can withstand, without sustaining damage to the optic nerve. If the pressure in your eye goes above your target pressure, we take steps to lower your pressure. This is how we prevent vision loss from glaucoma.
Every patient gets a specific TARGET PRESSURE for each eye based on the results of the tests performed above. An example will make this process clearer.
EXAMPLE OF A SEECA GLAUCOMA WORKUP
During an eye examination Dr. D discovers optic nerve changes suggestive of glaucoma. The patient is scheduled for glaucoma testing, after which Dr. D assess the patient’s risk for glaucoma and sets a TARGET PRESSURE.
The logic for setting the TARGET PRESSURE is based on all the tests performed above, as well as factors such as the patient’s family history, their ocular history, their race, age, and medical history. Setting the TARGET PRESSURE is a complex process that we have perfected at SEECA using our own copyrighted software.
After the initial work up, the patient is given the diagnosis of “Glaucoma Suspect” which means the patient DOES NOT HAVE GLAUCOMA, but does have a risk for developing glaucoma in the future. Unfortunately, as we get older, our risk of developing glaucoma increases significantly.
We then schedule the patient for a follow up visit to check the intra ocular pressure 3 to 6 times a year depending on their risk factors. At the follow up visits, we will verify the patient’s intra ocular pressure is LESS THAN THEIR TARGET PRESSURE.
If the patient’s intra ocular pressure is lower than their TARGET PRESSURE (low is good) in each eye, we celebrate and re-check the pressure in 2-4 months.
If the patient’s intra ocular pressure is higher than the TARGET PRESSURE (high is bad), we recheck the patient’s intra ocular pressure in 2-4 weeks. If the intra ocular pressure stays elevated above the TARGET PRESSURE (high is bad) for three consecutive visits, we will take steps to lower the intra ocular pressure.
What treatment is available if my Pressure is too high?
The treatments available to lower the intra ocular pressure include Laser, Medications and Conventional Surgery. Numerous studies have shown Laser Surgery to be highly effective and safe at lowering Ocular pressure in patients with glaucoma. Furthermore, newer “Cold Lasers” have the additional benefit of causing no damage to the eye whatsoever, and therefore can be repeated numerous times to lower the intra ocular pressure if necessary. SEECA is proud to own one of the few “Cold Lasers” in the region and we have been very successful using this technology to keep patients pressure controlled. Simply put, Cold Lasers work well, they are very safe, and painless, which is why we use this treatment as our first line therapy, as does most of the world.
If Laser surgery does not work after multiple attempts, we will typically start glaucoma medications. If glaucoma medications do not successfully lower the intra ocular pressure below your TARGET PRESSURE, then we will typically perform Conventional Glaucoma Surgery where we create a small release valve in the eye to relieve the excess pressure.
What is the purpose of Yearly Testing?
Repeating your diagnostic tests on a yearly basis is crucial to knowing if your glaucoma is getting worse. If repeat tests show increasing damage, then your TARGET PRESSURE must be lowered to prevent further damage.
Why is Glaucoma so complicated?
Glaucoma IS A COMPLICATED CONDITION that is challenging to diagnose and manage. Some people get frustrated with the uncertainty of glaucoma, which is completely understandable. After all, the thought of losing your sight can be scary.
Rest assured that Dr. D is highly trained and experienced in treating glaucoma and we will provide you with the best care possible. We will answer any questions that you may have and we will do our best to make you feel comfortable with your care.
Part of our commitment to your care is educating you about your condition. We’re confident that the more you know about glaucoma, the more you’ll appreciate our meticulous attention to detail. For example, we have built our own world class software program developed specifically for taking care of your eyes and making sure you never lose your sight from glaucoma. Our goal is to keep your vision perfect until you reach 100 years of age.
Can I skip a few appointments and still be OK?
Glaucoma is the second leading causes of blindness in the world because it has no symptoms, no warning signs and most patients cannot tell when their ocular pressure is high. If you skip visits, you risk losing your vision permanently.
So please keep your appointments and take all medications (if prescribed) as directed. This will minimize your risk of serious vision loss.
Dr. D is FULLY committed to protecting your vision, we simply ask for your cooperation in managing this complex condition. Thank you for your trust and for making SEECA your eye care provider.