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Glaucoma – The Sneaky Thief of Vision

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We are speaking with Dr. Young of Cove Eyecare about Glaucoma. Dr. Young, can you please explain to us what glaucoma is?

Dr. Young: Glaucoma is a neurodegenerative disease which affects the optic nerve (which is the connection between the eye and the brain). How do I know if I have glaucoma?

Dr. Young: It is called the sneaky thief of vision, because there is not real way for people to tell on their own if they have it. Besides “angle closure” glaucoma, other glaucomas have no signs or symptoms, so patients will not know that they have it, at least not until the very end stage of glaucoma when the patient is nearly blind. Glaucoma is a disease which must be checked for during an eye examination. We may find during a routine eye exam that the patient has risk factors for glaucoma which need to be investigated, or we may find that the disease process is already active and needs to be treated.

Do you test for glaucoma during a regular eye exam?

Dr. Young: Yes. During a regular eye examination, we look for several different factors which can show symptoms of glaucoma.

We look at the optic nerve. That is the most important thing when we are trying to rule out the presence of glaucoma. Does the optic nerve look healthy? Does this optic nerve have an anatomy or appearance suggestive of the glaucoma process? Then we look at pressure readings that are taken inside the eye.

Glaucoma Eye DiagramHowever, it’s not so simple to diagnose. It’s like high blood pressure - one reading doesn’t give you the full picture, and we need to do more advanced testing to determine conclusively if the patient has glaucoma.

There are many different types of glaucomas, where the most common kind registers normal pressure in the eyes. However, there are some patients that will register higher than normal pressure in the eye, which requires further investigation. There are other patients that, during a regular eye exam, exhibit other structures at the front of the eye that suggests a risk for a special kind of glaucoma called an “angle closure” glaucoma.

There are many different areas of the eye that we look at in order to get clues for risk of Glaucoma. Sometimes it ca be a very black and white picture - the doctor will look at certain factors, see that all of them are negative, and conclude that the patient's risk for Glaucoma is minimal.

However, there are less conclusive cases where it may not be so clear to us.  For instance, we see that the patient's eye pressure is normal, but we the optic nerve that looks unusual. This could be normal for that patient, or it could be glaucoma, or it could be another disease.

The next step would be to speak with the patient about further testing and diagnosis. This is now a gray area because we don’t yet know if the patient has glaucoma. The odds are against it, but we do need to perform more tests to determine where the patient is at, what are their risk factors, why do things look this way, and whether this normal for this patient. And if we do believe it's Glaucoma, we then need to further decide what kind of Glaucoma it is.

You now see how crucial it truly is to safeguard your eyes and make sure to come in every 1-2 years for a complete eye exam.