I Know Glaucoma

Most patients with glaucoma don’t have any symptoms and can’t tell if it’s getting worse. It’s therefore vital to have regular eye check-ups.

At each visit an assessment will be made of three things

• Eye pressure
• The optic nerve appearance
• The visual field (how well your optic nerve is functioning)

It is important to assess how these three elements change over time – an accurate record of your care is therefore essential.

This lesson explains how regular eye checks can show if your glaucoma is getting worse and allow preventative action to be taken.

Eye pressure changes throughout the day. The ideal eye pressure is one at which the eye can function well and not be damaged. This lesson discusses why and how eye pressure is measured.

• There is no ideal eye pressure for everybody, each person has an individual “perfect pressure”
• People with thick corneas have higher measured pressures than people with thin corneas
• There are lots of different ways of measuring the eye pressure – it’s important to consistently use the same one

The drainage structures of they eye are damaged in glaucoma. They are found in the "angle".This is the angle formed between the cornea and the iris.

This lesson describes how these structures can be examined by applying a contact lens containing a mirror to the eye. This is called gonioscopy.

Examination of these structures can tell your eye doctor what type of glaucoma you have.

• Is it open or closed angle glaucoma?

Is your glaucoma caused by blockage of the drainage structures by

• New blood vessels?
• Pseudoexfoliation (Dandruff)?
• Pigment (bits that have fallen off the iris)?

Patients are often not aware that a bit of the visual field is missing because the brain fills in the blanks. The visual field test assesses how well the optic nerve is working and documents these missing bits of vision.

Regular field testing is the best way to show if glaucoma is getting worse over time. This lesson discusses why visual field testing is conducted and gives pointers about how to perform a good field test.

When you are doing your visual field test

• Make sure you are comfortable
• Blink normally during the test – it won’t alter the results
• If you need a rest you can pause the test at any time by holding down the button continuously
• Don’t worry if there are times when you are not aware of any lights as this is a normal part of the test

Pictures of the optic nerve head allow your eye doctor to see if your glaucoma is changing. There are several ways to take pictures of the optic nerve head and this lesson describes a few of them.

• Ideally the same method will be used on multiple occasions
• Your eye doctor will guide you as to how often this should occur
• If you are changing eye doctor try get copies of all your pictures and visual fields for your new eye doctor

There are many treatments for glaucoma all of which aim to reduce the intraocular pressure (eye pressure). This lesson gives an overview of the different types of treatment currently available.

Intraocular pressure can be reduced by

• Reducing the production of fluid in the eye
• Increasing the drainage of fluid from the eye

The right intraocular pressure has been achieved when no further visual field or vision loss occurs.

This “target” intraocular pressure is different for all patients and each patient should have an individual intraocular pressure “target” which can be achieved by using medicines, lasers or surgery.

Glaucoma is a chronic disease, it cannot be cured. Treatment is therefore a lifelong process.

This lesson discusses the three things your eye doctor needs to consider in order to provide you with appropriate treatment.

• The amount of visual field loss that you have
• Your intraocular pressure
• Your life expectancy

When you are first diagnosed the aim will be to reduce your eye pressure by 30%, a third

Your eye doctor will then monitor you closely to see if your glaucoma is getting worse slowly or quickly

If your glaucoma is getting worse quickly, at a rate that will result in severe visual impairment in your lifetime, your eye doctor may recommend more intensive treatment. This may either be more drops, laser treatment or a glaucoma operation.

This lesson explores the five different types of glaucoma medication (drops) and discusses why different medications may be recommended by your eye doctor.

• All eye drop treatments for glaucoma need to be taken long term
• More than one eye drop may be needed to get your eye pressure under control
• There are several combination drops that can reduce the number of drops that you need to apply per day
• Most drops are well tolerated but there can be side effects which can force you to stop taking a particular drop
• If you feel that your drops are causing problems ask your eye doctor for advice

This lesson describes how lasers can be a useful alternative treatment for glaucoma in some patients

Four types of laser are commonly used in glaucoma

• Laser iridotomy – to make a hole in the iris
• Laser iridoplasty – to shrink the iris and pull it away from the drainage structures
• Laser trabeculoplasty – to stimulate the trabecular meshwork
• Cyclodiode laser – to reduce aqueous production by the ciliary body

If eye drops fail to control your glaucoma you may require surgery. This lesson covers some of the different operations for glaucoma and discusses the most common operation ”trabeculectomy”.

When a trabeculectomy is performed a trap door is created to allow the fluid inside the eye to slowly drain away under a ”bleb”

• Most operations are performed using local anaesthesia and take about an hour to complete
• After surgery many visits are required while the eye is recovering
• Complications are possible but most patients have a successful outcome and are often able to stop taking drops

Putting in eye drops can be a challenge. This lesson gives some helpful tips including:

• Tips for remembering when to take your drops
• How to put in drops
• What order to put in drops
• Ways to reduce drop side effects
• What to do if you're having problems with your drops

Patient with glaucoma are often unaware that their peripheral vision has been damaged. This is because the brain tricks you and fills in the bits of the visual field that can't be seen.

Patients with glaucoma can be a danger to other road users when driving. This lesson covers the effects of glaucoma on vision and the legal requirements to drive if you have a diagnosis of glaucoma.

This lesson describes how glaucoma may run in families.

If you have a diagnosis of glaucoma close family members (father, mother, sisters, brothers, children) should seek eye testing when over the age of forty.

In the United Kingdom eye tests are free over the age of 40 for people with a family history of glaucoma.

It is important to know where to find reliable information about glaucoma. This lesson covers some of the places that you might look for further information.

• The International Glaucoma Association is one example: www.glaucoma-association.com

Patients can lose central or peripheral vision or both. Patients with glaucoma typically lose periferal vision first.

Low vision care is important because it can improve and make best use of the vision that is left. This lesson describes several low vision aids and strategies that can be used or learned to maximise the remaining vision.

If you’re having problems with your vision ask about referral for a low vision assessment.

If you've got any thoughts about how we could improve the course please do get in touch.

This course has been produced by a group of European eye doctors who are members of the European Glaucoma Panel. This lesson gives a brief introduction to the different members of the team.