Consultant Ophthalmologist,
Cataract & Refractive Surgeon

BMedSci BM BS MRCS MRCSEd MRCOpth FRCOphth MMedLaw PgD Cataract & Refractive Surgery

Glaucoma

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What is glaucoma and how is it treated?

What’s going on?

The optic nerve is under attack and therefore so is your vision.  Typically the pressure goes high inside the eye and compresses the optic nerve causing it to bow out. As a result of this damage you will lose patches of your peripheral vision. If untreated the visual loss will worsen and eventually result in your central vision being lost and blindness. Thankfully with modern treatments this hardly ever occurs. The danger is that this loss of peripheral vision is silent and in the great majority of cases you do not get any symptoms from the raised pressure. You don’t notice the patchy visual loss because your brain fills in the gaps for you. That is why doing visual field tests at the opticians is important to pick up this disorder early.

What will my ophthalmologist see?

We will be able to check the true pressure inside the eye (sometimes the techniques used by the opticians can be inaccurate). We can also assess the optic nerve for damage and arrange for visual field tests to be done.

What will my ophthalmologist do for me?

If appropriate we will start treatment with glaucoma drops. We will need to check that the drops are working and that they have reduced the pressure to an adequate level. You will be on drops for life and you need to make sure that you get repeat prescriptions from your GP. You will also need to attend the clinic on a regular basis forever I’m afraid. You and your ophthalmologist will become close friends over the years. 

What can I do?

Use the drops religiously. The only way to stop you going blind is for you to use the treatment and attend the clinic regularly. Your treatment is a partnership between your ophthalmologist and you. I cannot hope to do the best by you if I do not have your help and cooperation.

What do I need to know?

You have a chronic problem that will never be cured but can be controlled, usually by drops. You need lifelong follow-up in order to monitor the pressure in your eyes, however, and even if the drops have worked for years, checks are still necessary because the pressure may build up gradually over a long period with consequent damage to the vision. If the drops do not control the pressure, then surgery may be necessary. Don’t panic – in the vast majority of patients drops do the trick. With appropriate management and follow-up, the prognosis is excellent, however. Few people diagnosed in recent years are likely to go blind because of their disease.

Sometimes you can have glaucoma without high pressure (Normal Tension Glaucoma - see below) and sometimes your pressure can be high but you don’t have glaucoma (Ocular Hypertension - see below).

Normal Tension Glaucoma (also normal pressure glaucoma)

What’s going on?

Usually in glaucoma the pressure inside the eye is high. In some patients (almost a quarter!) the pressure is normal on all our measurements but despite this the patient develops damage to the optic nerve and glaucoma. For some reason a pressure which wouldn’t affect someone else is too much for your nerve.

What will my ophthalmologist see?

We’ll see the typical signs of glaucoma.

What will my ophthalmologist do for me?

We will decide whether to treat you or not. Usually treatment with drops brings the pressure down and makes sure that you do not worsen.

What can I do?

Use the drops and attend for follow-up.

What do I need to know?

Sometimes if the drops cannot get the pressure low enough we may need to operate.

Ocular Hypertension

What's going on?

The pressure in your eye is high but there is no evidence of pressure-associated damage. The optic disc (the visible bit of the optic nerve) is normal with no evidence of glaucoma and you have no visual field loss. You are at risk however of developing glaucoma in the future.

What will my ophthalmologist see?

We will see that the pressure is high and confirm that there has been no damage from this.

What will my ophthalmologist do for me?

We will decide whether you need follow-up by us or by your own optician. Sometimes the pressure is high enough and other risk factors give you a significant chance of developing glaucoma. We will weigh this risk up and discuss it with you. Together we will reach a decision as to whether we should treat you or not.

What can I do?

Attend follow-up appointments and use your drops religiously if you are prescribed them.

What do I need to know?

You do not have glaucoma but your high pressure does put you at risk of developing it. If you are not treated then you will be followed up and should we detect any signs of glaucoma we will commence treatment at that stage.