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If you have a problem, our caring staff will take the time to explain the various treatment options. We'll help guide your decision process by answering any questions or concerns. Our expert staff can help correct vision problems for a happier, healthier life.
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Glaucoma
Glaucoma may take many forms, but the most common form, the type you hear most about, is Primary Open Angle Glaucoma. This form of glaucoma has NO SYMPTOMS. It develops slowly over several years or even over decades. People who got POAG started out without glaucoma, passed through a period in which they may have glaucoma, and then entered a period in which glaucoma would be easily recognized by an eye doctor. By that time vision has become threatened. If no treatment is begun there will be gradual and progressive loss of vision, until in the end there will be complete and irreversible blindness. These days medications to treat glaucoma are quite effective in most cases. Not that POAG can be cured, but that it can be controlled. The problem is that glaucoma medications must be taken forever. So that at this time in this country blindness from glaucoma is a personal choice. You may choose to take your medicine, or you may choose to go blind instead. My job as an eye doctor who treats glaucoma is to see to it that my patients live out their entire lives without going blind. This is not such an easy task. Remember, I have to convince a person who has absolutely no symptoms that they have to put drops in their eyes every day for the rest of their lives, or face the possibility of blindness.
Let’s take a look at the process which is POAG. Light enters the eye through the pupil and is focused on the retina in the back of the eye. The retina is a very complex structure which receives the image and changes the light energy into electricity. Millions of microscopic fibers, like tiny wires, carry the electrified image. They converge on the optic nerve head, and bundle up into a cable called the optic nerve. The optic nerve carries the image to the brain, where it is integrated with all kinds of other information from memory, experience, other senses, etc. and the visual image you see is created. If we over simplify, we can think of glaucoma as a disease of the optic nerve. Without the Optic Nerve, the brain gets no messages from the eyes. Remember the optic nerve is composed of millions of fibers. Glaucoma is the gradual death of those fibers. Each fiber represents only a tiny bit of information from the light that entered the eye, and there is a lot of built in redundancy, so in order to be able to measure any loss of vision, a lot of nerve fibers have to be lost. Nerve fibers can never grow back. So once they are lost they are gone forever. We can now define glaucoma as a gradual and progressive loss of fibers from the optic nerve, and somehow that loss is related to the intra ocular pressure (IOP).
The eyeball is filled up with fluid. That fluid is always being produced by glands inside the eyeball, and it is always being drained out. A little goes in at a time, and a little goes out. As the years go by, sometimes the drain slows down. Just like adding air to the tires on your car raises the pressure in the tire, adding fluid to the inside of your eye raises the pressure in your eyes. When the pressure gets a little too high, optic nerve fibers start to get squeezed out. So when the IOP gets too high, you start to lose optic nerve fibers. The eye drops we use to treat glaucoma reduce the IOP and slow down the loss of fibers from the optic nerve. We used to think that IOP of less than 21 is normal. IOP greater than 21 was deemed reason enough to start treatment. Now we know that normal IOP is different for different people.
Everyone has a unique appearance to their optic nerves, like fingerprints. That appearance does not change over time unless something goes wrong. Glaucoma causes very specific changes in the appearance of the optic nerves. Those changes are gradual and progressive just like glaucoma itself. One of the ways of identifying glaucoma is to recognize that a person’s optic nerve has changed. If glaucoma is suspected, the optic nerves are imaged with photographs or other imaging devices, and the nerves are monitored for change over time.
Another way to diagnose and/or monitor POAG is with a visual field test. This is a computerized map of how sensitive your vision is at various places in your periphery. Again, glaucoma causes gradually worsening characteristic losses in the field of vision, until there is no vision left. I have always been surprised to find that people can lose a great deal of field and not even know that there is anything wrong.
When a new patient enters my office, I am always concerned about the possibility of glaucoma. I know how the optic nerves look now, but I don’t know how they looked 5 years ago. If the nerves look a little funny, have they always been that way? If IOP’s are borderline I start to look more carefully at family history, since POAG tends to run in families. Race has to be considered since blacks tend to have significantly higher rates of glaucoma. Maybe I should check the visual field, take photos of the optic nerves or do other tests to satisfy myself that there is no glaucoma. If I have been seeing this patient for years, I have records to check. Has there been any change?
Advanced glaucoma is fairly easy to diagnose. The IOP is unusually high, the optic nerves have little tissue left, and the visual field has large and characteristic defects. The difficult task is to diagnose POAG early enough to prevent any loss of vision, and then to convince the individual to comply with the treatment over a period of many years. This is one of the tasks to which I have dedicated my professional life.
We accept MEDICARE, MEDICAID, VSP, UFT and most private medical insurance.
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