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Treatment And Management Of Glaucoma
20/20 Optometry - In San Ramon & San Mateo, CA



Glaucoma is an umbrella term for eye conditions which cause a loss of vision by damaging the optic nerve, usually caused by excess fluid pressure within the eye. Glaucoma is a leading cause of blindness for people over 60 years old, and can also inflict younger people with a family history of the disease. Because people with glaucoma usually do not display any symptoms in the early stages, it is often not detected until it is in a moderate to severe stage. Regular eye exams are essential for early detection and prevention of optic nerve damage and blindness.

Dr. Kawai says “the first line of treatment for all patients is an eye drop regimen, which is usually pretty effective at reducing eye pressure and thereby reducing glaucoma-related damage to the optic nerve. We monitor patients with glaucoma closely to make sure we’re seeing improvement or stabilization of the disease.” For more severe stages of the disease, laser or conventional surgery by a specialist can prevent further loss of vision.

Glaucoma Evaluation:

About glaucoma…

Our doctors are trained to detect, diagnose, and treat glaucoma. Glaucoma is a “silent” eye disease that can cause complete blindness to the eyes. It is estimated that over 66 million people worldwide have glaucoma, with approximately 6.7 million people suffering from vision blindness. Glaucoma is the leading cause of blindness in African-Americans. African-Americans are 6 times more likely to develop glaucoma than Caucasians.

Glaucoma is an eye disease in which vision loss is caused by damage to the optic nerve. The optic nerve serves as a cable that connects all the visual information from the eye to the brain. It was once believed that high eye pressure within the eye, intraocular pressure (IOP), was the main cause for glaucoma. However, it is now known that many people with normal IOP can still develop glaucoma.

Symptoms of vision loss are not apparent in the early stages of glaucoma, which is why having your eyes checked yearly is vital in the early detection of glaucoma. By the time a person notices some loss of vision, there is already considerable damage to the eye. Most of the vision loss due to glaucoma is irreversible. The vision loss generally affects the peripheral vision first and then attacks the central vision as the disease progresses.

Presently, there is no cure for glaucoma. However, the treatments available are effective and can slow down or prevent further vision loss. The treatments include using eye drops to help decrease the pressure of the eye or surgical intervention.

Risk factors for glaucoma:

  1. Family history of glaucoma
  2. High IOP
  3. African-American decent
  4. Over the age of 45
  5. Diabetes
  6. Myopia
  7. Previous eye injury
  8. Regular, long term steroid use
  9. Corneal thickness < 0.5mm

Glaucoma exam

If a patient is suspected to have glaucoma or a patient has glaucoma, the doctors will recommend a separate glaucoma evaluation beyond the tests performed during a comprehensive examination. It is vital to establish a good baseline of data to properly diagnose and treat glaucoma. These tests may include procedures such as gonioscopy, serial tonometry, threshold visual field testing, nerve fiber layer and retinal analysis.

The intraocular pressure (IOP) is measured on all of our patients during the comprehensive examinations. The IOP is measured many times during the diagnosis and treatment of glaucoma. It is important to determine a baseline of what a person’s normal range of IOP level is so that we can determine how effective the treatment is by comparing the new IOP level to the old one. Visual field testing is also performed to determine if there is any existing vision loss or new vision loss.

Visual field testing

We perform a visual field screening test on all of our patients. This test measures peripheral vision (side to side vision) and allows us to confirm if all the information is connected between the eyes and the brain. Anything affecting this function will cause the visual field to be abnormal. Eye diseases such as glaucoma will cause visual field defects in the testing, which shows the optometrist which area of peripheral vision is reduced in sensitivity.

If a person does not pass the screening test, a more detailed threshold visual field testing is performed. This type of field test quantifies various points of a person’s visual field to allow the eye doctor to determine what areas have decreased sensitivity or no sensitivity at all. People that are considered legally blind may not be able to perform the test or if they can perform it, the results will show that they have reduced vision.

Other problems such as pituitary tumors, head injuries, and strokes can show different patterns of field defects. These tests can diagnose health problems that a patient may be completely unaware of. If the results are abnormal, the optometrist may refer the patient to the general practitioner or other specialist for additional testing to diagnose what the problem may be.

So the different eye tests do not just test out problems in the eye, it can help detect early signs of general health problems too. This is why it is important to get the eyes checked yearly.

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