At Pepose Vision Institute, we know that the best glaucoma patient is an informed glaucoma patient. Our patients are encouraged to carefully review the information provided about glaucoma diagnosis and treatment options. Please understand that it is your PVI SURGEON who is ultimately responsible for deciding which treatment plan is right for you. We will not settle for anything less than preserving and protecting your vision to the highest degree possible.
To help you learn more about glaucoma diagnosis and treatment, we have developed a list of the answers to questions most commonly asked by our patients. We look forward to answering any additional questions you may have during your office visit or laser procedure.
"Dr. Pepose's skill is surpassed only by his compassion and dedication to his fellow man." -- Sandra K. Purcell
1. What is glaucoma? Glaucoma is a permanent loss of side vision caused by damage to the optic nerve. It is often caused by pressure buildup in the eye, but can also be triggered by other factors. The Glaucoma Research Foundation estimates that more than 3 million Americans have glaucoma, but only half of these people know they have it. Approximately 120,000 people go blind from glaucoma each year, accounting for 9-12 percent of all new cases of blindness in the United States.
Glaucoma is the second leading cause of blindness and the first leading cause of preventable blindness. There are two major types of glaucoma: open angle and closed angle. The most common type - open angle glaucoma - occurs when the eye's drainage canal becomes clogged over time, leading to a decrease in fluid drainage and an increase in intraocular pressure. It may also be the result of a sustained increase in fluid production.
Consistently high intraocular pressure reduces blood flow to the optic nerve, over time destroying the optic nerve fibers and compromising peripheral (side) vision.
Back to Top 2. How do I know if I have glaucoma or am at risk for it? The best way to protect yourself from loss of vision due to glaucoma is to have annual eye exams with an eye care professional who has the most advanced testing technology to detect glaucoma at its earliest stages. Glaucoma usually has no signs or symptoms until serious vision loss occurs. Risk factors for glaucoma include:
1) Diabetes
2) High degree of nearsightedness
3) Family history of glaucoma
4) African-American descent
5) High blood pressure
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6) Elevated ocular pressure
7) High degree of farsightedness
8) Previous eye injury
9) Prolonged steroid use
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In recognition of the importance of early detection and management of glaucoma, Medicare and most private insurers offer coverage for annual glaucoma screenings. For patients that have been diagnosed with glaucoma, they should schedule an eye exam every 3 to 4 months, since there is no way to determine whether glaucoma is under control based on the way they feel.
Back to Top 3. How is glaucoma detected? Are the tests uncomfortable? The current "gold standard" for detecting increased eye pressure, a known risk factor for the development of glaucoma, uses a device that touches the eye. The pressure required for the tip of this instrument to flatten the cornea is recorded. However, it is known that some patients with apparently normal pressures recorded with this device still go on to develop glaucoma; others with high pressure readings never develop it.
Pepose Vision Institute is one of the few centers in the U.S. chosen to evaluate the Ocular Response Analyzer (ORA), developed by Reichert Instruments, as a potentially more sensitive and accurate approach to measuring eye pressure. Not only does this Analyzer offer a potential breakthrough in detecting glaucoma in those patients with truly elevated eye pressure, but it can likewise save millions of dollars in pharmacy costs for patients that actually have normal eye pressure but have been measured improperly using current measurement techniques.
In addition to the ORA, Pepose Vision Institute uses the innovative NERVE FIBER ANALYZER (NFA) to perform a quick, thorough, noninvasive test for early signs of glaucoma. The NFA can detect nerve fiber loss and early onset glaucoma years before older testing methods. Don't settle for anything less than an NFA test to monitor the health of your eyes! The NFA test allows for early intervention treatment options, before glaucoma has compromised your vision.
Utilizing a unique combination of polarized light and scanning laser ophthalmoscopy, the NFA rapidly scans the retina and measures the thickness of the nerve fiber layer. The results reveal whether a patient is within/outside normal limits or borderline with respect to clinical indications for early glaucoma. This test does not require the patient's eyes to be dilated. There are no bright flashes of light, no pain or discomfort. It is recommended for patients with pre-existing early stage glaucoma, or any patient considered at risk for glaucoma.
Back to Top 4. Can previous eye surgery for example, vision correction surgery affect my eye pressure? Research studies, including those performed by the doctors at Pepose Vision Institute, have demonstrated that the measurement of eye pressure not the actual eye pressure itself can be affected by surgery that changes a patient's corneal thickness. The degree of measurement error will depend upon the technology that is used to measure your eye pressure. PVI is one of the few centers in the U.S. chosen to evaluate the Ocular Response Analyzer (ORA), developed by Reichert Instruments, as a potentially more accurate approach to measuring eye pressure, irrespective of changes in corneal thickness, thereby detecting glaucoma in those patients with truly elevated eye pressure.
If you have had laser vision correction, or have naturally changing corneal thickness due to a chronic condition such as keratoconus, it is crucial that your eye pressure be monitored by a cornea subspecialist who has experience in differentiating between real increases in eye pressure and simple measurement error. PVI is one of only a handful of eye centers in the country that has conducted clinical research related to this measurement issue. Our cornea subspecialty trained physicians have substantial experience dealing with vision correction patients and other patients with corneal conditions in order to accurately measure and monitor true eye pressure.
Back to Top 5. If I am found to have glaucoma, how will it be treated? Generally, eye drops can be prescribed to help lower the pressure in the eye. These drops must be used daily to have optimal effect, and continued for the rest of your life. It is not uncommon to be prescribed more than one type of drop to be used at the same time.
Back to Top 6. What are the side effects of using a daily eye drop to control my glaucoma? Are there any alternatives to this treatment? Unfortunately, eye drops that control glaucoma can have such side effects as headaches, effects on the heart, asthma and decreased libido. Moreover, there can be a substantial financial side effect in terms of the cost of these drops if you do not have comprehensive prescription drug insurance coverage and are required to take more than one type of drop.
For patients who are on many drops or do not have an optimal response to the drops, a new "cold laser" in-office treatment (Selective Laser Trabeculoplasty) may be used to decrease the intraocular pressure in patients with chronic open angle glaucoma. Oftentimes, this procedure can eliminate the need for one or more of the eye drop medications. Pepose Vision Institute is one of the first eye practices in the bi-state area to offer SLT to its patients.
Back to Top 7. I've heard about laser treatments for glaucoma. What does this entail? Is there only one type of laser used? The traditional laser treatment for open angle glaucoma (OAG) applied an argon laser to burn tissue to create tiny, evenly spaced openings in the eye's trabecular meshwork to improve the draining of eye fluid. Unfortunately, the heat generated by this procedure often results in scarring around these openings, limiting its success and/or ability to retreat the eye in the future should the treatment need to be repeated.
Pepose Vision Institute is one of the first eye practices in the bi-state area to offer the advanced, FDA-approved "cold laser" in an in-office procedure referred to as Selective Laser Trabeculoplasty (SLT). Instead of burning tissue, SLT selectively treats only specific cells to stimulate increased fluid drainage. SLT produces equivalent drops in eye pressure as earlier laser methods, yet it results in less tissue damage, thereby avoiding adverse scarring effects. For this reason, SLT can be repeated throughout a patient's life when clinically indicated. Moreover, it is often found to be successful when traditional laser methods fail to appreciably reduce eye pressure.
Back to Top 8. How is this laser treatment performed? Is it painful? Selective Laser Trabeculoplasty (SLT) is performed in our office and only takes about 20-25 minutes. Prior to the procedure, you will be given eye drops that will numb your eye and prepare it for treatment. You should plan to be at our office for two (2) hours on the day of treatment, giving us sufficient time to optimize your treatment plan.
Back to Top 9. Will I see an immediate drop in my eye pressure after my laser treatment? Your eye pressure should drop substantially as quickly as a day or more after having SLT. You may be told to use an anti-inflammatory drop for up to a week after the procedure to prevent discomfort, and must return for follow-up visits to re-check the treated eye.
Back to Top 10. Are there any complications associated with laser treatment for glaucoma? Because SLT does not burn tissue like earlier laser treatments for glaucoma, no tissue scarring results. Temporary complications that have been reported include inflammation and conjunctivitis. Of course, any technology, in inexperienced hands, can result in adverse outcomes. At Pepose Vision Institute, we have had extensive experience performing SLT. Most importantly, we are available 24/7, 365 days a year should you have any concerns prior to, or after, your treatment.
Back to Top 11. Will my insurance cover laser treatments for glaucoma? Virtually all health insurance providers, including Medicare, view laser treatment for glaucoma as a functional surgery, meaning that it is necessary to preserve sight. For this reason, SLT is covered in the same fashion as other surgical procedures. The staff of Pepose Vision Institute will work with your insurance company to ensure that you are pre-certified for treatment, should this be a requirement of coverage.
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