Glaucoma Diagnosis and Treatment
Diagnosis
Your health care provider will review your medical history and conduct a comprehensive eye examination. Your provider may perform several tests, including:
- Measuring intraocular pressure, also called tonometry
- Testing for optic nerve damage with a dilated eye examination and imaging tests
- Checking for areas of vision loss, also known as a visual field test
- Measuring corneal thickness with an exam called pachymetry
- Inspecting the drainage angle, also known as gonioscopy
Treatment
The damage caused by glaucoma can't be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially if you catch the disease in its early stages.
Glaucoma is treated by lowering intraocular pressure. Treatment options include prescription eye drops, oral medicines, laser treatment, surgery or a combination of approaches.
Eyedrops
Glaucoma treatment often starts with prescription eye drops. Some may decrease eye pressure by improving how fluid drains from your eye. Others decrease the amount of fluid your eye makes. Depending on how low your eye pressure needs to be, you may be prescribed more than one eye drop.
Prescription eye drop medicines include:
- Prostaglandins. These increase the outflow of the fluid in your eye, helping to reduce eye pressure.
- Beta blockers. These reduce the production of fluid in your eye, helping to lower eye pressure.
- Alpha-adrenergic agonists. These reduce the production of the fluid that flows throughout the inside of your eye. They also increase the outflow of fluid in your eye.
- Carbonic anhydrase inhibitors. These medicines reduce the production of fluid in your eye.
- Rho kinase inhibitor. This medicine lowers eye pressure by suppressing the rho kinase enzymes responsible for fluid increase.
- Miotic or cholinergic agents. These increase the outflow of fluid from your eye.
Because some of the eye drop medicine is absorbed into your bloodstream, you may experience some side effects unrelated to your eyes. To minimize this absorption, close your eyes for 1 to 2 minutes after putting the drops in. You also may press lightly at the corner of your eyes near your nose to close the tear duct for 1 or 2 minutes. Wipe off any unused drops from your eyelid.
You may have been prescribed multiple eye drops or need to use artificial tears. Make sure you wait at least five minutes in between using different drops.
Oral medications
Eye drops alone may not bring your eye pressure down to the desired level. So your eye doctor may also prescribe oral medicine. This medicine is usually a carbonic anhydrase inhibitor.
Surgery and other therapies
Other treatment options include laser therapy and surgery. The following techniques may help to drain fluid within the eye and lower eye pressure:
- Laser therapy. Laser trabeculoplasty is an option if you can't tolerate eye drops.
- Filtering surgery. This is a surgical procedure called a trabeculectomy.
- Drainage tubes. In this procedure, the eye surgeon inserts a small tube in your eye to drain excess fluid to lower eye pressure.
- Minimally invasive glaucoma surgery (MIGS). Your eye doctor may suggest a MIGS procedure to lower your eye pressure.
After your procedure, you'll need to see your eye doctor for follow-up exams. And you may eventually need to undergo additional procedures if your eye pressure begins to rise or other changes occur in your eye.
Treating acute angle-closure glaucoma
Acute angle-closure glaucoma is a medical emergency. If you're diagnosed with this condition, you'll need urgent treatment to reduce the pressure in your eye. This generally will require treatment with medicine and laser or surgical procedures.
You may have a procedure called a laser peripheral iridotomy. The doctor creates a small hole in your iris using a laser. This allows fluid to flow through the iris. This helps to open the drainage angle of the eye and relieves eye pressure.
Lifestyle and home remedies
These tips may help you control high eye pressure or promote eye health.
- Eat a healthy diet. Several vitamins and nutrients are important to eye health.
- Exercise safely. Regular exercise may reduce eye pressure.
- Limit your caffeine. Drinking beverages with large amounts of caffeine may increase your eye pressure.
- Sip fluids carefully. Drink moderate amounts of fluids.
- Take prescribed medicine. Using your eye drops or other medicines as prescribed can help you get the best possible result from your treatment.
Alternative medicine
Some alternative medicine approaches may help your overall health, but none is an effective glaucoma remedy. Talk with your doctor about their possible benefits and risks.
- Herbal remedies. Some herbal supplements, such as bilberry extract, have been advertised as glaucoma remedies.
- Relaxation techniques. Stress may trigger an attack of acute angle-closure glaucoma.
- Marijuana. Research shows that marijuana lowers eye pressure in people with glaucoma, but only for 3 to 4 hours.
Coping and support
When you receive a diagnosis of glaucoma, you're potentially facing lifelong treatment, regular checkups and the possibility of progressive vision loss.
Meeting and talking with other people with glaucoma can be very helpful, and many support groups exist.
Preparing for your appointment
You may start by seeing your primary health care provider. Or you may be referred immediately to an eye specialist (ophthalmologist).
What you can do:
- When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:
- Your symptoms
- Key personal information
- All medications, vitamins or other supplements
- Questions to ask your doctor
Take a family or friend along, if possible, to help you remember the information you're given.
For glaucoma, some basic questions to ask include:
- What's likely causing my symptoms?
- Other than the most likely cause, what are other possible causes for my symptoms?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What's the best course of action?
- What are the alternatives to the primary approach you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there restrictions I need to follow?
- What other self-care measures might help me?
- What is the long-term outlook in my case?
- Should I see a specialist?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor:
Your doctor is likely to ask you several questions, such as:
- When did your symptoms begin?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?