Glaucoma Treatment Summary

Glaucoma is a multi-factorial disease of the optic nerve and eye. It is not just a simple matter of measuring an eye pressure. In the initial stages of open angle glaucoma, there are no symptoms. No one ever comes into an eye doctor’s office and says that they are losing their side-vision and have glaucoma. The vision loss is so insidious that most people are unaware of it.

Anyone with a family history of glaucoma should have their eyes examined on a yearly basis after age forty. If during your routine eye exam your eye doctor has measured your eye pressure above 21 mmHg, discovers that your optic nerves have a very large cup-to-disc ratio, and/or there is asymmetric cupping of your optic nerves, you will need a work up for glaucoma. There are many people with an elevated eye pressure who never develop glaucoma and there are others who have a normal eye pressure that go blind from glaucoma. Many people may have an eye pressure of 25 or 26 mmHg and never develop glaucoma. Other people may go blind with an eye pressure of 16 or 17 mmHg. So, who needs to be treated for glaucoma?

If your eyes are normal and all glaucoma tests show no evidence of glaucoma damage, many eye doctors will not start glaucoma treatment until the eye pressure is consistently 27 or 28 mmHg or higher. This number will be different between eye doctors. If the eye pressure remains too high, it puts the eye at risk of other eye diseases. So, an eye pressure of 27 or 28 mmHg needs to be treated in most cases.

If any of the glaucoma tests show evidence of glaucoma damage, the eye pressure needs to be lower to stop the progression of glaucoma damage to the optic nerve as any damage to the nerve is permanent.

How low does the eye pressure need to be in order to be safe? Again, that varies between individuals. A major factor in how low the eye pressure needs to be is based on the severity of the damage to the optic nerve. Anyone with significant documented damage from glaucoma, needs to have a low eye pressure in the range of 10 -12 mmHg. If there is no significant damage from glaucoma, the eye pressure may be fine at 20 or 21 mmHg.

Other important factors in determining the treatment of glaucoma is the thickness of the cornea. A normal corneal thickness is 550 microns. A thin cornea will result in measuring the eye pressure lower than what it truly is and a thick cornea will result in measuring the eye pressure higher than what it truly is. The corneal thickness needs to be factored in when deciding what the real eye pressure is inside the eye.

Another important consideration in preventing blindness from glaucoma is patient compliance. Since there are almost no symptoms from open angle glaucoma until the end-stage of the disease, many people get complacent and do not use their glaucoma medications until it is time for their eye appointment. If patients are compliant with their treatment and keep their eye appointments, most people will not lose their vision from glaucoma. If you have glaucoma or at risk of developing glaucoma, the eye doctor will have you return for eye appointments every 3 to 6 months depending of your particular situation. They will perform many of the tests described in the article.

Glaucoma Test Graphs and Charts

The most common eye tests for glaucoma are eye pressure, corneal thickness, OCT, visual field, and examination of the optic nerve. These will usually be performed on a yearly basis scattered throughout the year.

If your glaucoma is not controlled with medications, a SLT laser can lower the eye pressure. If the eye pressure is still not controlled an MP3 laser may be indicated. If none of these treatments are able to lower the eye pressure, a trabeculectomy or shunt may be needed. If you are having cataract surgery, discuss with your eye surgeon about one of the MIGS being performed during the cataract surgery. There are many options available to treat glaucoma today. Educate yourself and ask questions when you see your eye doctor about the status of your glaucoma.

You do not have to lose your vision from glaucoma. You need to follow your eye doctor’s recommendations, stay compliant with your medications, keep your eye appointments, and if there is any question about your treatment seek a second opinion.