Alamo Optometry Blog

January 6, 2010


Filed under: Educational — Tags: — admin @ 11:41 pm

(As appeared in Alamo Today, January 2010, pg. 27)

Since I have had a few cases recently of glaucoma, I believe a discussion on the disease itself and its treatment is needed. There seems to be a lot of confusion and misinformation regarding this sight-threatening disease.

First of all, let’s talk about the definition of glaucoma. Glaucoma is a group of diseases that slowly kills your optic nerve and is a leading cause of blindness in the world. The typical age of onset is late 60’s and later, and affects about 4% of the population. The exact cause of glaucoma is not known at this time. However, the end-stage result of glaucoma is blindness, since the optic nerve is the wiring connection between your retina and brain. Glaucoma usually develops when the pressure in the eye becomes elevated. This can usually happen when too much fluid is produced, or the drainage channels in the eye do not drain the fluid properly. However, a patient does not have to have high pressures to have glaucoma. Up until recently, glaucoma used to be a completely pressure-dependent disease. Studies have now shown that not to be the case. Unfortunately, the exact etiology still eludes us.

One of the big problems with glaucoma is that it is a “silent” killer; it does not bring you into the office. It does not give you a headache, blur your vision, make your eye red, etc., like the normal conditions that bring you in for an eye exam. I tell my patients that when you can start to appreciate some peripheral vision loss, you are already about 75% of the way to full progression of the disease. Therefore, annual exams are extremely important for early detection because we can only stretch out the course of the disease, not cure it.

The difficulty with glaucoma is that the diagnosis is usually not definitive. Most patients I see are initially labeled as “glaucoma suspects”, pending further tests. When the diagnosis is not evident, we try to elicit some personal and family history that can help sway the verdict one way or the other. Information such as age, ethnicity, family history of glaucoma, personal history of diabetes, hypertension, or heart disease can be instrumental in assessing a patient. Glaucoma is more common as we age and has a strong genetic component. African-Americans have a higher incidence of glaucoma; however, the exact reason is unknown. In addition, if a patient has any condition that is vascular (related to blood vessels) in origin such as diabetes and hypertension, they would need to be followed more closely if they are suspected of having glaucoma.

If you are sent to the glaucoma specialist for an evaluation, he or she will run specific tests on your optic nerve, retina, visual field, and they will also measure the thickness of your cornea, which has been shown to be a contributing factor in glaucoma. If a diagnosis of glaucoma is determined, drops to lower and control your pressures are usually prescribed. Since glaucoma is a chronic disease, it is imperative to know for sure if you have glaucoma, because you will be treated and monitored for the rest of your life. Frequent visits to help monitor the progression will occur several times a year. It is also paramount for patients to continue to take their drops. Since patients initially do not experience any visual symptoms, non-compliance with treatment is high because the patient otherwise feels and sees fine.

As described above, glaucoma is a disease that is difficult to diagnose and continue to treat because of the long-term care needed for the patient. At your annual exams, we will measure your pressures and assess eye health including the optic nerves to determine the likelihood of glaucoma. I always recommend to my patients that if some uncertainty exists regarding glaucoma, to get a consult at the specialist. I definitely prefer a conservative approach and have a full evaluation and determine that there is no disease versus waiting several years to have a consult and you have progressed in that time frame without any treatment.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at:

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