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How is glaucoma diagnosed? [ 08/30/13 ]

Individuals at high risk for glaucoma should have a dilated-pupil eye examination at least every two years. Eye doctors use several tests to detect glaucoma:

Tonometry measures the pressure inside the eye. Examples of tonometers include:

  • The air-puff (noncontact) tonometer, which emits a puff of air. Eye pressure is measured by the eye's resistance to the air.
  • The applanation tonometer, which touches the eye's surface after the eye has been numbed and measures the amount of pressure necessary to flatten the cornea. This is the most sensitive tonometer, but a clear, regularly-shaped cornea is needed for it to function properly.
  • The electronic indentation method, which measures pressure by directly contacting anesthetized eyes with a digital pen-like instrument.

In pupil dilation, special drops temporarily enlarge the pupil so the doctor can better view the inside of the eye. Various instruments allow the doctor to determine the thickness of the cornea, to view the front and/or the interior of the eye, and to monitor optic nerve changes over time.

Visual field testing measures the entire area seen by the forward-looking eye to document straight-ahead (central) and/or side (peripheral) vision.

A visual acuity test uses an eye chart to measure sight at various distances.

Are there different forms of glaucoma? [ 08/30/13 ]

There are two main forms of glaucoma: open-angle (the most common form, affecting approximately 70-95% of individuals); and angle-closure. There are also several other forms of glaucoma, including normal-tension, congenital, juvenile, and secondary.

Open-angle glaucoma, the most common form of the disease, is progressive and characterized by optic nerve damage. The most significant risk factor for the development and advancement of this form is high eye pressure. Initially, there are usually no symptoms, but as eye pressure gradually builds, at some point the optic nerve is impaired and peripheral vision is lost. Without treatment, an individual can become totally blind.

Angle-closure glaucoma may be acute or chronic. In acute angle-closure glaucoma, the normal flow of eye fluid (aqueous humor) between the iris and the lens is suddenly blocked. Symptoms may include severe pain, nausea, vomiting, blurred vision, and seeing a rainbow halo around lights. Acute angle-closure glaucoma is a medical emergency and must be treated immediately, or blindness could result in one or two days. Chronic angle-closure glaucoma progresses more slowly and can damage the eye without symptoms, similar to open-angle glaucoma.

Normal-tension glaucoma occurs when eye pressure is normal, yet the optic nerve is damaged and peripheral vision is lost. Lowering eye pressure through medication sometimes slows the progress of the disease, but this type of glaucoma may worsen despite low pressure. The treatment is generally the same as for open-angle glaucoma.

Congenital glaucoma affects infants born with defects that prevent the normal drainage of fluid from the eye.

Juvenile glaucoma is open-angle glaucoma that affects children, adolescents and young adults.

Secondary glaucoma can be open-angle or closed-angle and is the result of some other medical condition in the eye or the body.

What is considered normal eye pressure? [ 08/30/13 ]

Unfortunately, the answer is not any single number. While the average eye pressure is approximately 15, the range of normal eye pressure is much larger. About 90 percent of people will fall between a pressure of 10 and 21. Even so, this does not mean that if you have a pressure of 22 or higher it is abnormal. Every individual and every eye is different. There are many patients with pressures in the mid-20s who do not have glaucoma, and they can be followed with routine eye examinations by their eye care specialist. There are also patients who have been diagnosed with glaucoma and yet, even though treatment may decrease their pressure below 22, they still experience worsening of their glaucoma.

It is important that you see an eye care specialist to receive a thorough examination and determine if your eye pressure is problematic.

Can glaucoma be cured by laser techniques? [ 08/30/13 ]

Laser surgery can aid in controlling the symptoms of glaucoma, but no treatments currently available will cure the disease. Several forms of laser surgery can help fluid drain from the eye or decrease the amount of fluid produced. These techniques support the maintenance of normal eye pressure and minimize the risk of further damage to the optic nerve.

What is glaucoma? [ 08/30/13 ]

Glaucoma is actually a group of eye diseases that lead to damage of the optic nerve (the bundle of nerve fibers that carries information from the eye to the brain), which can then lead to vision loss and possibly blindness. Optic nerve damage usually occurs in the presence of high eye (intraocular) pressure; however, it can occur with normal or even less than normal eye pressure. More than three million Americans are living with glaucoma, 2.7 million of whom—aged 40 and older—are affected by its most common form, open-angle glaucoma. Some studies have shown that perhaps half of people living with glaucoma aren't even aware they have the disease. Worldwide, an estimated 66.8 million people are visually impaired due to glaucoma, and an estimated 6.7 million are blind.

How do eye doctors document optic nerve damage? [ 08/30/13 ]

When a patient has glaucoma or is at high risk for developing the disease, physicians may document changes over time in the optic nerve through imaging techniques including stereo optic nerve photographs, scanning laser polarimetry (GDx), confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph or HRT II) and optical coherence tomography (OCT). An eye care professional will determine which method(s) to use.

What new research is being done to find a cure for glaucoma? [ 08/30/13 ]

New research is focused on lowering pressure inside the eye, and finding medications to protect and preserve the optic nerve from the damage that causes vision loss. Scientists are also investigating the role of genetics in glaucoma, and over the last few years their understanding of this factor has progressed. Researchers have discovered genes associated with congenital glaucoma, juvenile glaucoma, normal-tension glaucoma, adult-onset open-angle glaucoma, pigmentary glaucoma and other conditions related to secondary glaucoma.

Where can I find more information about glaucoma? [ 08/30/13 ]

The BrightFocus National Glaucoma Research website goes into greater depth on many topics and covers additional areas of concern, both medical and social. You can learn where to get help and access to resources, as well as download free publications. And explore our Ask an Expert section where you can read or post queries to doctors. For more information dealing with the topics below, please visit the helpful organizations section of our website.

  • Clinical Trials
  • Organizations of Eye-care Professionals
  • Federal Government Programs and Services
  • General Information, Resources and Referrals
  • Legal Assistance
  • Low Vision Aid Resources
  • Low Vision Organizations
  • Print and Audio Materials for the Visually Impaired
  • Senior Housing
  • State and Local Resources
Can you have glaucoma without having increased pressure inside the eye? [ 08/30/13 ]

Elevated eye pressure increases the risk of developing glaucoma; however, the disease can occur in people with normal or even lower-than-normal eye pressure. It is optic nerve damage that can lead to vision loss and possible blindness. In many people, fluid pressure increases inside the eye and damages the optic nerve (the bundle of nerve fibers that carries information from the eye to the brain). In addition, individuals with higher-than-normal eye pressure do not always develop the symptoms of glaucoma.

Since normal-tension glaucoma does not involve high eye pressure, it is diagnosed by observing the optic nerve for any signs of damage. The eye doctor will use an ophthalmoscope to look through the pupil at the shape and color of the optic nerve. In addition, a visual field test can help determine if there is any loss of peripheral vision. The risk factors for developing normal-tension glaucoma include a family history of glaucoma, low eye pressure, and cardiovascular disease. Ongoing research is aimed at determining all of the factors that contribute to the optic nerve damage. For example, scientists believe the optic nerve may be affected by blood flow in the eye. Researchers are also investigating susceptibility and genetic factors.

What resources are available to help people with glaucoma and their caregivers? [ 08/30/13 ]

There are a great many resources available to people with low vision and their caretakers. For instance, every state has an agency on aging. You may find it in the phone book, online, or with the help of a librarian or friend.

Professional low vision therapists at eye clinics or other organizations can assist you. Let your eye doctor know what kind of limitations you are experiencing due to vision loss. He or she can then refer you to a vision rehabilitation center, where a low vision therapist can work with you to help you adapt and resolve specific problems.

You can also modify your environment, use low vision aids, develop your senses of hearing and touch, and practice using peripheral vision. Your doctor can prescribe optical devices such as magnifiers. Many non-prescription magnifying glasses and devices are also available to assist with reading and other close work, such as sewing or model-building. These devices range from the simple and inexpensive to more expensive high-tech products that can aid in using computers and watching television.

Many styles of magnifiers, including discreet ones, can be found at drug stores, medical supply stores, or may be ordered online or by phone through low vision product catalogs. A hand-held magnifying glass can help with reading medicine bottle labels, mail, price tags in stores, and restaurant menus. Other magnifiers come in the form of eyeglasses or clip onto glasses to free your hands for other activities.

Commonly used household items with large numbers and letters, and others that "talk," are also available. There are many sources for large-print books and audio materials, as well as services that read newspapers and magazines by phone or over the radio.

Electronic reading aids are proliferating, such as: computer programs that magnify the computer screen and/or read screen text out loud; special scanners to carry while shopping that read out prices, sizes, and colors; web browser plug-ins; and smartphone applications. One specialized device can take pictures of signs or menus and read the words in the pictures aloud.

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Disclaimer: The information provided in this section is a public service of the BrightFocus Foundation, and should not in any way substitute for the advice of a qualified healthcare professional and is not intended to constitute medical advice. Although we take efforts to keep the medical information on our website updated, we cannot guarantee that the information on our website reflects the most up-to-date research. Please consult your physician for personalized medical advice; all medications and supplements should only be taken under medical supervision. The BrightFocus Foundation does not endorse any medical product or therapy.

Some of the content in this section is adapted from other sources, which are clearly identified within each individual item of information.

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