How would I know if I have glaucoma?

• Most patients will have no symptoms or warnings.
• Your optometrists usually screen your eyes when you go for glasses.
• If they have any suspicion, you will be referred to an ophthalmologist.
• Early glaucoma is very hard to detect and may take a few visits to confirm.
• The key to diagnosis is measuring changes over time.
• Anyone over 40 should have an annual eye check and a baseline nerve scan or Optical Coherence Tomography (OCT).
• Acute angle-closure glaucoma is the most sudden and dangerous type.
• You may experience:
  • Gradual blurring of vision.
  • Rainbow-coloured halos around lights.
  • Sudden severe eye pain and redness.
  • Severe headache.
  • Nausea and vomiting.
• This requires urgent medical attention from either your ophthalmologist or The Royal Victorian Eye and Ear Hospital.

How is glaucoma detected?

• The diagnosis and management of glaucoma will be made by ophthalmologist following a comprehensive eye examination and review which includes:
  • Visual acuity testing.
  • Visual field testing (measuring the extent to which each eye can see on either side).
  • Tonometry (checking eye pressure).
  • Gonioscopy (checking angles in your eye).
  • Optic nerve and macular scans (OCT).
  • Retinal photography (taking photos of the back of the eyes).
• Sometimes an MRI to rule out other neurological conditions.

How is glaucoma treated?

The treatment options for glaucoma depend on the type of glaucoma, degree of optic nerve damage, eye pressure, age, current medical history, the presence of other eye problems and how well you can handle specific medicines or procedures.

Medical treatment:

• Pressure-lowering eye drops are the most common form of treatment.
• Some drops cause the eye to make less fluid, while others lower pressure by increasing fluid drainage from the eye.
• Compliance with the eye drop regime is important in ensuring success of medical therapy.

Laser treatment:

• Selective laser trabeculoplasty (SLT):
  • Lower the eye pressure by using gentle laser energy to clean the filter system.
  • Can be used as a first-line treatment for early glaucoma.
  • Can also be used to reduce the need for eye drops or in combination with eye drops, which alone may not be adequate.
  • Extremely safe with almost no risk of loss of vision.
• Laser peripheral iridotomy (PI):
  • Used for narrow angle or acute angle closure glaucoma.
  • Creates a small passage in the iris, bypassing the obstructed angle.
  • Can also be used in Pigment Dispersion Syndrome (PDS) to prevent further shedding of pigment cells from the iris.
• Cyclodiode:
  • High destructive energy applied onto ciliary bodies.
  • Aim to shut down eye fluid production. (Requires local anaesthetic injection around the orbit.)
  • Can be painful.
  • Reserved only for patients with very high retractable IOP or end stage glaucoma.

Surgical treatment:

• Indicated if medical/laser therapy fails to control glaucoma progression.
• The purpose of the surgery is to create a new drainage point for the eye fluid.
• Three types of drainage operation:
  • Minimally Invasive Glaucoma Surgery (MIGS)
  • Trabeculectomy
  • Tube implantation

Is Glaucoma vision loss irreversible?

• Yes. The loss of vision is permanent.
• Early detection, early proactive intervention and regular checkups will prevent visual loss from glaucoma.