Diagnosis & Treatment of Glaucoma at The Eye Care & Surgery Center in New Jersey

Diagnosis of Glaucoma
The best way to maintain eye health and preserve your vision is to have regular and complete eye examinations with the appropriate level of diagnostic testing for glaucoma as recommended by the Ophthalmologists at The Eye Care & Surgery Center in New Jersey. During your examination, our eye doctors and staff may perform a number of tests in order to make the most accurate diagnosis of Glaucoma. These include the following testing procedures:

The Tonometry Test is a method of measuring your Intraocular Pressure (IOP). This test involves first placing some eye drops into your eyes to numb them and then lightly touching the surface of the cornea with a specialized measuring instrument. There is no discomfort involved. The test is quick and gives the eye physicians the first piece of important information in determining whether you have glaucoma.

Ophthalmoscopy is a method of carefully examining the inside of the eye-especially the optic nerve-in order to detect glaucoma. Some eye drops will be placed in your eyes in order to dilate your pupils so that the doctors can make a clear and direct observation of the optic nerve. The examination will take place in a darkened room using different types of ophthalmoscopes in order to examine the shape and color of your optic nerve.

If either the Intraocular Pressure (IOP) is elevated or the optic nerve appears unusual, additional tests will be necessary in order to complete the glaucoma examination. These may include the following test procedures:

Visual Field Perimetry
Perimetry or Visual Field testing is an important part of the glaucoma examination. During this test you will be asked to sit in front of a large “bowl like” instrument and look directly straight ahead. A computer program will present a number of lights in different positions of their “side” or peripheral vision to see how sensitive your side vision is in various directions. The computer will then plot an actual map of the field of vision so that your doctor can interpret this map in conjunction with other examination tests in order to understand how well the optic nerve is functioning. Glaucoma usually affects your side vision before your central vision, so visual field testing can often show any problems from glaucoma before you can notice them.

Gonioscopy is a quick and painless test that allows the doctors to directly observe the health and condition of the angle where the iris meets the cornea. By directly observing the angle and its status your eye doctor will be know more about whether you are at risk for the angle to become closed or whether the Trabecular Meshwork appears to have a normal anatomical structure.

Optic Nerve Computer Imaging
At The Eye Care & Surgery Center, we use the most advanced computer imaging technology in order to make the earliest and most accurate diagnosis of glaucoma. The doctors at The Eyecare & Surgery Center use OCT or Optical Coherence Tomography, a method that is capable of creating digital images through the use of special beams of light in order to create a contour map of the optic nerve and measure the retinal nerve fiber thickness. In many regards this is similar to the CT Scans used to study organ systems and tissues throughout your body. The goal of OCT Optic Nerve Computer Imaging is to give our eye doctors the ability to detect the slightest loss of optic nerve fibers, at the first possible moment, in order to diagnose glaucoma at the earliest possible stage in order to stop the progression of the disease and preserve your vision. These tests are also useful in monitoring for the possibility of progression by comparing tests over time. We perform OCT Optic Nerve Computer Imaging right in the comfort and convenience of our office at The Eye Care & Surgery Center.

Pachymetry Measurement of Corneal Thickness
The National Eye Institute of the National Institutes of Health released a key study in 2002, called the Ocular Hypertension Study (OHTS). In this study an important finding was made regarding corneal thickness and its role in Intraocular Pressure and the development of Glaucoma. The OHTS study found that corneal thickness is important because it can alter the accuracy of the measurement of Intraocular Pressure, potentially causing doctors to treat you for a condition that may not actually exist or to treat you unnecessarily when you are normal. Your actual Intraocular Pressure may be UNDERESTIMATED if you have thin corneas and it may be OVERESTIMATED if you have thicker corneas. In addition, it appears that patients with thin corneas may be inherently more likely to develop glaucoma apart from its influence on the measurement of intraocular pressure. During a glaucoma examination, your doctor or a staff member may perform a Pachymetry Test to measure your corneal thickness as part of your examination and consider this finding in conjunction with the other glaucoma testing in order to make the most accurate diagnosis. The Pachymetry Test is a simple, quick and painless way of accurately measuring your corneal thickness that we do right in our office. The test is performed by first placing some drops in your eyes to make them numb and then lightly touching the cornea with a “pencil like” probe that uses sound waves to precisely measure your corneal thickness.

Treatment of Glaucoma
There are three main methods that our doctors can use to treat Glaucoma: Medical Treatment of Glaucoma, Laser Treatment of Glaucoma and Surgical Treatment of Glaucoma.

These treatment options for controlling glaucoma are quite important, as glaucoma has no cure. The good news is that in almost all cases, glaucoma is treatable, but must be diagnosed as early as possible. Thanks to advances in the medical, laser and surgical treatment of glaucoma your doctor will be able to recommend an individual treatment plan that is best for each patient.
The following information is limited to treatment of Primary Open Angle Glaucoma, as it is the most common type of Glaucoma. Primary Open Angle Glaucoma is treated by the three different approaches above depending on the severity of the disease and the ability of each treatment option to slow or halt the disease progression and preserve vision.

Medical Treatment of Glaucoma
Primary Open Angle Glaucoma is most often treated with eye drops. There are many types of eye drops that can be prescribed to lower Intraocular Pressure (IOP). By using a single type of medication or sometimes 2 eye drops in combination, more than 80% of the patients with Open Angle Glaucoma can be successfully treated. These eye drops work by either decreasing the amount of fluid being produced inside your eye or by increasing the rate of drainage of fluid from your eye. For most patients, by using the eye drops as prescribed-1-2 times per day it is possible to control the Intraocular Pressure (IOP) and slow or even halt the loss of vision.

Unfortunately, some patients are unable to achieve adequate control with eye drops alone, or may experience intolerable side effects from the eye drops, and require laser treatment for glaucoma in order to maintain control.

Laser Treatment of Glaucoma
Our eye physicians and surgeons have found that the use of laser treatment for glaucoma has become an important treatment option for many patients and may in fact be useful as a primary treatment along with eye drops. In the past, laser eye surgery for glaucoma was considered a “last resort” before glaucoma Surgery. Today, thanks to advances in lasers, using a laser treatment for glaucoma in conjunction with the eye drop treatment or sometimes even using the laser treatment as the primary treatment, are excellent options to help maintain control and slow or stop the progression of the disease. Laser treatment for glaucoma is regularly used to help prevent vision loss and is becoming a glaucoma treatment of choice for many patients who have problems with eye drops or are unable to use eye drops properly.

Argon Laser Trabeculoplasty (ALT) is one type of glaucoma laser treatment that helps to reduce the Intraocular Pressure (IOP) by creating more effective drainage of fluid through the Trabecular Meshwork. Unfortunately, the effect of ALT decreases over time for some patients, rendering it ineffective. This is limiting, as ALT cannot usually be repeated. Another type of laser treatment for glaucoma that our eye doctors can use is called Selective Laser Trabeculoplasty (SLT). SLT may offer advantages over ALT for some patients in that should the effect decrease over time, SLT can be repeated several times in order to control the pressure and slow or halt the progression of the disease. SLT has become an important treatment option not only for glaucoma patients who are unable to use eye drops and obtain control, but as a primary treatment to help glaucoma patients avoid needing to use eye drops altogether.

For patients who have glaucoma and are having cataract surgery, it may be possible to treat your glaucoma during cataract surgery using a laser procedure called "Endocylcophotocoagulation"-or "ECP", sometimes called EndoLaser. ECP allows the cataract surgeon to place a very tiny fiber optic probe through the same incision that is used to remove the cataract. Through the fiber optic probe, the surgeon delivers gentle laser energy to the internal structures of the eye-called ciliary processes-that are responsible for producing the eye's fluid. By reducing the amount fluid being produced inside the eye it is often possible to reduce the Intraocular Pressure (IOP) resulting in patients being able to reduce their glaucoma eye drops and medication and sometimes even eliminate them totally. It has been reported that 80% of patients having ECP experience a dramatic reduction in IOP and one in four can actually stop using eye drops. If you have glaucoma and are in need of cataract surgery, ECP may be suggested as part of your cataract surgery. In cases of severe glaucoma, one can also use the diode laser for a treatment called cyclophotocoagulation. By treating the ciliary processes with laser, similar to the ECP procedure, the inflow of aqueous can be reduced. Unlike the ECP, this procedure is done externally without any incisions and the ciliary processes are not directly visualized.

Surgical Treatment of Glaucoma
Another new innovation is the iStent bypass device which is used at time of cataract surgery either with or without ECP. Similar to a cardiac bypass stent, the iStent, bypasses the obstruction from the trabecular meshwork to help reduce the IOP by increasing the outflow.

For a small number of patients, even with the maximum medical therapy with glaucoma eye drops and laser eye surgery, it is still not possible to achieve good stable control of their disease and stop the progression of vision loss. For these patients our glaucoma specialists can perform a number of surgical procedures to help achieve control of the Intraocular Pressure (IOP) and help to slow or stop the progression of the disease. These include removing a tiny piece of the Trabecular Meshwork, a surgical procedure called “Trabeculectomy”, “Sclerostomy” or “Filtering Procedure”, or even implanting a shunt such as the ExPRESS Mini Shunt to help reduce and stabilize the Intraocular Pressure (IOP) and prevent vision loss.

Another surgical treatment of glaucoma involves the implantation of a tube shunt into the eye to help drain the fluid. The Baerveldt valve is commonly used and gives good results in a properly selected group of patients.

If you or someone you know would like to learn more about the diagnosis and treatment of glaucoma or needs an appointment for a glaucoma eye exam, please call The Eye Care & Surgery Center at 908-789-8999 to schedule an appointment.