NARROW ANGLE GLAUCOMA

Definition

Closed or narrow angle glaucoma (NAG) is a very different manifestation of the disease. In acute NAG the patient can lose permanent vision very rapidly and can go completely blind in hours. This is one of the few true ocular emergencies in eye care. In NAG, the patient slowly loses optic nerve tissue due to the anatomy of the patient causing a mechanical reason for decreased outflow of intra-ocular fluid. These glaucoma sub-varieties are very serious and typically fast in their progression.

Work-up

Work-up for NAG patients need to have careful history, especially of eye pain (could be sub-acute attacks), headaches and feelings of pressure and redness of the eye. This is in contrast to open angle glaucoma patients as these are not typical symptoms of that disease. Pupils also take on a more important role and measurement of angle openness performed by skilled technicians and doctors. Careful examination of the patients anatomy and optic nerve are needed for diagnosis.

Testing

NAG testing is no different than other glaucoma patients except that the depth and appearance of the anterior chamber becomes much more important in the evaluation and management of the case. Due to this fact, gonioscopy is done more often at the doctor’s discretion.

Treatment

NAG glaucoma is treated much differently than open angle glaucoma.  Laser peripheral iridotomy takes primary role here, with other treatments sometimes being needed in mixed mechanism cases. This treatment is easily performed in office at Newsom Eye as we have medical lasers on site for quick and effective management.

Gonioscopy:This is an important test where a mirrored, handheld device is used by the doctor to look at the drainage channel in the patient’s eye. 3 mirror gonioscopy lens and a view inside the eye
Visual Field:This is required to analyze and document the peripheral vision of the patient. Peripheral vision is what glaucoma damages over time. Humphrey Visual Field
Photos of the Optic Nerve: Glaucoma damages the optic nerve, therefore pictures are taken to watch for changes in this important tissue. Digital Retina Camera
Optical Coherence Tomography (OCT): Perhaps the most important and technologically advanced instrument available for glaucoma, this instrument provides an optical analysis of the nerve with stunning accuracy. Zeiss OCT instrument and scan
Serial Tonometry: Intraocular pressure, or the pressure in the eye, varies throughout the day and is a critical measurement in glaucoma.  Multiple pressure measurements are necessary to record the variation and help understand this condition. Pressure test
Pachymetry: This is a newer test that standardizes the pressure reading for patients by measuring the thickness of their cornea. Corneal Pachymetry