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Frequently Asked Questions
Glaucoma
What is glaucoma?
Is there more than one type of glaucoma?
What is Primary Open Angle Glaucoma (POAG)?
What happens to the eye in glaucoma (POAG)?
What are the symptoms of glaucoma POAG)?
What are the symptoms of late glaucoma (POAG)?
At a health screening my eye pressure was high. Do I have
glaucoma?
How do you determine that there is nerve fiber loss?
What is Ocular Hypertension?
My eye pressure is normal. Is it safe to say I do not have
glaucoma?
Does increased eye pressure mean glaucoma?
How can I be sure I do not have glaucoma?
How is glaucoma diagnosed (POAG)?
If I have glaucoma - How often do my eyes need to be examined
(POAG)?
I was told I am a Glaucoma Suspect. What now?
My mother (sister, any blood relative) has glaucoma. How
significant is this?
What are the chances my children will develop glaucoma?
Should my family members be checked for glaucoma?
What is the GDx test?
What is the Visual Fields test?
Why do you do the GDx and the Visual field tests?
What is Discam?
What medicines should glaucoma (POAG) patients avoid?
What medicines are generally considered safe for glaucoma
(POAG) patients?
Why is it important to recognize glaucoma progression early?
How is glaucoma treated (POAG)?
ALT - Laser surgery for POAG.
Conventional surgery (not laser surgery) for glaucoma (POAG).
Can lost vision be restored by treatment?
What are "Beta-blocker" eyedrops?
I have been using Timoptic without problems. Recently I
was diagnosed with chronic bronchitis (or heart disease). What should
I do?
Cost of glaucoma drops.
How to instill eyedrops
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What is glaucoma?
Glaucoma is a condition in which the nerve fibers inside the eye are destroyed.
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Is there more than one type of glaucoma?
There are several types. The most important are the Primary Open Angle
Glaucoma or POAG and the Narrow Angle Glaucoma (NAG). These two conditions
are very different. If you have glaucoma make sure to ask the doctor which
type you have.
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What is Primary Open Angle Glaucoma (POAG)?
This is the most common type of glaucoma. When we talk about "glaucoma",
this is the type we are talking about. When we talk about the Narrow Angle
Glaucoma (NAG) we will let you know about it.
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What happens to the eye in POAG?
Each eye has about 1 million nerve fibers. They come together in the back
of the eye to make up the eye nerve. Glaucoma destroys nerve fibers. When
many nerve fibers are lost, the eye becomes blind.
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What are the symptoms of POAG?
There are no symptoms until very late in the disease. There is no pain.
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What are the symptoms of late POAG?
Side vision is lost. Central vision (used for reading and similar tasks)
remains relatively good. The field of vision narrows. The patient feels
as if he is looking through a long narrow tube. Just the central, straight
ahead vision is clear. When driving across an intersection such a patient
might be able to read the license plate of the car in front of him, but
would not be able to see the bus coming at him from the side.
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At a health screening my eye pressure was high. Do I have glaucoma?
You have either glaucoma or ocular hypertension. If you have nerve fiber
loss, you have glaucoma.
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How do you determine that there is nerve fiber loss?
By carefully examining the eye nerve and by doing certain tests (GDx,
FDT, Visual Fields and Digital Stereo Photoimaging).
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What is Ocular Hypertension?
Ocular Hypertension is a mild increase in eye pressure with no nerve damage.
It requires no treatment. It must be followed up carefully to detect nerve
fiber loss as early as possible.
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My eye pressure is normal. Is it safe to say
I do not have glaucoma?
No. Pressure screening detects about one-half to two-thirds of glaucomas.
The rest are missed.
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Does increased eye pressure mean glaucoma?
The popular concept that glaucoma is simply high pressure inside the eye
is not correct.
We know now that:
· People with high eye pressure and nerve damage have Glaucoma.
· People with high eye pressure and no nerve damage have Ocular Hypertension.
· People with normal pressure but showing nerve damage have Normal or Low Tension Glaucoma.
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How can I be sure I do not have glaucoma?
You need a complete, dilated eye exam. We routinely check the nerve, the
eye pressure, and the draining area. If this eye exam is normal, and you
do not have family history of glaucoma, it is pretty safe to assume that
you do not have glaucoma.
If you have a blood relative with glaucoma you may need, in addition to the eye exam, a nerve fiber analysis test (GDx test).
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How is glaucoma diagnosed (POAG)?
The key is to identify loss of nerve fibers. Loss of nerve fibers is suspected
from the appearance of the nerve in the back of the eye. A positive Visual
Fields test or the GDx Test confirms it. Sometimes, when the pressure
in the eye is very high, glaucoma is diagnosed even without proving nerve
fiber loss.
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If I have glaucoma - How often do my eyes need to be examined?
When the glaucoma is first diagnosed you will be seen at short intervals
to evaluate results of treatment. The desirable level of control is different
for each individual. Once good control is obtained you will need to be
examined every 3-6 months.
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I was told I am a Glaucoma Suspect. What now?
This means that your eye pressure is too high or the nerve looks abnormal.
You may need repeat measurement of the eye pressure and baseline special
tests - the Visual Fields tests, the GDx test and the computerized 3-D
photographic evaluation of the nerve head.
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My mother (sister, any blood relative) has glaucoma. How significant
is this?
If one of your parents has glaucoma, your chance of developing glaucoma
is increased 10 fold. If your brother or sister has glaucoma your risk
is increased 20 fold (1 chance in 10 that you will develop glaucoma).
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What are the chances my children will develop glaucoma?
If you have glaucoma, your children's chance of developing glaucoma is
10 times greater than for other children (1chance in 25).
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Should my family members be checked for glaucoma?
Yes. If you are diagnosed with glaucoma your blood relatives (parents,
children, brothers, sisters) should have a complete eye exam.
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What is the GDx test?
GDx stands for Glaucoma Diagnosis. It is a new computerized test that
measures the thickness of the eye nerve tissue. It is similar to taking
a picture of the inside of the eye. It is painless, quick and does not
require that your eyes be dilated. It is used for diagnosis of early glaucoma;
for follow up of glaucoma treatment and in early detection of glaucoma
in relatives of glaucoma patients.
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What is the Visual Fields test?
It is a test of eye nerve function. Faint spots of light are projected
on a screen and you press a button if you see them. The computer tells
us if you are missing spots you should have been able to see.
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Why do you do the GDx and the Visual field tests?
They measure different aspects of the nerve. Both are necessary for best
evaluation. The Visual Fields test measures functioning nerve fibers.
About 300,000 nerve fibers (out of 1 million) have to be lost before the
Visual Fields test becomes positive. GDx test is usually more sensitive
than the Visual Fields test. Another visual fields test we use is the
Frequency Doubling Technology.
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What is Discam?
Discam is a new instrument that obtains computerized 3-D image of the
nerve head. It also measures and calculates critical features of the nerve
head. These images and calculations are then used as a baseline against
which later images and calculations are compared. Minute changes indicative
of progression of glaucoma are detected earlier than before and treatment
can be adjusted sooner.
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What medicines should glaucoma (POAG) patients avoid?
Steroids (cortisone, hydrocortisone, prednisolone, etc.) increase eye
pressure. If you need to use steroids for longer than 2 weeks, your eye
pressure has to be monitored during use. This includes use of steroid-containing
eyedrops, steroid pills, and steroid creams over large areas of the body.
Use of steroid creams for small skin lesions is unlikely to increase pressure.
If you are taking steroids now, do not discontinue them - just tell us
about it and come in for a re-evaluation. Steroid use for less than 2
weeks generally does not require special monitoring of eye pressures.
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What medicines are generally considered safe for glaucoma (POAG)
patients?
Cold remedies containing Pseudoephedrine, Phenylephrine or Neo-Synephrine;
anti-histaminics Chlorpheniramine, Diphenhydramine or Benadryl and overactive
bladder remedies such as Detrol often carry a warning telling you not
to use them if you have glaucoma. These warnings do not apply to your
type of glaucoma (POAG). You can safely use them for a week or two; beyond
that, monitoring may be needed. The warnings are intended primarily for
patients with Narrow Angle Glaucoma. If you are not sure what type of
glaucoma you have, consult us before taking these medicines.
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Why is it important to recognize glaucoma progression early?
Because nerve fibers, once lost, cannot be replaced. Since treatment slows
down the rate of nerve fiber loss, it should begin as soon as we detect
progressive nerve loss.
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How is glaucoma treated (POAG)?
Initially, treatment consists of eyedrops. If adequate control is not achieved, laser surgery is done (ALT). If the disease still progresses, conventional surgery, which helps drain fluid from the eye, is done.
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ALT - Laser surgery for POAG type glaucoma.
Argon Laser Trabeculoplasty (ALT) is a painless, in-office laser treatment
for glaucoma. It is commonly done on patients who do not respond well
to eyedrops, or are unable to comply with eyedrops treatment.
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Conventional surgery (not laser surgery) for glaucoma (POAG).
Generally reserved for patients whose glaucoma cannot be controlled with
eyedrops and laser surgery.
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Can lost vision be restored by treatment?
No. Lost nerve fibers will not grow back.
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What are "Beta-blocker" eyedrops?
Some glaucoma eyedrops contain "Beta-blocker" medicine. They are absorbed
into the blood circulation and may cause shortness of breath in patients
with lung or heart conditions. The most common beta-blocker eyedrops are
Timoptic and Timoptic-XE. They are excellent anti-glaucoma eyedrops and
cause no problems in people with normal heart and lungs.
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I have been using Timoptic (or Timoptic-XE) without problems. Recently
I was diagnosed with chronic bronchitis (or heart disease). What should
I do?
Glaucoma patients on Timoptic who develop chronic bronchitis, asthma,
COPD (chronic obstructive lung disease), emphysema or heart problems,
should let us know about it. They should also remind their family doctor
that they are using beta-blocker eyedrops for glaucoma.
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Cost of glaucoma drops.
Glaucoma is a lifetime condition. Over time the cost of drugs is high.
You will pay less if you shop around for glaucoma drops. If cost is a
major problem, you may consider Argon Laser Trabeculoplasty (ALT). Initially,
ALT controls the pressure in 4 out of 5 patients. The effect may fade
with time but, one year after ALT, the pressure still remains under control
in about one half of patients. Medical insurance and Medicare cover ALT.
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How to instill eyedrops.
The proper technique to instill eye drops is very important.
Detailed instructions are on the How To page.
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Other glaucoma links:
www.glaucoma-foundation.org/info (The Glaucoma Foundation)
www.nei.nih.gov/publications/glauc-path.htm (National Eye Institute at the National Institutes of Health)
© Copyright 2001 Southland Eye Clinic All Rights Reserved.