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Glaucoma
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This service provides care for patients with all kinds of glaucoma, from early to advanced, and performs consultation and management of complex and unusual glaucoma cases.
In addition to the vision and eye pressure, the thickness of the cornea (the clear window of the front of the eye) is measured to determine if the eye pressure may actually be higher or lower than the value measured by the standard applanation technique, which is affected by the corneal thickness. Knowledge of the corneal thickness helps to predict how likely it is for a given patient with a high eye pressure and no optic nerve or visual field damage to go on and develop glaucoma later on if the pressure is not treated. Therefore, not all patients with a high eye pressure may need to be treated, while some with lower eye pressures should be aggressively treated to prevent vision loss years down the road.
The drainage angle of the front of the eye between the cornea and iris (the colored part of the eye with the pupil that lets in light to the back of the eye) is where the clear, watery fluid in the eye drains out. This area is examined with a small, mirrored contact lens by gonioscopy to determine if a patient has an open, narrow or closed angle and whether there is any indication of abnormal blood vessels or prior eye injury to explain the cause of the increased eye pressure. Knowledge of the angle structure can greatly help in the initial diagnosis and appropriate management of each individual patient's type of glaucoma.
The peripheral visual field (or peripheral vision) is routinely tested with the new and faster method called the Swedish Interactive Threshold Algorithm, or SITA (usually 4-6 minutes per eye instead of 6-12 minutes with the older machines). This newer test can measure the peripheral vision faster and more reliably to aid in the early diagnosis of vision loss from glaucoma and helps to follow glaucoma patients for long-term change. Finding early changes on this visual field test can help the physician intervene sooner to lower eye pressure more aggressively, to prevent long-term vision loss, before the patient is aware of it.
The latest technology for computerized diagnostic imaging of the optic nerve with the Optical Coherence Tomography (also called OCT) or GDx instruments, along with standard computerized, digital photography, is utilized routinely to examine and document the appearance and shape of the optic nerve in the back of the eye. These instruments also measure the nerve fiber layer thickness, which is usually the first part of the eye to be damaged in glaucoma. These instruments can pick up early loss of the microscopic nerve fibers of the optic nerve to help diagnose early glaucoma, before it becomes visually significant, and help the physician decide when to begin early glaucoma treatment or increase therapy for advanced disease.
Up-to-date medical therapy is utilized for early, moderate, and advanced glaucoma. Laser and intraocular surgical procedures for moderate and advanced glaucoma are routinely performed. Patients with cataracts, both with and without glaucoma, are helped with up-to-date cataract surgery. The following procedures are performed:
- Trabeculectomy, or filtering surgery, with the anti-scarring agent Mitomycin C to increase surgical success in advanced glaucoma
- Baerveldt and Ahmed glaucoma implants in advanced glaucoma
- Cataract surgery utilizing the latest techniques of a small, temporal clear corneal incision, phacoemulsification, and modern foldable intraocular lenses
- Cataract surgery in patients with small pupils from previous scarring due to inflammation or trauma, patients on Flomax or similar medications to treat prostate gland enlargement, or patients who have previously used pilocarpine eye drops
- Combined cataract and glaucoma surgery utilizing all of the above techniques
- A variety of laser surgical procedures for various types of open-angle and angle-closure (also called narrow angle) glaucoma
Faculty:
Sandra Johnson, M.D.
Bruce E. Prum, M.D.
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