Montes Eye


See Better. Be Better.



glaucoma





Jorge A . Montes, MD, FACS



Glaucoma is a condition that damages the optic nerve through high pressures within the eye. If sufficient damage occurs, vision loss will become manifest.


To visualize where the damage occurs, we will review some basic anatomy as it pertains to glaucoma.



ANATOMY

As the eye's pressure rises, the tension surrounding the optic nerve increases. Sustained tension or compression of the optic nerve causes damage. When this occurs, a layer called the nerve fiber layer, which makes up the optic nerve, will get damaged and becomes less prominent. The loss of the nerve fiber layer will be evident in the eye as cupping.


Below is a set of pictures that portray normal optic nerves. Thereafter, I detail what the cup looks like and contrast that with cupping. I also include a normal visual field test that reflects no optic nerve damage.



NORMAL OPTIC NERVES



OPTIC NERVE AND THE CUP



NORMAL VISUAL FIELD TESTS



CAUSES AND RISK FACTORS

Although there are many glaucoma forms, most will lead to high eye pressure that damages the optic nerve. High eye pressure places strain around the optic nerve, and if not controlled, nerve damage will occur.


The most common risk factors are:

• High eye pressure

• Age over 40

• Family history of someone having glaucoma (genetics)

• African American, Hispanic, or Asian descent

• Thinning of the cornea

• Thinning of the optic nerve, or "Cupping"

• Trauma to the eye

• Myopia

• Diabetes




SYMPTOMS

There are no screening symptoms for glaucoma sensitive enough for people in early glaucoma. No symptom can accurately point to the diagnosis of glaucoma early on.



SIGNS

If there are no symptoms, then how do people get diagnosed with glaucoma? A thorough and complete eye exam can determine whether you are at risk for glaucoma or have glaucoma.


Signs that may point to glaucoma during your examination:

• High Intraocular Pressures

• Optic Nerve Damage, or Cupping



OPTIC NERVE CUPPING



Patients who have risk factors should complete a unique set of tests to evaluate for optic nerve damage. You will need treatment if you have enough optic nerve damage or mild optic nerve damage with vision loss.


We recommend treatment to decrease the risk of progression of optic nerve damage. No form of treatment can reverse any loss of vision that has already occurred.


Below is an example of photos and testing showing progression, from left to right.




Below is a cross-sectional view of the optic nerve showing an enlarging cup as the disease progresses. The enlargement of the cup is due to loss of the nerve fiber layer.



TREATMENT

Of all the risk factors mentioned above, the only modifiable risk factor is intraocular pressure. All glaucoma treatments revolve around lowering the intraocular pressure, whether it be drop therapy, surgical laser therapy (also known as Selective Laser Trabeculoplasty), or surgery. Your eye surgeon will determine which form of treatment is best for you.


Medications

There are many classes of medications, and they all have their unique benefits and risk profiles.


Each class of medication has a unique color to the top of the drop. This is helpful when visiting with your physician and did not bring your drops with you.


Surgical Laser Therapy (Selective Laser Trabeculoplasty)

SLT focuses treatment on specific pigmented tissue in the eye's drainage system, minimizing any collateral damage. It is as effective at lowering intraocular pressure as one of the better, if not, the best drop therapy available, the prostaglandin analogs. Its effect is minimized if other drops are already in use. SLT's effect can last from 1-5 years or more, but more than one session may be required to achieve lasting results. Additionally, SLT is considered a great first-line treatment option in certain types of glaucoma.


Surgery

Surgery is offered when medical and surgical laser therapy fails to lower the pressure sufficiently to halt the ongoing optic nerve damage. Surgical glaucoma options are evolving rapidly as increased technology develops various ways to perform these procedures with lasting effects. Given the wide variety of options available, your eye surgeon will present the best available option after a complete exam and discussion with you.



Education videos



Understanding Glaucoma



By: american academy of ophthalmology



An overview of glaucoma and its treatment options.



Patient Education Video: Treatment of Glaucoma with SLT Laser



By: lumenis



This video discusses glaucoma and how SLT can help control eye pressure



SLT TREATMENT



Video of SLT Treatment





DHR Health Eye Institute



4500 North 10th Street, Suite 100, McAllen, TX 78504
Phone: 956-362-2070
Fax: 956-362-2074