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 cause have no signs or symptoms, so patients will not know that they have it, at least until the very end stage of glaucoma when the patient is nearly blind from it already. 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.
However, it’s not so simple to diagnose. It’s like high blood pressure. One reading doesn’t give you the full picture. We have more advanced testing to determine conclusively if the patient does have glaucoma or not.
There are many different types of glaucomas. The most common kind presents with normal pressure in the eyes. However, there are some patient’s that will register higher than normal pressure in the eye. This all needs to be investigated. There are other patients that, during a regular eye exam, we see other structures at the front of the eye and they can present in such a way that we may think the patient is at risk for a special kind of glaucoma called an “angle closure” glaucoma.
There are many different areas of the eye that we look at, to give us clues in terms of what everyone’s risk is for glaucoma. Sometimes it’s a very black and white presentation. The doctor can look at these three factors and see that all of those things are negative, and very much in the clear and that the probability of this patient having glaucoma is close to zero right now.
Then there are cases where it may not be so clear to us. For instance, we see the patients’ pressures are normal, but we have an optic nerve that looks unusual. This could be normal for that patient, it could be glaucoma, or it could be another disease process.
The next step would be to speak with the patient about further testing and diagnosis. This is now a gray area. 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? Is this normal for this patient or is there indeed a problem. If it is a problem, then we need to decide, what is this? Is this caused by glaucoma? If so, which kind of glaucoma is it? It is a complex process to arrive at a conclusion of “this is glaucoma”.
Therefore, you 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.