Glaucoma: Putting the Pieces Together

Disclaimer:  I’ve retooled this post because it’s being published in the local newspaper – thus I’ve toned down the goofball humor; I know, I’m a sell-out.

Ask someone to name an eye disease and one of the answers you’ll hear the most is “glaucoma.”  Everyone’s heard of it, but not many are familiar with the complexity of the disease.  It used to be simple:  if you had an eye pressure above a specified reading, then you had glaucoma, end of story.  Those were the old days of eyecare, and in this age of evidence-based medicine, glaucoma has become more of a chimera than a pitbull.  Nowadays there are many more factors to consider when the diagnosis of glaucoma is explored; so, how exactly is it diagnosed?

First, eye pressure still plays a significant role, and that is why measuring eye pressure is an integral part of any routine eye examination.  Many people associate the feared “air-puff test” with measuring ocular pressure, but today there are a number of different ways to obtain this important reading.  And though ocular pressure is a large part of diagnosing glaucoma, it is not a definitive measure any longer.  That being said, it is unfortunately still the only factor that is treatable.

There was me, that is Alex, and my three droogs, that is Pete, Georgey, and Dr. Smith.

Also of consideration in diagnosing glaucoma is the appearance of the optic nerve.  After all, this is a disease which causes peripheral vision loss secondary to the destruction of nerve fibers.  If enough of these fibers are eliminated, observable changes will be exhibited in the optic nerve itself, which is sort of a bundle of all the nerve fibers of the eye.  Viewing the optic nerve after dilating the eyes  is another significant portion of an eye examination.

Looks like glaucoma is sticking its tongue out at you.

Yet a third piece of the glaucoma puzzle is an evaluation of a patient’s visual fields.  Optometrists and ophthalmologists utilize visual field analyzing technology to essentially map out what a person sees when they are viewing the world.  In glaucoma, telltale defects may appear in the visual field which are indicative that functional changes are occurring due to optic nerve damage.  Usually the results of the visual field test are correlated with the appearance of the optic nerve and thus a diagnosis of glaucoma can be made.

Example of a visual field test printout. And not a normal one.

Recently, more technological advances in eyecare have led to retinal imaging devices which can provide even more information as to changes in the nerve fiber layer of the eye.  Many times these imaging studies can detect glaucoma sooner than it takes for visual field defects to show up, making imaging an invaluable tool in the arsenal of eye doctors.  Once again, the results of this sort of testing must be compared with other findings of the eye examination to properly diagnose the disease.

If there is any good news about glaucoma, it’s that the disease is one of slow progression.  If diagnosed with glaucoma, you will not lose your vision overnight; however, it is likely you will be placed on medication indefinitely since the disease is not curable.  Topical pressure-lowering eyedrops are the mainstay of glaucoma treatment and can drastically slow the destruction of ocular nerve fibers.  Due to its insidious nature, glaucoma is a disease that makes it important for all people to have a regular eye examination.  With early detection, vision loss can be minimized.

End local newspaper section.

I hope that wasn’t too boring.  I find it hard to believe that anyone would read something like that in a newspaper.  Heck, does anyone read the newspaper, period?  I doubt it.  You know what newspapers lack?  Explosions.  People like explosions – like Arnold Schwarzenegger-style explosions.  If your newspaper was called The BOOM Gazette, I’d read it.