There are two main types of glaucoma: Primary Open Angle Glaucoma (POAG) and Angle Closure Glaucoma. Primary Open Angle Glaucoma 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. Acute Angle Closure Glaucoma is one of the only types of glaucoma that produces distinct symptoms that include pain, light sensitivity, redness, blurry 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 Outlook Eyecare at 609-419-1920 in Princeton or 609-409-2777 in Monroe and relay these symptoms to the Patient Services Representative 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 glaucoma laser procedure called Laser Peripheral Iridotomy to produce a small opening or hole in the Iris so that Aqueous Humor can drain from the eye more effectively.

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 our eye doctors 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.

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

Primary Open Angle Glaucoma has most often been treated with eye drops. 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 in office glaucoma laser treatment to maintain control as a first choice of treatment.

Laser Treatment of Glaucoma

Selective Laser Trabeculoplasty (SLT) and Micropulse Laser Trabeculoplasty (MLT) are glaucoma laser treatments for Primary Open Angle Glaucoma that helps to reduce the Intraocular Pressure (IOP) by creating more effective drainage of fluid through the trabecular meshwork. We perform these painless procedures 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

Glaucoma surgery used to only be reserved for patients who were still losing vision while on maximal medications and after laser therapy because of the high incidence of complications associated with these surgeries. More recently there have been several minimally invasive glaucoma procedures (MIGS) developed for glaucoma treatment that have minimal risk and can be used for patients with mild to moderate glaucoma. Many of these procedures are done concurrently with cataract surgery and can help with long term pressure control over a patient’s lifetime and may even decrease the need for drops. Some of these minimally invasive procedures involve opening up the internal drainage system of the eye including KDB Goniotomy and OMNI Viscocanaloplasty. In addition, our glaucoma specialist is able to implant microscopic stents into the drainage system such as the iStent® or Hydrus MicroStent for cataract patients needing glaucoma surgery combined with cataract surgery to help control the intraocular pressure (IOP).