Definition and Overview
Patients who are suspected of having glaucoma are encouraged to consult an optometrist to obtain a diagnosis and if needed, treatment for their condition. This is the first step to obtaining professional care to control the disease, slow its progression, and prevent vision loss.
Glaucoma can present in many different types of eye diseases, all of which involve some degree of optic nerve damage resulting in vision loss. It is a progressive condition that gets worse over time especially when not diagnosed in time and left untreated.
Who Should Undergo and Expected Results
Glaucoma, a group of eye conditions brought about by the buildup of pressure in the optic nerve leading to damage, is a serious eye disease that can result in blindness. It can be either acute, wherein it develops suddenly and progresses rapidly, or chronic, wherein it occurs slowly.
A glaucoma consultation can benefit any person who is suffering from any of the different types of the disease, which include:
Open-angle glaucoma – Also known as primary glaucoma, this is the most common type of the disease, occurring in up to 90% of all recorded cases. It is linked to clogs in the eye’s drainage canals leading to increased pressure inside the eyes. Although this is a slowly progressing type, it can affect a patient throughout his life.
Angle-closure glaucoma – This is a rapidly progressing type of glaucoma that causes highly noticeable symptoms. It is caused by intraocular pressure and causes a closed or narrow angle between the cornea and the iris. Angle closure cases need to be treated at the soonest possible time.
Congenital glaucoma – This affects newborn babies and occurs when the drainage canals in their eyes do not develop completely or properly inside the womb.
Normal tension glaucoma – This is a type of glaucoma wherein, although eye pressure is not very high, the optic nerve becomes damaged for some reason. In many cases, the exact cause is unknown.
A glaucoma consultation can also help diagnose even the rarer types of the disease, such as:
- Pigmentary glaucoma
- Traumatic glaucoma
- Neovascular glaucoma
- Pseudoexfoliative glaucoma
- Iridocorneal endothelial syndrome
- Uveitic glaucoma
If a person has not been diagnosed with the disease but is experiencing some or many of its telltale symptoms, a consultation will serve as the first step to receiving a diagnosis and, later on, treatment. The symptoms of glaucoma include:
- Blurred or hazy vision
- Rainbow-colored circles surrounding bright lights
- Severe eye pain
- Severe headaches
- Sudden vision loss (partial or complete)
At the end of a glaucoma consultation, the patient should have a clear diagnosis and a list of all his possible treatment options, so he can make the right decision regarding his condition. When conducted during the early stages of the condition, the consultation can help control the progression of the disease, preventing the patient from totally losing his vision.
How the Procedure Works
A glaucoma consultation takes place in an optometrist’s clinic or office. Depending on whether the consultation will include an eye exam, it can last between one to two hours. The consultation will begin with the doctor checking the patient’s eye care record and asking about the latter’s symptoms. If the symptoms are those that are linked to glaucoma, the optometrist will perform additional tests to rule out other possible causes before making a diagnosis.
If there is equipment available, the optometrist may ask the patient to undergo a consultation exam on the same day. This is a more comprehensive type of eye exam specifically designed to detect glaucoma or signs of it. The exam typically involves:
- Pachymetry, which measures the thickness of the cornea’s central part
- Gonioscopy, which examines the eye’s drainage system
- Visual field test, which determines whether the patient’s peripheral vision loss has already been affected and, if so, up to what extent, so that the stage of the disease can be determined
- Fundus photography, or when the optic nerve is captured in photos for future reference
- Tonometry, which measures the pressure inside the eye
- Optical coherence tomography or OCT, which is a new imaging technology
- Heidelberg retinal tomography imaging, which is a new laser-based imaging scan that can detect glaucoma
To ensure the accuracy of the consultation, patients should provide complete and accurate information about their eye health, overall medical state, and medications they are taking. Patients should also bring with them all eyeglasses and contact lenses that they are currently using.
Possible Risks and Complications
A glaucoma consultation typically involves a comprehensive eye exam, which does not only detect the disease but also determines the most appropriate course of treatment for the patient, depending on the nature and severity of damage involved.
This exam, which involves several different tests and scans, does come with certain risks, not least of which has to do with the effects of the medication used to make the eyes dilate. Also known as dilating eye drops, the medication can cause the eyes to become dilated for approximately 4 hours. Its effects eventually wear off, but for people with light-colored eyes, the effects can last up to 24 hours. The eye drops are not painful to use, but may cause the following side effects or risks:
- Eye sting
- Blurry vision
- Light sensitivity
- Allergic reaction
- Lid swelling
- Red eyes
- Dry mouth
- Facial flushing
- Rapid heartbeat
The use of dilating eye drops has also been associated with esotropia or eye crossing. In rare instances, the drops can cause esotropia to occur; however, more commonly, the drops cause an existing esotropia case to worsen.
Thus, optometrists exercise caution in performing tests that require dilating eye drops. In fact, in all cases, the risks and benefits of these eye drops are carefully evaluated and weighed before they are even suggested to the patient.
Mandelcorn E, Gupta N. Lens-related glaucomas. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 3, chap 54A.
Saheb H, Ahmed II. Micro-invasive glaucoma surgery: current perspectives and future directions. Curr Opin Ophthalmol. 2012 Mar;23(2):96-104. PMID: 22249233 www.ncbi.nlm.nih.gov/pubmed/22249233.