Glaucoma Risks,
Diagnosis, Types,
& Treatment

About Glaucoma

Glaucoma is a disease of the optic nerve that is most often associated with a high pressure inside the eye-Intraocular Pressure (IOP)-that damages the nerve and causes progressive loss of vision. In the United States there are more than three million people with glaucoma. The most common form, Primary Open Angle Glaucoma (POAG) begins without any symptoms or obvious loss of vision. With early detection, diagnosis & treatment, in the vast majority of cases, glaucoma vision loss can be controlled or prevented. It is critical to diagnose and treat glaucoma as early as possible through regular eye exams in order to prevent vision loss.

Glaucoma Risk Factors

There are a number of known health, ethnic, lifestyle and demographic factors that influence your risk of developing glaucoma, including:

  • High Intraocular Pressure-regardless of age anyone with high IOP is at risk
  • Age-Risk increases after the age of 40 and is 6 times greater if you are over 60.
  • Race-African-Americans have a six to eight fold increased risk for glaucoma.
  • Myopia-Severely nearsighted people have a higher risk of developing glaucoma.
  • Hypertension or High Blood Pressure
  • Diabetes
  • Family History-Any family history of glaucoma is considered a very significant risk factor, especially among siblings
  • Steroids-Taking steroid medication for allergies, asthma or arthritis
  • Early Menopause
  • Sleep Apnea
  • Thin Corneal Tissue
  • Eye Trauma
  • Smoking

Please be sure to tell us if you have one or more of these glaucoma risk factors when you come to Schefkind Eye Care for your eye exam.

Types of Glaucoma
Primary Open Angle Glaucoma (POAG) and Angle Closure Glaucoma are the two most common types of glaucoma we see at Schefkind Eye Care.

Primary Open Angle Glaucoma (POAG) is the most common type of glaucoma whereby the production and/or drainage of fluid inside the front of the eye-called aqueous humor-is imbalanced, resulting in an elevation in eye pressure (IOP). This pressure deprives the optic nerve of oxygen and nutrients causing irreversible changes and damage, which if left untreated results in vision loss and ultimately blindness.

Angle Closure Glaucoma accounts for about 10% of all cases of glaucoma and about 2/3 of these produce no symptoms for patients.

closed angle glaucoma

Acute Angle Closure Glaucoma is one of the only types of glaucoma that produces distinct symptoms that include pain, light sensitivity, redness, blurred vision, colored haloes around lights and nausea or vomiting. Acute Angle Closure Glaucoma is considered a medical emergency. If you experience a sudden onset of pain, redness, blurred vision, light sensitivity, haloes around lights, nausea and vomiting, please call Schefkind Eye Care at (703) 997-9710 and relay these symptoms to the staff member so that you can be given an appointment immediately. In the event that you are at risk for Angle Closure Glaucoma or in the event that you have Acute Angle Closure Glaucoma we may initially prescribe some medication to begin to lower the pressure but will also perform a type of in office glaucoma laser procedure called Laser Peripheral Iridotomy (LPI) to produce a small opening or hole in the Iris so that Aqueous Humor can drain from the eye more effectively. Fortunately these treatments are very effective at quickly lowering the pressure and preserving vision.

Glaucoma Eye Exams & Diagnosis

During your routine eye exam or as part of a special glaucoma testing visit, we may perform a number of tests in order to be able to provide early detection and make the most accurate diagnosis of glaucoma. These may include the following:

  • Tonometry-Intraocular Pressure (IOP) measurement.
  • Ophthalmoscopy-Examination of the optic nerve through a dilated pupil which may be performed using special instruments or a high magnification lens at the Slit Lamp Biomicroscope.
  • Visual Field Perimetry-A computerized examination to plot an actual map of the field of your vision.
  • Gonioscopy-Direct examination of the drainage structures of your eye called “trabecular meshwork”-using a specialized contact lens at the Slit Lamp Biomicroscope.
  • Computerized Imaging of Optic Nerve & Fibers-OCT uses a method called “optical coherence tomography” to create digital images with beams of light to examine the optic nerve and measure the retinal nerve fiber thickness.
  • Pachymetry Measurement of Corneal Thickness

From this testing we will be able to make a diagnosis and recommendations for additional visits and treatment as required. They will be sure to answer all questions you may have and help you understand how we will work together to help maintain your eye health & vision.

Schefkind Eye Care Visual Field

Output of Humphrey’s Visual Field test showing subtle progression of glaucoma

 

Schefkind Eye Care Advanced Imaging

Output of Optical Coherence Tomography, used to create a three dimensional map of your optic nerves

Medical, Laser & Surgical Glaucoma Treatment
The goal of glaucoma treatment is to stabilize and control your eye pressure in order to provide the best chance of preserving your vision. The three main glaucoma treatments are medical-using eye drops, glaucoma laser treatment & glaucoma surgery, most often minimally invasive glaucoma surgery (MIGS).

View Video


Medical Treatment of Glaucoma Primary Open Angle Glaucoma can initially been treated with eye drops and/or an in office laser treatment called Selective Laser Trabeculoplasty (SLT). By using one or two types of glaucoma eye drops most patients are able to achieve a stable and lowered eye pressure. Some patients are unable to achieve adequate control with eye drops alone, or may experience intolerable side effects from the eye drops, and do better with an the office glaucoma laser treatment to maintain control as a first choice of treatment. Laser Treatment of Glaucoma Selective Laser Trabeculoplasty (SLT) is a type of glaucoma laser treatment for Primary Open Angle Glaucoma that helps to reduce the Intraocular Pressure (IOP) by creating more effective drainage of fluid through the trabecular meshwork. slt glaucoma laser We perform this painless procedure in the comfort of our office and often patients are able to obtain good stability and also reduce the number or frequency of eye drops they need to use. Laser Peripheral Iridotomy (LPI) is a type of glaucoma laser treatment for Angle Closure Glaucoma that creates a hole on the outer edge, or rim, of the iris, the colored part of the eye which allows the aqueous humor fluid to easily flow between the anterior chamber, the front part of the eye, and the area behind the iris, the posterior chamber. This is performed for patients with narrow chamber angles or those patients experiencing angle closure to prevent sudden buildup of pressure within the eye, which occurs during an episode of acute closed-angle glaucoma. 

View Video

Surgical Treatment of Glaucoma Even with the maximum eye drop medical therapy and glaucoma laser treatment, for some patients it is still not possible to achieve good stable control of their disease and stop the progression of vision loss. Glaucoma specialist Edward Chay, M.D. is able to perform Minimally Invasive Glaucoma Surgery (MIGS) for most patients. While sometimes traditional glaucoma surgery may be an option and may include removing a tiny piece of the trabecular meshwork-called Trabeculectomy, Dr. Chay is able to provide a number of minimally invasive glaucoma surgery (MIGS) options including a procedure call Kahook Dual Blade (KDB) which is a quick and painless outpatient procedure often performed at the time of cataract surgery. KDB doesn’t require and avoids risks of eye bleb leakage and infection while providing a quick visual recovery. Dr. Chay is often able to implant microscopic tubes, shunts, valves or stents such as the iStent®, HYDRUS® MicroStent or XEN Stent for cataract patients who need to control their eye pressure. In addition, he is able to use the OMNI procedure to help both those patients having cataract surgery, as well as those patients not requiring cataract surgery, to help lower eye pressure and reduce the need for eye drops.

 

 
Glaucoma Risk Factors

There are a number of known health, ethnic, lifestyle and demographic factors that influence your risk of developing glaucoma, including:

  • High Intraocular Pressure-regardless of age anyone with high IOP is at risk
  • Age-Risk increases after the age of 40 and is 6 times greater if you are over 60.
  • Race-African-Americans have a six to eight fold increased risk for glaucoma.
  • Myopia-Severely nearsighted people have a higher risk of developing glaucoma.
  • Hypertension or High Blood Pressure
  • Diabetes
  • Family History-Any family history of glaucoma is considered a very significant risk factor, especially among siblings
  • Steroids-Taking steroid medication for allergies, asthma or arthritis
  • Early Menopause
  • Sleep Apnea
  • Thin Corneal Tissue
  • Eye Trauma
  • Smoking

Please be sure to tell us if you have one or more of these glaucoma risk factors when you come to Schefkind Eye Care for your eye exam.

Types of Glaucoma
Primary Open Angle Glaucoma (POAG) and Angle Closure Glaucoma are the two most common types of glaucoma we see at Schefkind Eye Care.

Primary Open Angle Glaucoma (POAG) is the most common type of glaucoma whereby the production and/or drainage of fluid inside the front of the eye-called aqueous humor-is imbalanced, resulting in an elevation in eye pressure (IOP). This pressure deprives the optic nerve of oxygen and nutrients causing irreversible changes and damage, which if left untreated results in vision loss and ultimately blindness.

Angle Closure Glaucoma accounts for about 10% of all cases of glaucoma and about 2/3 of these produce no symptoms for patients.

closed angle glaucoma

Acute Angle Closure Glaucoma is one of the only types of glaucoma that produces distinct symptoms that include pain, light sensitivity, redness, blurred vision, colored haloes around lights and nausea or vomiting. Acute Angle Closure Glaucoma is considered a medical emergency. If you experience a sudden onset of pain, redness, blurred vision, light sensitivity, haloes around lights, nausea and vomiting, please call Schefkind Eye Care at (703) 997-9710 and relay these symptoms to the staff member so that you can be given an appointment immediately. In the event that you are at risk for Angle Closure Glaucoma or in the event that you have Acute Angle Closure Glaucoma we may initially prescribe some medication to begin to lower the pressure but will also perform a type of in office glaucoma laser procedure called Laser Peripheral Iridotomy (LPI) to produce a small opening or hole in the Iris so that Aqueous Humor can drain from the eye more effectively. Fortunately these treatments are very effective at quickly lowering the pressure and preserving vision.

Glaucoma Eye Exams & Diagnosis

During your routine eye exam or as part of a special glaucoma testing visit, we may perform a number of tests in order to be able to provide early detection and make the most accurate diagnosis of glaucoma. These may include the following:

  • Tonometry-Intraocular Pressure (IOP) measurement.
  • Ophthalmoscopy-Examination of the optic nerve through a dilated pupil which may be performed using special instruments or a high magnification lens at the Slit Lamp Biomicroscope.
  • Visual Field Perimetry-A computerized examination to plot an actual map of the field of your vision.
  • Gonioscopy-Direct examination of the drainage structures of your eye called “trabecular meshwork”-using a specialized contact lens at the Slit Lamp Biomicroscope.
  • Computerized Imaging of Optic Nerve & Fibers-OCT uses a method called “optical coherence tomography” to create digital images with beams of light to examine the optic nerve and measure the retinal nerve fiber thickness.
  • Pachymetry Measurement of Corneal Thickness

From this testing we will be able to make a diagnosis and recommendations for additional visits and treatment as required. They will be sure to answer all questions you may have and help you understand how we will work together to help maintain your eye health & vision.

Schefkind Eye Care Visual Field

Output of Humphrey’s Visual Field test showing subtle progression of glaucoma

 

Schefkind Eye Care Advanced Imaging

Output of Optical Coherence Tomography, used to create a three dimensional map of your optic nerves

Medical, Laser & Surgical Glaucoma Treatment
The goal of glaucoma treatment is to stabilize and control your eye pressure in order to provide the best chance of preserving your vision. The three main glaucoma treatments are medical-using eye drops, glaucoma laser treatment & glaucoma surgery, most often minimally invasive glaucoma surgery (MIGS).

Medical Treatment of Glaucoma

View Video


Primary Open Angle Glaucoma can initially been treated with eye drops and/or an in office laser treatment called Selective Laser Trabeculoplasty (SLT). By using one or two types of glaucoma eye drops most patients are able to achieve a stable and lowered eye pressure. Some patients are unable to achieve adequate control with eye drops alone, or may experience intolerable side effects from the eye drops, and do better with an the office glaucoma laser treatment to maintain control as a first choice of treatment. Laser Treatment of Glaucoma Selective Laser Trabeculoplasty (SLT) is a type of glaucoma laser treatment for Primary Open Angle Glaucoma that helps to reduce the Intraocular Pressure (IOP) by creating more effective drainage of fluid through the trabecular meshwork. slt glaucoma laser We perform this painless procedure in the comfort of our office and often patients are able to obtain good stability and also reduce the number or frequency of eye drops they need to use. Laser Peripheral Iridotomy (LPI) is a type of glaucoma laser treatment for Angle Closure Glaucoma that creates a hole on the outer edge, or rim, of the iris, the colored part of the eye which allows the aqueous humor fluid to easily flow between the anterior chamber, the front part of the eye, and the area behind the iris, the posterior chamber. This is performed for patients with narrow chamber angles or those patients experiencing angle closure to prevent sudden buildup of pressure within the eye, which occurs during an episode of acute closed-angle glaucoma. Surgical Treatment of Glaucoma View Video

Even with the maximum eye drop medical therapy and glaucoma laser treatment, for some patients it is still not possible to achieve good stable control of their disease and stop the progression of vision loss. Glaucoma specialist Edward Chay, M.D. is able to perform Minimally Invasive Glaucoma Surgery (MIGS) for most patients. While sometimes traditional glaucoma surgery may be an option and may include removing a tiny piece of the trabecular meshwork-called Trabeculectomy, Dr. Chay is able to provide a number of minimally invasive glaucoma surgery (MIGS) options including a procedure call Kahook Dual Blade (KDB) which is a quick and painless outpatient procedure often performed at the time of cataract surgery. KDB doesn’t require and avoids risks of eye bleb leakage and infection while providing a quick visual recovery. Dr. Chay is often able to implant microscopic tubes, shunts, valves or stents such as the iStent®, HYDRUS® MicroStent or XEN Stent for cataract patients who need to control their eye pressure. In addition, he is able to use the OMNI procedure to help both those patients having cataract surgery, as well as those patients not requiring cataract surgery, to help lower eye pressure and reduce the need for eye drops.