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General

What are acceptable eye pressures and at what ages?

I have cataracts, can my glaucoma be treated and how?

Do some people with glaucoma produce too much fluid and also have a drainage problem?

What is Pre-Glaucoma?

What is the difference between cataracts and glaucoma?

Can a person who has had glaucoma and cataract surgery wear contacts?

Would I still have to wear glasses once I start a treatment plan for glaucoma?

Is my blood pressure linked to my eye pressure (IOP)?

If I have glaucoma, what are the first signs of the disease?

What do the terms “controlled glaucoma― and “uncontrolled glaucoma― mean? My
doctor says that to me at the completion of the exam and I am not sure I understand.

Is glaucoma hereditary?

Is it safe to use eye makeup after glaucoma surgery?

I've heard about cup to disc ratio. What does this actually mean?

Are there gender-based risk factors for glaucoma?

What is ocular hypertension and how should it be treated?

What type of doctor should I see about glaucoma?

What's the difference between a glaucoma suspect and a glaucoma patient?

Is glaucoma painful?

Can you have glaucoma without having increased pressure inside the eye?

Are diabetics at greater risk for glaucoma?

Do intraocular pressure (IOP) fluctuations matter in glaucoma?

What can a doctor do in cases of extreme IOP fluctuation?

Can glaucoma be prevented?

What can I do for my dry eye condition?

What is the role of the optic nerve in glaucoma?

Any tips for how I should be communicating with my ophthalmologist? What kinds of questions
should I be asking?

I'm looking for a well-trained glaucoma specialists/surgeon. Any suggestions on how I can make an
excellent choice?

Does glaucoma usually affect one or both eyes?



General top
Q.
What are acceptable eye pressures and at what ages?
A.
Intraocular pressure works differently in different individuals, and there is not one pressure level
that works for everyone. When your doctor conducts a comprehensive eye examination, it is likely
that s/he is identifying a target pressure measurement that s/he believes would be "normal" for
your specific condition, meaning it would hopefully prevent further optic nerve damage from
occurring if you could stabilize your pressure at this target level. It would be very appropriate for you
to ask your treating doctor what this target number is so that you can interpret and understand how
your eyes are doing each time you visit the doctor for an eye exam. To put intraocular pressure
measurements in perspective, the national average pressure measurement in the U.S. is between 14
and 16, and normal population pressures up to 21 may be within normal range. There are also many
other personal characteristics and genetic issues, such as race, family history and corneal thinness
just to name a few, that must be considered when a doctor reviews your examination results and
determines whether your present condition can be damaging to your optic nerve. We encourage you
to ask questions and communicate regularly with your doctor so that you can be an active and
knowing participant in your treatment plan. If you continue to have questions about the right course
of treatment for your glaucoma, consider seeking a second or even third opinion from another
doctor.

top

Q.
I have cataracts, can my glaucoma be treated and how?
A.
Cataracts and glaucoma are two separate problems. Cataracts can be cured by having them removed
with a relatively benign surgical procedure. Commonly, however a combined procedure can be
performed at the time of cataract extraction, thereby, hopefully getting the glaucoma under control.
Remember, the glaucoma is not cured, just controlled.

top

Q.
Do some people with glaucoma produce too much fluid and also have a drainage problem?
A.
Fluid is constantly produced within the eye by a small gland called the ciliary body. This clear fluid,
known as aqueous humor, supplies the internal structures of the eye with nutrients and oxygen. The
fluid then exits the eye through the drainage angle, which is called the trabecular meshwork.
Increased resistance within the trabecular meshwork decreases the rate of flow across it and causes
a buildup of fluid within the eye, resulting in elevated eye pressure. This is invariably a result of poor
drainage function, rather than an increase in aqueous humor production by the ciliary body.
Essentially, elevated eye pressure in glaucoma occurs because the rate of fluid production exceeds
the eye's ability to drain it. The degree of this resistance to outflow varies from individual to
individual. This situation is analogous to your kitchen sink. The faucet is always on and water goes
down the drain. Imagine that you pour coffee grinds into the sink. What happens? The water level
slowly rises and then overflows. In the eye, the fluid can't overflow, so the pressure goes up.
Glaucoma medications lower intraocular pressure by either decreasing fluid production (turning
down the faucet) or increasing fluid outflow from the eye (improving the function of the drain).

top

Q.
What is Pre-Glaucoma?
A.
This is another way of saying that you are a glaucoma suspect. A glaucoma suspect is someone who
might have glaucoma but it's too early to tell. This term includes patients with ocular hypertension
(persons with elevated intraocular pressure but no detectable disc or visual field damage), and
patients with large cup/disc ratios and normal visual fields who may or may not have early normal-
tension glaucoma. Since you have been diagnosed as a glaucoma suspect, it is important that you
see your eye care specialist regularly to monitor your condition so that you do not experience any
loss of vision.

top

Q.
What is the difference between cataracts and glaucoma?
A.
The optical system of the eye allows us to see. When light enters the eye, it is focused by the lens
onto the retina, which perceives the image, much in the same way a camera lens focuses light onto
the film torecord a picture. As we age, the normally clear lens begins to thicken and gradually
becomes discolored. This condition is called a cataract. This results in a loss of vision, and occurs at
different rates in different individuals. Vision loss in glaucoma occurs because of damage to the optic
nerve, which connects the eye to the brain. Because of its similarity to the nerve cells (called
neurons) of the brain, once it is injured it cannot be repaired. The loss of nerve cells is irreversible.
Cataracts and glaucoma may occur together in the same person. For most people, these two disease
processes are separate and distinct and may progress at different rates. It is important to remember
that a cataract is a reversible form of vision loss and that glaucoma is not. Permanent loss of vision
from glaucoma, however, can be prevented in most people by early detection and careful follow-up
examinations to detect early signs that the eye is being damaged, followed by appropriate, timely
intervention should these signs develop.

top

Q.
Can a person who has had glaucoma and cataract surgery wear contacts?
A.
Most people who undergo cataract surgery no longer need to wear contact lenses because their
nearsightedness or farsightedness is usually corrected when the lens implant is placed. This
correction of vision should be discussed before surgery, so that the patient and the doctor are
pleased with the postoperative visual results. Although patients who undergo cataract surgery alone
may usually be able to tolerate contact lenses after surgery, some individuals who also undergo
glaucoma surgery may not be able to wear contact lenses after surgery because of changes which
occur on the surface of the eye after glaucoma surgery. The use of contact lenses after eye surgery
should be discussed with your doctor both before and after the surgery.

top

Q.
Would I still have to wear glasses once I start a treatment plan for glaucoma?
A.
Yes

top

Q.
Is my blood pressure linked to my eye pressure (IOP)?
A.
Blood pressure and eye pressure vary independently. Controlling blood pressure does not mean IOP
is controlled. But studies have shown that patients with high blood pressure have an increased risk
for glaucoma.
The relationship of low blood pressure to glaucoma has been better established. Chronic low blood
pressure is a risk factor for developing progressive glaucoma damage. We now understand that in
some forms of glaucoma, there is a strong link between glaucoma and poor (reduced) blood flow to
the optic nerve. Low blood pressure is strongly associated with normal-tension glaucoma—a type of
glaucoma that occurs even though the pressure inside the eye is not elevated.

Patients who are taking medication for high blood pressure may actually have their blood pressures
dropping to very low levels during the hours they are sleeping. This reduces the amount of blood
flow to the eye and optic nerve and may compromise the optic nerve. The role of blood flow in optic
nerve damage is the subject of ongoing study.

Patients with any progressive glaucoma need to make sure their blood pressure is not dropping to
very low levels while they sleep. Your ophthalmologist needs to know about all your medical
conditions and the medications you are taking and needs to work with your other doctors to make
sure everything is in synch.

top

Q.
If I have glaucoma, what are the first signs of the disease?
A.
There’s a reason that glaucoma is often called the sneak thief of sight. It’s because in most cases
there are no early symptoms or warning signs for the disease and when vision is lost, it cannot be
restored. With primary open angle glaucoma (POAG), the most common form of glaucoma, there is
no blurred vision and no pain. Usually, peripheral vision is affected first and central vision in affected
later in the course of the disease. For that reason a person with undetected untreated POAG may
not become aware of vision field changes until a significant amount of vision has been permanently
lost.
Another form of open angle glaucoma is called low-tension or normal-tension glaucoma (NTG). NTG
tends to be a very progressive and aggressive form of glaucoma which, however, is not characterized
by elevated intraocular pressure. Although pressures may be in the normal range, patients develop
damage to the optic nerve that results in a loss of peripheral vision. In NTG, visual field changes
often start more centrally, so a patient might notice a visual field loss earlier.

Acute narrow-angle or angle-closure glaucoma is a second basic category of glaucoma.
Symptoms may include severe pain, nausea, vomiting, blurred vision, and seeing a rainbow halo
around lights. Acute angle-closure glaucoma is a medical emergency and must be treated
immediately or blindness could result in one or two days. Chronic angle-closure glaucoma
progresses more slowly and can damage the optic nerve without symptoms as in open-angle
glaucoma.

The bottom line: regular eye exams are critical to detection and treatment of the disease to prevent
blindness!

top

Q.
What do the terms “controlled glaucoma― and “uncontrolled glaucoma― mean? My
doctor says that to me at the completion of the exam and I am not sure I understand.
A.
Reducing the intraocular pressure (IOP) inside the eye to prevent optic nerve damage and preserve
the patient's vision is the only proven method of treatment for glaucoma, even when the IOP is not
significantly elevated.
Controlling glaucoma is maintaining a level of IOP sufficiently low to avoid further optic nerve
damage and loss of peripheral (side) vision. Generally an IOP of 10 to 21 mm. Hg is considered
normal and IOP above 21 is considered elevated. But some people require as low as 8 to 10 to
prevent damage to the optic nerve. The doctor determines the patient’s unique target level IOP
based in part on the extent of damage and level of IOP. Other things that are considered as the
target level is determined are family history, age, medical and ocular history, health, and rate of
change (if known).

The doctor will have an understanding if your glaucoma is controlled based upon the IOP at that
office visit (is it at the target pressure) as well as by periodically assessing the structure of the eye
(examining the eye with a lens and slit lamp, ophthalmoscope or with an imaging device such as an
OCT) and with Perimetry (visual field test). Each of the tests is compared to ones done previously to
look for change. Thus he/she may say your condition is controlled because the IOP is where the
doctor would like it to be or the back of the eye has not appeared to change or the visual fields have
not changed (or a combination of all/some of these).


top

Q.
Is glaucoma hereditary?
A.
Glaucoma is actually a group of disorders, a number of which are caused at least in part by heredity
and the action of genes. However only a small percentage of genes that determine risk for glaucoma
have been discovered, and most are still unknown. Specific genes can influence the development
and likely the progression of the disease.


top

Q.
Is it safe to use eye makeup after glaucoma surgery?
A.
Your eye doctor will give you instructions about the use of cosmetics before and after eye surgery in
order to avoid bacterial contamination. Before your surgery, your doctor may give you a packet to
make sure the area around your eyes is well cleaned of eye liner, mascara and any other eye
makeup. The goal is to achieve a sterile environment – one that should be maintained for several
weeks after your surgery. Make sure your doctor tells you when you can start wearing makeup
again.
When it comes to eye makeup products, certain rules should apply at all times. Select water-based
rather than oil-based products that are gentler on the eye -- especially an eye healing from surgery.
The fact that they dissolve in water makes removal quicker and easier without excessive rubbing.
Avoid pearlized and iridescent eye shadows that may contain ingredients that could scratch your
eye. And if you care about your eyes, definitely stay away from false eyelashes. The adhesives used
are very corrosive to the eye and removing the lashes can be dangerous.
Here are some other tips to minimize your eyes’ exposure to bacteria. Don’t hold onto old makeup –
throw it away after a few months. Avoid those multi-pack discount packages – too much time for
bacteria and fungi to multiply and for those germs to transfer directly to your eyes. Never share
cosmetics with a friend. Never apply your eye makeup while you’re driving in a car or riding in a bus
or train – too easy for the mascara wand to scratch your cornea. And don’t use eyeliner on the inner
eyelids, where makeup can get inside your eye.

top

Q.
I've heard about cup to disc ratio. What does this actually mean?
A.
Glaucoma damages the optic nerve. The cup to disc ratio is one way to describe the optic nerve and
to detect damage or progression in glaucoma. All optic nerves (the disc) have a round depression or
'cup' in the center of the optic nerve. This is because the nerve fibers that connect the eye to the
brain exit the eye through an opening and fill this opening (the scleral canal) from outside to in.
Usually the canal is not entirely filled so there is some space in the center - the cup. Think of a white
teacup sitting on an orange-pink saucer (healthy nerve tissue). This is the head of the optic nerve
that the doctor sees upon examination.

The relative size of the cup compared to the larger disc is called the cup to disc ratio, expressed as a
fraction of their respective diameters. If a doctor gives a single number it is usually the vertical cup
to disc ratio. For example, 0.4 means the vertical cup diameter is 40% of the vertical disc diameter.
This reflects the structure of the nerve, and changes can suggest to your doctor whether there has
been damage from glaucoma.
If the cup to disc ratio increases over time it suggests the glaucoma is progressing. (A slight increase
in cup to disc ratio with aging is normal.) In the normal optic nerve head, the cup to disc ratio varies
widely. There are other features that can help determine if a large cup to disc ratio suggests the
presence of glaucoma. While some people can have higher ratios without having glaucoma, as a
general rule the greater the ratio, the greater the possibility that glaucoma has damaged the nerve
fibers, increasing the size and depth of the cup, thus increasing the cup to disc ratio.

top

Q.
Are there gender-based risk factors for glaucoma?
A.
Glaucoma is a group of related diseases that share a common endpoint: glaucomatous damage to
the optic nerve. Studies have definitely shown that women are three to five times more likely to
have angle-closure glaucoma, one form of the disease. When it comes to primary open-angle
glaucoma (POAG), the most common form of the disease, studies have not demonstrated a
definitive gender bias.


As women outlive men worldwide, and age is one of the risk factors for glaucoma, it is expected that
statistically more women have glaucoma than men. There is some evidence that female sex
hormones might be protective to the optic nerve. It has also been hypothesized that with age,
decreased estrogen might be associated with increased risk for POAG. But the results of related
studies have to date been inconclusive. However, age remains a primary risk factor for glaucoma and
monitoring for the disease is especially important. Everyone 40 or older should have a
comprehensive dilated eye examination every one and a half to two years. If you are 40 or older and
have an additional risk factor, get tested annually.

top

Q.
What is ocular hypertension and how should it be treated?
A.
Ocular hypertension (OHT) usually refers to a situation in which the pressure inside the eye, called
intraocular pressure (IOP), is higher than normal but there is no optic nerve damage or visual field
loss. If you have been diagnosed with ocular hypertension but no damage from glaucoma, it is
important to speak to your doctor about your risk for developing the disease and whether you
should have preventative treatment. For some people, close monitoring is an appropriate option if
no damage has occurred.

According to the recent Ocular Hypertension Treatment Study, key risk factors for people with ocular
hypertension to consider: their age (older age increases risk), elevated pressure in the eye, cup/disc
ratio (a measure of the appearance of the optic nerve visible inside the eye - higher values increase
the risk), corneal thickness (thinner corneas increase the risk) and pattern standard deviation (a
measurement derived from computerized visual field tests). Comprehensive dilated eye
examinations are generally recommended every one and a half to two years for individuals under
age 40 with one risk factor, and for all people 40 years or older. If you are 40 and have additional risk
factors, get tested annually.


top

Q.
What type of doctor should I see about glaucoma?
A.
Optometrists (ODs), ophthalmologists (MDs) and glaucoma specialists are all qualified eye care
professionals who can provide comprehensive eye examinations.

Optometrists can examine the eye to diagnose and treat vision problems and abnormalities through
non-surgical means, and prescribe glasses, contact lenses and some types of medications.

Ophthalmologists have received graduate training in a medical school and then sub-specialized in
the medical and surgical treatment of eye diseases and injuries. They see patients for routine eye
care, do eye examinations, prescribe medications and perform eye surgery.

Glaucoma Specialists are ophthalmologists who have completed additional post residency fellowship
training specific to glaucoma.

top

Q.
What's the difference between a glaucoma suspect and a glaucoma patient?
A.
Elevated intraocular eye pressure (IOP) alone does not mean a diagnosis of glaucoma. A glaucoma
suspect is a person with normal visual fields but with (1) normal IOPs and slightly suspicious optic
nerve(s) or (2) elevated IOPs and normal optic nerves. While vision loss has not been detected, the
patient should be monitored closely and/or prophylactically treated to prevent subsequent
development of glaucoma. By definition a diagnosis of glaucoma implies that detectable damage has
occurred (either the optic nerve and/or visual field). At this point, treatment is necessary to prevent
any further damage or vision loss.

top

Q.
Is glaucoma painful?
A.
Glaucoma is usually a painless disease without symptoms or discomfort. Infrequently eye pain can
be present and is likely related to a rapid pressure rise, as seen in the acute forms of glaucoma. For
instance, in acute-angle closure glaucoma, the normal flow of eye fluid between the iris and the lens
is suddenly blocked, thereby causing dramatic IOP elevations and symptoms such as severe pain,
nausea, blurred vision and a halo effect around lights. Acute-angle glaucoma is a medical emergency
and must be treated immediately or ensuing blindness could occur.

top

Q.
Can you have glaucoma without having increased pressure inside the eye?
A.
In normal-tension glaucoma, sometimes called normal-pressure glaucoma, the IOP is not
significantly elevated.

The absolute level of IOP may not correlate with the amount of optic nerve damage or visual field
abnormality present. However, despite a lack of IOP elevation in normal-tension glaucoma, the optic
nerve does have abnormal disc cupping and the visual field test shows vision loss.

top

Q.
Are diabetics at greater risk for glaucoma?
A.
While the link between diabetes and primary open-angle glaucoma (POAG), the most common form
of the disease, hasn’t been proven conclusively, some new studies are pointing in that direction.
There’s also one form of the disease, neovascular glaucoma, that is known to be directly related to
diabetes. The most important thing anyone with diabetes can do is to get regular annual eye exams
for glaucoma and other serious eye diseases associated with diabetes.

top

Q.
Do intraocular pressure (IOP) fluctuations matter in glaucoma?
A.
While elevated intraocular pressure (IOP) is the most commonly recognized risk factor for glaucoma,
the role of IOP fluctuation throughout the day has also been shown to be a risk factor in glaucoma
disease development and progression. IOP is not a static phenomenon – it varies throughout the
entire 24-hour period. Diurnal (throughout the day) and nocturnal (throughout the night) variations
may range from 3 to 6 mm Hg. Some studies have found that in the majority of patients, the
highest IOP in a 24-hour period occurs at night in a supine position. It has also been found that
patients with greater fluctuations are more likely to have glaucoma progression. Large IOP
fluctuation has emerged in some recent studies as a possible independent risk factor for glaucoma
progression.
Doctors are becoming more convinced of the importance of measuring daytime and nighttime IOP
fluctuations, Multiple measurements at different times over a period of months can help monitor
how great the range of fluctuation is between visits. 24-hour monitoring is still very difficult and
costly as it requires a hospital setting.

top

Q.
What can a doctor do in cases of extreme IOP fluctuation?
A.
Since prostaglandins are a class of glaucoma medications that lowers both the mean pressure and
minimizes IOP fluctuations, they are often a physician’s first line medical choice. Sometimes a
second drug is added or the doctor performs laser trabeculoplasty, which has been shown to reduce
both IOP and its variability. Another treatment option is incisional glaucoma surgery such as the
traditional trabeculectomy procedure, a surgery that appears to reduce greatly the extent of IOP
fluctuation.

top

Q.
Can glaucoma be prevented?
A.
Most types of glaucoma cannot be prevented. And while vision loss due to glaucoma can not be
recovered, further vision loss can hopefully be prevented with appropriate treatment. Early
detection, ongoing treatment and monitoring are key factors to limiting damage from the disease,
which lasts a lifetime. Some types of secondary glaucoma, for example resulting from an eye injury,
such as being hit in the eye by a ball, or from certain diseases, such as diabetes, may be preventable
with measures such as protective eyewear to avoid eye injuries and proper management of
diabetes.

top

Q.
What can I do for my dry eye condition?
A.
Dry and irritated eyes, particularly common among older people, can be related to a hot, dry climate
(or dry forced-air heating in the winter), airplane travel, too many hours in front of a computer
screen, eyelid inflammation, or even taking some types of glaucoma medications. Dry eye syndrome
is mostly caused by a deficiency in the tear glands, and a common preservative in many glaucoma
medications can worsen the symptoms. Up to 40-50 percent of glaucoma patients have this
problem, and it seems to be more common in women than in men. Prolonged dryness may cause
blurred vision, burning, and itching. Some patients complain of tearing; others that their eyes feel
like sand. Symptoms can last for just a very short time and then come back again.
The main treatment for relief is the use of lubricating artificial tears, available as over the counter
eye drops, to replace natural tears and also provide an artificial protective coating for the eye. Leave
at least fifteen minutes between applications of the eye drops used to treat glaucoma and the
artificial tears to keep from washing the glaucoma drop out of the eye. Generally, the artificial tear
should be used after the glaucoma eye drops. Oral flax seed oil capsules have been shown in
scientific studies to be helpful for dry eye, and oral fish oil/omega 3 supplements may also be
helpful. A hot, moist compress (for example a face towel soaked in hot tap water) can also help
relieve symptoms. Place it on the closed eyes twice daily for 2 minutes, then massage the closed
eyelids gently, where the eyelashes attach to the eyelids. This maneuver helps keep eyelid glands
flowing, which is important for the tear film and eye comfort. For more severe cases, a thicker gel or
ointment can be used at night or a prescriptive eye drop is available.

Treating the dry eye syndrome is very important for the patient's comfort and for the long-term
health of the surface of the eye. Managing dry eye requires a team effort by the patient and the
doctor.

top

Q.
What is the role of the optic nerve in glaucoma?
A.
Glaucoma is a group of eye diseases that share a common endpoint – a specific type of damage to
the optic nerve that leads to visual disability. The optic nerve transmits image information, such as
color, shape and movement from the retina to the brain. The optic nerve consists of a bundle of
about one and a half million nerve fibers, each about twenty-thousandth of an inch in diameter. The
exact cause of optic nerve damage from glaucoma is not yet fully understood, but could involve
either mechanical compression of the nerve fibers, alteration of supporting cells that provide
nutrition to the fibers or decreased blood flow (or a combination of these). Although high eye
pressure plays a role in damaging the nerve fibers of the optic nerve, many people can also develop
glaucoma with eye pressures that appear to be normal. Therefore a diagnosis of glaucoma cannot be
made only with a measurement of eye pressure, but also an examination of the optic nerve and the
field of vision.

Because damage occurs to optic nerve fibers, the signal transmitted by them to the brain is either
degraded or missing altogether. The amount of vision that is affected depends on the extent of the
damage to the optic nerve. When a significant number of nerve fibers are damaged, blind spots
develop in the field of vision. Once nerve damage and visual loss occur, it is permanent. Most people
don't notice these blind areas until much of the optic nerve damage has already occurred. If the
entire nerve is destroyed, blindness results. Early diagnosis and treatment by your ophthalmologist
are the keys to preventing optic nerve damage and vision loss from glaucoma.

top

Q.
Any tips for how I should be communicating with my ophthalmologist? What kinds of questions
should I be asking?
A.
It’s important to consider yourself a team with your doctor – make sure you understand why your
need to take the medication prescribed and what the medication is doing for you. Be sure to ask
how to best take your medications – the time of day, the technique you should use to insert your
eye drops, the spacing between drops if you are taking more than one medication. Ask your doctor
or your doctor’s assistants for a written list of your medications and the times to use them.

Learn about the possible side effects and report any side effects or allergic reactions to your doctor
promptly. An allergic reaction may be related to the preservatives in the medication. Discuss that
possibility with your doctor – there are alternatives. And make sure to ask how any new medications
will interact with any other medications or dietary supplements you are taking.

Be an educated patient – for example, look at the results of your field of vision tests and optic nerve
evaluations. Ask your doctor to review and explain the tests in terms that you can understand. Are
the results consistent with stability? Are they suspicious for progression or worsening of the
glaucoma? Ask if any changes in your regimen are needed based on your test results.
Trained staff at your doctor’s office can be an enormous support in helping manage your glaucoma.
They can often give you the information, time and attention that can make a big difference.

top

Q.
I'm looking for a well-trained glaucoma specialists/surgeon. Any suggestions on how I can make an
excellent choice?
A.
You can start by asking your primary care physician (PCP), pediatrician, general ophthalmologist, or
optometrist for a recommendation. Your physician advisor may have the names of highly regarded
glaucoma specialist/surgeons in your geographical area; family, friends and coworkers can also be
good sources for referrals if they or their loved ones have ever undergone glaucoma surgery
(including laser treatments for glaucoma). If you are moving to a new location, the websites of two
medical organizations, the American Glaucoma Society (AGS) and the American Academy of
Ophthalmology (AAO), may have the names and biographical information of well-trained glaucoma
specialists in your area. Other resources for glaucoma specialist referrals include major hospitals
and/or medical universities. Consult with the ophthalmology department of local/regional academic
medical centers or hospitals to find out their specific physician referral policies. Finally, your
insurance company may provide information regarding glaucoma specialists who are covered under
your medical plan.

Glaucoma specialist/surgeons are eye MDs (medical doctors) – physicians who graduated from
medical school, completed an internship in general medicine or surgery, followed by a 3-year
residency program in ophthalmology, focusing on the diagnosis and medical and surgical
management of diseases of the eye. Thereafter, the majority of glaucoma specialists have completed
one or two year additional fellowship training in glaucoma and anterior segment diseases (e.g.
cataracts). For adults and children, they can provide comprehensive eye exams, test and treat eye
diseases including glaucoma, and perform glaucoma surgery and laser procedures, as well as
cataract surgery. Once you contact the office of your selected choice for a glaucoma specialist,
several initial questions may be asked: Does the specialist provide the full spectrum of glaucoma
services including initial consultation, long-term glaucoma follow-up, laser procedures, and incisional
surgery? When is the first available appointment with the physician? Does he/she take my medical
insurance? How should I best forward my previous medical records (e.g. previous clinic or surgical
records, visual field tests, optic nerve imaging studies) to the physician? It is also helpful if you
familiarize yourself with the glaucoma specialist’s professional credentials and experience before
your initial office visit (checking online can supplement biographical information provided by the
glaucoma physician’s office).

top

Q.
Does glaucoma usually affect one or both eyes?
A.
Primary open-angle glaucoma, the most common form of glaucoma in the United States,generally
presents itself in both eyes (i.e., bilaterally). But it often presents initially in an asymmetric (not
equal) manner and does not usually develop at the same rate in your two eyes. While often only one
eye has damage at the time of diagnosis or recognition, the second eye will show damage over time
without therapy. Secondary open-angle glaucoma may present in a monocular fashion if the cause of
the glaucoma occurs in just one eye, such as trauma to one eye, new blood vessel growth associated
with diabetes or vascular occlusion (neovascular glaucoma), etc. Pigmentary glaucoma tends to be
bilateral. While exfoliative glaucoma often presents in one eye (33% in one eye at time of
presentation), the second eye becomes involved about 50% of the time within 15 years. Acute angle
closure glaucoma usually also initially occurs in one eye but the second eye is at great risk and can
develop angle closure over a period of years. Your doctor may decide to treat the unaffected eye to
prevent an angle closure attack.

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