Definition

An open angle glaucoma (OAG) patient is no longer a suspect, but has been diagnosed with an incurable disease that has damaged their optic nerve. The open angle description means that the angle of the eye is open and that the angle is not contributing to the status of the disease. Again, much like other chronic disease like high blood pressure or diabetes OAG is incurable and requires chronic management.

Work-up

The work-up for a patient with open angle glaucoma requires interval testing that allows the doctor to monitor for progression of disease. Usually the patient is seen three to four times a year for pressure evaluation and interval tests that allow the doctors at Newsom Eye to appropriately intervene with treatment if the patient is not doing as planned.

Testing

The amount of glaucoma testing varies to some extent with the severity of the disease, but usually is performed on an annual basis. Each test gives us a different piece of information on how the patient is doing.

Gonioscopy is usually used on the first few visits to look where the fluid drains from the eye. Most patients have abnormal anatomy revealing a key to treatment.

Optic nerve photography also is an important tool providing photographic evidence of what the patient’s optic nerve looks like at any particular moment.

HRT or Optical Coherence Tomorography are the modern technologies that Newsom Eye uses to laser scan the nerve fiber layer of the optic nerve. This not only analyzes against a database
for disease, but also stores the findings for future reference to detect even the slightest progression of the disease.

Pachymetry is used to measure the central corneal thickness which is an important data point of reference for glaucoma risk.

Treatment

Open angle glaucoma is treated in one of three ways; medically, with laser or with surgery. Typically, less risky options such as SLT and medication are used before the jump to filtration, shunts or valves. It is the doctor’s duty to choose the course of action and follow through with it to stabilize the patient. Endocyclophotocoagulation or ECP is a laser procedure usually performed simultaneously with cataract surgery.

SLT Treatment

Selective Laser Trabeculoplasty (SLT) is a clinically proven treatment that can help to lower the intraocular pressure (IOP) in patients with glaucoma, most commonly, open-angle glaucoma. The SLT laser works by appling laser energy to the drainage system of the eye, causing a greater outflow of fluid, which in turn lowers the eye pressure. The effects of SLT treatment can take 1-3 months for optimal results to appear. This is procedure is usually covered by insurance.

To begin the treatment, your Newsom Eye doctor will numb your eye before applying the SLT laser. Typically, he or she will only treat one eye at a time. Most patients experience little to no discomfort during the treatment. The procedure itself only takes a few minutes to perform, although the entire experience might take 1-2 hours for pre and post-op observation.

Although many patients can have their IOP controlled with the SLT laser treatment, some patients still require drops. However, most patients substantially reduce the amount of glaucoma drops required to control their IOP.

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