Glaucoma Diagnosis & Treatment at Baltimore Washington Eye Center serving greater Baltimore & Washington, D.C.

Diagnosis of Glaucoma

The best way to maintain eye health and preserve your vision is to have regular and complete eye examinations with the appropriate level of diagnostic testing for Glaucoma as recommended by the eye doctors at Baltimore Washington Eye Center. During your examination, our eye doctors and the staff may perform a number of tests in order to make the most accurate diagnosis of Glaucoma. These include the following testing procedures:

Tonometry
The Tonometry Test is a method of measuring your Intraocular Pressure (IOP). This test involves first placing some eye drops into your eyes to numb them and then lightly touching the surface of the Cornea with a specialized measuring instrument. There is no discomfort involved. The test is quick and gives the eye physicians the first piece of important information in determining whether you have Glaucoma.



Ophthalmoscopy
Ophthalmoscopy is a method of carefully examining the inside of the eye-especially the optic nerve-in order to detect Glaucoma. Some eye drops will be placed in your eyes in order to dilate your pupils so that the doctors can make a clear and direct observation of the optic nerve. The examination will take place in a darkened room using different types of Ophthalmoscopes in order to examine the shape and color of your optic nerve.

If either the Intraocular Pressure (IOP) is elevated or the optic nerve appears unusual, additional tests will be necessary in order to complete the Glaucoma examination. These may include the following test procedures:


Visual Field Perimetry
Perimetry or Visual Field testing is an important part of the Glaucoma examination. During this test you will be asked to sit in front of a large “bowl-like” instrument and look directly straight ahead. A computer program will present a number of lights at different points of your “side” or peripheral vision to see how sensitive your side vision is in various directions. The computer will then plot an actual map of the field of vision so that your doctor can interpret this map in conjunction with other examination tests in order to understand how well the optic nerve is functioning. Glaucoma usually affects your side vision before your central vision, so visual field testing can often show any problems from glaucoma before you can notice them.



Gonioscopy
Gonioscopy is a quick and painless test that allows the doctors to directly observe the health and condition of the angle where the Iris meets the Cornea. By directly observing the angle and its status your eye doctor will know more about whether you are at risk for the angle to become closed or whether the Trabecular Meshwork appears to have a normal anatomical structure.



Optic Nerve Computer Imaging
At Baltimore Washington Eye Center, we use the most advanced computer imaging technology in order to make the earliest and most accurate diagnosis of Glaucoma. Our Optic Nerve Computer Imaging system is called OCT or Ocular Coherence Tomography. The OCT uses a method called “optical coherence tomography” that is capable of creating digital images through the use of special beams of light in order to create a contour map of the optic nerve and measure the retinal nerve fiber thickness. In many regards this is similar to the CT Scans used to study organ systems and tissues throughout your body. 

The goal of OCT Optic Nerve Computer Imaging is to give our eye doctors the ability to detect the slightest loss of optic nerve fibers, at the first possible moment, in order to diagnose Glaucoma at the earliest possible stage in order to stop the progession of the disease and preserve your vision.

We perform OCT Optic Nerve Computer Imaging right in the comfort and convenience of our office at Baltimore Washington Eye Center.



Pachymetry Measurement of Corneal Thickness
The National Eye Institute of the National Institutes of Health released a key study in 2002, called the Ocular Hypertension Study (OHTS). In this study, an important finding was made regarding corneal thickness and its role in Intraocular Pressure and the development of Glaucoma.

The OHTS study found that corneal thickness is important because it can alter the accuracy of the measurement of Intraocular Pressure, potentially causing doctors to treat you for a condition that may not actually exist.  In other words, to treat you unnecessarily when you are normal. Your actual Intraocular Pressure may be UNDERESTIMATED if you have thin corneas and it may be OVERESTIMATED if you have thicker corneas.

During a Glaucoma examination, your doctor or a staff member may perform a Pachymetry Test to measure your corneal thickness as part of your examination and consider this finding in conjunction with the other Glaucoma testing in order to make the most accurate diagnosis.

The Pachymetry Test is a simple, quick and painless way of accurately measuring your coneal thickness that we do right in our office. The test is performed by first placing some drops in your eyes to make them numb and then lighty touching the cornea with a “pencil like” probe that uses sound waves to precisely measure your corneal thickness.

Treatment of Glaucoma

There are three main methods that our doctors can use to treat Glaucoma: Medical Treatment of Glaucoma, Laser Treatment of Glaucoma and Surgical Treatment of Glaucoma.

These treatment options for controlling Glaucoma are quite important, as Glaucoma has no cure. The good news is that in almost all cases, Glaucoma is treatable, but must be diagnosed as early as possible. Thanks to advances in Medical Treatment for Glaucoma, Laser Treatment for Glaucoma and Surgery for Glaucoma, your doctor will be able to recommend an individual treatment plan that is best for each patient.

The following information is limited to treatment of Primary Open Angle Glaucoma, as it is the most common type of Glaucoma. Primary Open Angle Glaucoma is treated by the three different approaches above depending on the severity of the disease and the ability of each treatment option to slow or halt the disease progression and preserve vision.

• Medical Treatment of Glaucoma
  Primary Open Angle Glaucoma is most often treated with eye drops. There are many types of eye drops that can be prescribed to lower Intraocular Pressure (IOP). By using a single type of medication or sometimes 2 eye drops in combination, more than 80% of the patients with Open Angle Glaucoma can be successfully treated. These eye drops work by either decreasing the amount of fluid being produced inside your eye or by increasing the rate of drainage of fluid from your eye. For most patients, by using the eye drops as prescribed-1-2 times per day it is possible to control the Intraocular Pressure (IOP) and slow or even halt the loss of vision.
  
  Unfortunately, some patients may experience side effects of these eye drops making the use of eye drops a poor treatment option. Also, some patients are unable to achieve adequate control with eye drops alone and require Laser Treatment for Glaucoma in addition to the eye drops in order to maintain control.
  
  
• Laser Treatment of Glaucoma
  Our eye physicians and surgeons have found that the use of Laser Treatment for Glaucoma has become an important treatment option for many patients. In the past, Laser Eye Surgery for Glaucoma was considered a “last resort” before Glaucoma Surgery. Today, thanks to advances in lasers, using a laser treatment for Glaucoma in conjunction with the eye drop treatment or sometimes even using the Laser Treatment as the primary treatment, are excellent options to help maintain control and slow or stop the progression of the disease. Laser Treatment for Glaucoma is regularly used to help prevent vision loss and is becoming a Glaucoma treatment of choice for many patients who have problems with eye drops or are unable to use eye drops properly.
  
  Argon Laser Trabeculoplasty (ALT) is a type of glaucoma laser treatment that helps to reduce the Intraocular Pressure (IOP) by creating more effective drainage of fluid through the Trabecular Meshwork. Unfortunately, for some patients, the effect of ALT decreases over time, rendering it ineffective. This is limiting, as ALT cannot usually be repeated.
  
  Another type of Laser Treatment for Glaucoma that our eye doctors can use is called Selective Laser Trabeculoplasty (SLT). SLT may offer advantages over ALT for some patients in that should the effect decrease over time, SLT can be repeated several times in order to control the pressure and slow or halt the progression of the disease. SLT has promise in becoming an important treatment option not only for Glaucoma patients who are unable to use eye drops and obtain control, but as a primary treatment to help Glaucoma patients avoid needing to use eye drops altogether.
  
  We routinely perform all types of Laser Eye Surgery for Glaucoma. If Laser Treatment is the best option to help control Glaucoma, our physicians and staff will spend the time necessary to explain the risks and benefits so that our patients fully understand their treatment options.

Surgical Treatment of Glaucoma
For a small number of patients, even with the maximum medical therapy they can achieve with Glaucoma eye drops and Laser Eye Surgery, it is still not possible to achieve good stable control of their disease and stop the progression of vision loss.

For these patients it is possible perform a number of surgical procedures to help achieve control of the Intraocular Pressure (IOP) and help to slow or stop the progression of the disease. These include removing a tiny piece of the Trabecular Meshwork, a surgical procedure called “Trabeculectomy”, “Sclerostomy” or “Filtering Procedure”, or even implanting a microscopic Glaucoma Valve to help reduce and stabilize the Intraocular Pressure (IOP) and prevent vision loss.

Glaucoma is a very complex eye disease, and not simply an elevated Intraocular Pressure (IOP). Nonetheless, when detected early it can be successfully treated.

Patients wishing to learn more about the Diagnosis and Treatment of Glaucoma in the greater Baltimore or Washington, D.C area will find that Baltimore Washington Eye Center is conveniently located for those coming from Arbutus, Carney, Clarksville, Columbia, Dundalk, Edgemere, Essex, Ellicott City, Ferndale, Glen Burnie, Kenwood, Laurel, Linthicum, Lutherville, Millersville, Odenton Owings Mills, Reisterstown, Towson, Parkville, Randallstown, Rivera Beach, Pasadena, Severna Park, South Gate, and Woodlawn Maryland. To schedule an appointment for a Glaucoma consultation or examination please call us at 800.495.3937.