Also referred to as: High Eye Pressure

Glaucoma is a disorder associated with pressure in the eye, and is characterized by damage to the optic nerve, with consequent visual loss, initially peripheral, but potentially blinding if relentlessly progressive. Unfortunately, glaucoma is usually a disease in which the patient is entirely asymptomatic (without symptoms) until late in the disease. The disorder we refer to as glaucoma, is not a single disease, but rather a myriad of diseases with one final common insult, injury to the optic nerve.

There are many risk factors for glaucoma, and these must be taken into account in the management of patients with suspected or manifest glaucoma. The strongest risk factors include elevated intraocular (eye) pressure, family history of glaucoma, advanced age, and being of African-American descent. Other risk factors include cardiovascular disease (e.g., history of heart attack or stroke), diabetes mellitus (sugar diabetes), myopia (nearsightedness), high blood pressure, and migraine headache

Glaucoma is not usually diagnosed on the initial exam, In general, the diagnosis of glaucoma implies optic nerve injury and loss of peripheral vision. Patients with increased eye pressures only, are said to have "ocular hypertension," or possibly are referred to as "glaucoma suspects". On the initial evaluation, most ophthalmologists will obtain eye pressure readings and complete a dilated eye exam in which the optic nerve is carefully evaluated. An enlarged depression (called a "cup to disc ratio") in the optic nerve may be indicative of glaucoma. (The exact description of this and a number of other important variables are disregarded here for the sake of succinctness.)

If the ophthalmologist is concerned about the possibility of glaucoma, the patient is scheduled for a visual field test. . If peripheral vision deficits are found on the visual field test that are consistent with glaucoma, the patient will be informed and further evaluation scheduled or a treatment plan discussed. Many ophthalmologists recommend two or three baseline pressure readings prior to initiating treatment. This helps the ophthalmologist to gauge the pressure reduction once treatment has begun.

During one of the initial visits, the ophthalmologist will also evaluate the angle by gonioscopy of the eye to determine whether it is "open", "narrow", or "closed". The angle of the eye is the primary anatomical site where fluid egress from the eye occurs. This piece of information is used not only to define the two major categories of glaucoma, i.e., open angle glaucoma vs. closed (narrow) angle glaucoma, but is critical to the treatment plan.

For those patients diagnosed with glaucoma, a treatment and follow-up plan will be organized. The goal of glaucoma therapy is to preserve the patient's present level of vision, i.e., to prevent further peripheral, and sometimes central, vision loss. The treatment plan will vary widely depending on the type of glaucoma diagnosed, the degree to which the glaucoma has progressed, the patient's underlying risk factors, and many other variables which are beyond the scope of this brief overview. In general, medicine (both topical eye-drops and oral medications), laser procedures, and operative procedures are all utilized in attempt to preserve vision.