Jason Wanner
Glaucoma: Technological Advancements
Glaucoma can be a devastating eye disease if it goes untreated. It is the leading cause of irreversible blindness in the world. The management of glaucoma has come a long way over the past several decades. A lot of this is due to advancements in glaucoma technology. Specifically, technological advancements in the way we monitor glaucoma changes over time as well as early detection of the disease. There are several key pieces of equipment that help us monitor and adjust treatments in the management of glaucoma.
Visual field testing helps us monitor exactly how much of the patient’s visual field has been lost or damaged. Baseline visual fields and the monitoring of visual fields over time are crucial in the management of the disease. Visual fields can be tested by confrontation, tangent screen or Goldman field testing, or by automated perimetry.
Confrontation field testing is helpful for very large losses of visual field but not for small losses or change over time. Tangent screen and Goldman field testing involves human testers. This is very labor intensive and highly dependent on the skills of the test administrator. Automated perimetry involves the use of visual field machines. These visual field machines have basically replaced the older tests. In their earlier forms they would often take an extremely long time for a patient to complete. The newest visual field machines can now map out a patient’s field of vision in a couple of minutes per eye and are extremely reliable. The new machines also have new modalities that have the ability to catch early disease long before the old machines could.
One of these is Sita-SWAP technology. This is Short Wavelength Automated Perimetry. It tests with a blue light against a yellow background. This is different than traditional field testing, which tests a white light against a white background. The blue light on a yellow background can catch very early loss of vision from glaucoma or other diseases. The earlier visual field loss is identified the better we are able to treat the disease. Time is a key factor in both the detection and management of glaucoma.
Nerve fiber and optic nerve analysis is another very useful tool in the detection and management of glaucoma over time. There are many machines now available to analyze the nerve fiber layer of the retina and the optic nerve in the eye. In glaucoma the nerve fiber layer of the retina and the optic nerve lose tissue over time. The machines available today are able to analyze how much of these tissues have been lost and can map out that loss. One of the best machines to do this is the OCT. OCT stands for Optical Coherence Tomography. It uses near-infrared light to measure the nerve fiber layer of the retina around the optic nerve and the optic nerve tissue itself. The measurements from the OCT can be compared against normative databases. They also can be used to compare the patient’s own measurements to themselves over time. This is very beneficial when managing the disease.
Glaucoma testing is a critical part of the detection and management of glaucoma. The technological advancements in visual field testing and nerve fiber and optic nerve analysis have improved our ability to diagnose and treat the disease significantly. It is important however to view these tests in light of other clinical information and tailor treatment for each individual patient.
Alternative Glaucoma Treatments
Alternative treatments for glaucoma have become quite common in recent years. It has been estimated that almost 50% of patients with glaucoma have tried alternative treatments. Glaucoma is a disease of the optic nerves; they carry all of our vision from our eyes to our brain. The treatment for glaucoma, to date, is centered on lowering the eye pressure. Traditional treatments for glaucoma include medications (topical and oral), laser surgeries (several types), and incisional surgeries (several types). These traditional treatments for glaucoma have been shown in large studies to lower eye pressures and slow the progression of glaucoma and vision loss.
Some alternative treatments for glaucoma that have been suggested include; physical exercise, nutrition, self-regulation techniques, acupuncture, vitamins, herbs, and marijuana. It is difficult to evaluate the effectiveness of some of these treatment suggestions since few studies have been published on these topics. Other alternative treatments have had studies published describing their efficacy in glaucoma treatment.
Several published studies have shown that people with glaucoma who exercise four times a week for forty minutes each time can lower their eye pressures. One study was with people riding stationary bikes and the other was with brisk walking. This moderate amount of cardiovascular exercise is an excellent way for people with glaucoma to help manage their disease. Besides helping treat their glaucoma, aerobic exercise has many other health benefits as well. It is always good to check with a primary care physician before embarking on any new exercise program.
There are no conclusive studies showing a treatment benefit between nutrition (food and beverages) and glaucoma. However, just like exercise, eating a healthy diet has many other health benefits. It is reasonable to think that one’s diet could affect their glaucoma. Studies have shown that many people with glaucoma who ingest large quantities of water in a short time will actually have elevation in their eye pressures. This was shown when people with glaucoma drank an entire quart of water in 20 minutes. So, for people with glaucoma it is more reasonable to drink fluids in smaller amounts throughout the day and not in large quantities. Caffeine intake may affect eye pressures as well. Some studies have shown a slight elevation in eye pressures with significant caffeine intake but other studies have not shown a significant change in eye pressures when consuming caffeine. Glaucoma patients may benefit from limiting caffeine intake.
Self-regulation techniques (meditation) have been studied in other areas of medicine with some positive results. The current studies on self-regulation techniques and the control of glaucoma are not yet conclusive. Acupuncture has been studied and in most cases no change in eye pressure or glaucoma was observed.
Certain vitamin combinations have been shown in studies to help in the treatment of age-related macular degeneration. Some vitamins may help with glaucoma but which combination and which doses are not yet known. The doses that may be needed to help with glaucoma may be so high that other adverse reactions may occur in the body. Certain herbal remedies may also help control glaucoma but which combination may be effective is unknown based on available studies.
Marijuana has been proposed as a possible treatment for glaucoma. When taken orally it has been shown to decrease eye pressure to some degree in the short term. The problem with this as an oral medication is that marijuana has many other chemicals in it, which may be unhealthy. Many other adverse health effects may also occur with the use of marijuana. The other issue with marijuana as a medication for glaucoma is how often it would need to be used to get a lowering of the eye pressure. Cannabis as a topical medication has also been studied without a good effect on eye pressures or glaucoma.
Certain alternative treatments for glaucoma have been shown to work. Most of the proposed alternative treatments need further research and published studies before being accepted as proven treatments of glaucoma. Hopefully, as new studies are published we will learn which of these alternative treatments truly will help control the disease of glaucoma and help preserve sight.
Glaucoma: Technological Advancements
Glaucoma can be a devastating eye disease if it goes untreated. It is the leading cause of irreversible blindness in the world. The management of glaucoma has come a long way over the past several decades. A lot of this is due to advancements in glaucoma technology. Specifically, technological advancements in the way we monitor glaucoma changes over time as well as early detection of the disease. There are several key pieces of equipment that help us monitor and adjust treatments in the management of glaucoma.
Visual field testing helps us monitor exactly how much of the patients visual field has been lost or damaged. Baseline visual fields and the monitoring of visual fields over time are crucial in the management of the disease. Visual fields can be tested by confrontation, tangent screen or Goldman field testing, or by automated perimetry. Confrontation field testing is helpful for very large losses of visual field but not for small losses or change over time. Tangent screen and Goldman field testing involves human testers. This is very labor intensive and highly dependent on the skills of the test administrator. Automated perimetry involves the use of visual field machines. These visual field machines have basically replaced the older tests. In their earlier forms they would often take an extremely long time for a patient to complete. The newest visual field machines can now map out a patient’s field of vision in a couple of minutes per eye and are extremely reliable. The new machines also have new modalities that have the ability to catch early disease long before the old machines could. One of these is Sita-SWAP technology. This is Short Wavelength Automated Perimetry. It tests with a blue light against a yellow background. This is different than traditional field testing which tests a white light against a white background. The blue light on a yellow background can catch very early loss of vision from glaucoma or other diseases. The earlier visual field loss is identified the better we are able to treat the disease. Time is a key factor in both the detection and management of glaucoma.
Nerve fiber and optic nerve analysis is another very useful tool in the detection and management of glaucoma over time. There are many machines now available to analyze the nerve fiber layer of the retina and the optic nerve in the eye. In glaucoma the nerve fiber layer of the retina and the optic nerve lose tissue over time. The machines available today are able to analyze how much of these tissues have been lost and can map out that loss. One of the best machines to do this is the OCT. OCT stands for Optical Coherence Tomography. It uses near-infrared light to measure the nerve fiber layer of the retina around the optic nerve and the optic nerve tissue itself. The measurements from the OCT can be compared against normative databases. They also can be used to compare the patient’s own measurements to themselves over time. This is very beneficial when managing the disease.
Glaucoma testing is a critical part of the detection and management of glaucoma. The technological advancements in visual field testing and nerve fiber and optic nerve analysis have improved our ability to diagnose and treat the disease significantly. It is important however to view these tests in light of other clinical information and tailor treatment for each individual patient.
Treatments For Glaucoma
Glaucoma is a group of diseases that damage the optic nerves and cause loss of vision. Many types of glaucoma exist, and the goal of treatment is to save vision. Unfortunately glaucoma is the leading cause of irreversible blindness in the world, so once vision is lost from glaucoma it is permanent. Currently, glaucoma is treated by lowering the pressure in the eye. This is most commonly done with topical eye medications. Some of these medications are aimed at decreasing how much fluid is made in the eye and others are aimed at increasing the amount of fluid that drains from the eye. The drops are used between one and four times a day, depending on the medication. Unfortunately we have a limited number of medications that can be used for the treatment of glaucoma. In addition many patients develop allergies to glaucoma medications and side effects from the medications also can exist. Oral medications are sometimes used to treat glaucoma but typically less often and sometimes only for short periods of time until a patient can have surgery. Moderate cardiovascular exercise for 40 minutes four times a week has been shown in several studies to lower eye pressure as well. This can be an excellent adjunctive treatment for glaucoma.
The other mainstay treatment of glaucoma is surgery. Several types of laser and incisional surgeries exist. Laser trabeculoplasty (selective and argon) can be very effective at lowering eye pressure. Iridotomies are another laser procedure that can help in treating as well as preventing certain angle closure glaucomas.
It is common in the treatment of glaucoma to perform laser surgeries early in the disease process and even in some circumstances to prevent some types of glaucoma. Glaucoma can continue to progress despite the best medications and laser treatments. When this occurs, incisional eye surgery is typically the next treatment needed. Incisional eye surgery includes trabeculectomies and aqueous tube shunt procedures. Other surgeries exist, but these are the most commonly performed.
Both of these surgical options work by creating new ways for the fluid to drain out of the eye. By doing so, they lower the intra-ocular pressure and slow down the disease process. Trabeculectomies work without any permanent devices in the eye. Aqueous tube shunts work by placing a permanent tube into the eye.
Trabeculectomies are typically preferred to tube shunts for most types of glaucoma. However, tube shunt procedures are the preferred surgery in certain less common types of glaucoma and sometimes if a Trabeculectomy has failed.
Both surgeries offer patients the option to slow down the disease process when medical and laser treatments cannot adequately control the disease.
In some very advanced glaucoma cases a laser procedure called Transcleral Cyclophotocoagulation can be performed. This surgery is aimed at treating the muscle in the eye that produces fluid. It is often performed after other medical and surgical treatments have already been utilized.
The majority of patients with glaucoma can be treated very well with only topical medications and lasers. Fortunately for more advanced and difficult glaucoma patients several surgical options do exist. The best way to save vision loss from glaucoma is to detect the disease as early as possible and then treat it appropriately.
The Eye Care Team
Health care and the professionals who care for patients have really blossomed and changed dramatically over the years. With this expansion in the variety of health care workers, confusion has arisen about the different titles as well as the different roles that everyone plays. In a typical hospital one will find physicians, pharmacists, nurse practitioners, physician assistants, nurses, medical assistants, physical therapists, occupational therapists, just to name a few. When we take a closer look at physicians there are more specialists and sub-specialists than one can imagine.
In this article, I will attempt to discuss and describe the various members of the eye care team and the roles that each plays in caring for patients. The eye care team is made up of Ophthalmologists (MDs and DOs), Optometrists (ODs), Opticians, Nurses, Ophthalmic technicians and Ophthalmic assistants.
Ophthalmologists are physicians who typically complete 12 or more years of education after high school. This includes 4 years of college, 4 years of medical school, 1 year of a surgical and medical internship in a hospital, and 3 years in an Ophthalmology residency program studying surgical and medical treatments of all eye diseases. Some Ophthalmologists decide to continue their education an additional 1 to 2 years and complete an Ophthalmology fellowship in a sub-specialty. Ophthalmologists consist of MDs (Medical Doctor) and DOs (Doctor of Osteopathic Medicine). MDs and DOs are physicians who can train in any area of medicine from Internal Medicine to Neurosurgery to Pediatrics etc., and who choose to train in Ophthalmology.
The majority of Ophthalmologists practice General Ophthalmology after their residency training. Most Ophthalmologists focus their practice on the diagnosis and management of eye diseases by medical and or surgical treatments. Ophthalmologists also perform refractions, measuring patients for glasses and contacts. To confuse the picture further, however, there are 10 sub-specialties in Ophthalmology. The sub-specialties in Ophthalmology include; Glaucoma, Retina, Cornea, Refractive Surgery, Pediatrics and Strabismus, Oculoplastics, Uveitis, Neuro-Ophthalmolgy, Ocular Oncology, and Ocular Pathology.
Optometrists (ODs) receive a Doctor of Optometry degree. They typically complete 8 or more years of education after high school. This includes 4 years of college and 4 years in Optometry school. Some Optometrists choose to do further training after they complete Optometry school in residency programs that are typically 1 additional year of education. Optometry school includes class room education as well as clinical training with patients. The practice of Optometry has changed over the years and continues to change. In the distant past Optometrists focused more on refractive error corrections and examining the eyes. Measuring the refractive error of patients and then dispensing the proper glasses and contact lenses is both a science as well as an art. The refractive part of an eye exam remains a cornerstone of most Optometrists practices. The majority of Optometrists today also are intricately involved in diagnosing and treating eye diseases. Optometrists and Ophthalmologists often work together in the total care of the patient.
Opticians undergo training to help fit and design eyeglass lenses and the frames as well as other devices to help correct eyesight. They use prescriptions for the glasses that are written by an Ophthalmologist or Optometrist at the time of the eye exam.
Nurses, Ophthalmic technicians, and Ophthalmic assistants are medical personnel who are trained, to varying levels, to perform tests and assist the Ophthalmologist or Optometrist who is treating the patient. These medical professionals play a key role in the care of eye patients.
The eye care team is made up of many dedicated health care professionals. All members of the eye care team are very important and by working together help deliver the best eye health care possible to our patients. Hopefully this article clarifies the different roles and the importance of each of them.
The Eye Care Team
Healthcare and the professionals who care for patients have really blossomed and changed dramatically over the years. With this expansion in the variety of healthcare workers, confusion has arisen about the different titles as well as the different roles that everyone plays. In a typical hospital one will find physicians, pharmacists, nurse practitioners, physician assistants, nurses, medical assistants, physical therapists, occupational therapists, just to name a few. When we take a closer look at physicians there are more specialists and sub-specialists than one can imagine.
In this article, I will attempt to discuss and describe the various members of the eye care team and the roles that each plays in caring for patients. The eye care team is made up of ophthalmologists (MD’s and DO’s), optometrists (OD’s), opticians, nurses, ophthalmic technicians and ophthalmic assistants.
Ophthalmologists are physicians who typically complete 12 or more years of education after high school. This includes four years of college, four years of medical school, one year of a surgical and medical internship in a hospital, and three years in an ophthalmology residency program studying surgical and medical treatments of all eye diseases. Some ophthalmologists decide to continue their education an additional 1-2 years and complete an ophthalmology fellowship in a sub-specialty. Ophthalmologists consist of MD’s (medical doctor) and DO’s (doctor of osteopathic medicine). MD’s and DO’s are physicians who can train in any area of medicine from internal medicine to neurosurgery to pediatrics, etc., and who choose to train in ophthalmology.
The majority of ophthalmologists practice general ophthalmology after their residency training. Most ophthalmologists focus their practice on the diagnosis and management of eye diseases by medical and or surgical treatments. Ophthalmologists also perform refractions, measuring patients for glasses and contacts. To confuse the picture further, however, there are ten sub-specialties in ophthalmology. The sub-specialties in ophthalmology include: glaucoma, retina, cornea, refractive surgery, pediatrics and strabismus, oculoplastics, uveitis, neuro-ophthalmolgy, ocular oncology, and ocular pathology.
Optometrists (OD’s) receive a doctor of optometry degree. They typically complete eight or more years of education after high school. This includes four years of college and four years in optometry school. Some optometrists choose to do further training after they complete optometry school in residency programs that are typically one additional year of education. Optometry school includes classroom education as well as clinical training with patients. The practice of optometry has changed over the years and continues to change. In the distant past optometrists focused more on refractive error corrections and examining the eyes. Measuring the refractive error of patients and then dispensing the proper glasses and contact lenses is both a science as well as an art. The refractive part of an eye exam remains a cornerstone of most optometrists practices. The majority of optometrists today also are intricately involved in diagnosing and treating eye diseases. Optometrists and ophthalmologists often work together in the total care of the patient.
Opticians undergo training to help fit and design eyeglass lenses and the frames as well as other devices to help correct eyesight. They use prescriptions for the glasses that are written by an ophthalmologist or optometrist at the time of the eye exam.
Nurses, ophthalmic technicians, and ophthalmic assistants are medical personnel who are trained, to varying levels, to perform tests and assist the ophthalmologist or optometrist who is treating the patient. These medical professionals play a key role in the care of eye patients.
The eye care team is made up of many dedicated health care professionals. All members of the eye care team are very important and by working together help deliver the best eye health care possible to our patients. Hopefully this article clarifies the different roles and the importance of each of them.
Glaucoma: The Silent Eye Disease
Glaucoma is the second leading cause of blindness in the world. According to the World Health Organization, 5.1 million people in the world are legally blind from glaucoma. The U.S. Department of Commerce’s Bureau of the Census reported that nearly 6% of African Americans and almost 2% of Whites, Hispanics, Asians and Native Americans have glaucoma. These are staggering percentages and many people who have glaucoma are unaware that they even have the disease. Often it is diagnosed late in the disease after much of the vision has already been lost.
The optic nerve is the nerve that carries vision from our eyes to our brains. Glaucoma is a disease of the optic nerve; it is what we call an optic neuropathy. We are all born with over a million nerve fibers that travel within the optic nerve. When the optic nerve is damaged by glaucoma, these nerve fibers may be lost and vision may be diminished.
Typically glaucoma affects
peripheral, or side vision, early in the disease and only affects central vision late in the disease. This is one of
the reasons it goes undetected for many years. No other symptoms are present with many types of glaucoma except for severe vision loss late in the disease.
Glaucoma is actually not a single disease but a group of diseases with a common final pathway. The final pathway is damage to the optic nerve, which causes progressive loss of the visual field. Some of the most important risk factors for developing glaucoma are: high eye pressures, large cupping of the optic nerve (loss of nerve fibers), older age, a family history of glaucoma, African-American descent, steroid use, diabetes, and nearsightedness. Other risk factors exist and different risk factors predispose people to different types of glaucoma.
To date, there is no cure for glaucoma, and we are not able to reverse the vision loss caused by glaucoma. This is why it is so important to diagnose it and to begin treatment as early as possible in the disease. The treatment of glaucoma depends upon the severity of the disease. The goal of treatment is to slow down the progression of visual loss and this is accomplished by lowering the pressure inside of the eye. Often medication drops are placed in the eye on a daily basis as treatment. Other treatment modalities, however, are often necessary. This includes laser surgery. It also includes conventional surgery to the eye, this allows the fluid from the eye to exit in a new way thereby lowering eye pressure.
Glaucoma is a devastating group of diseases. However, most people who are diagnosed early and treated do very well. If you have risk factors for developing glaucoma or are concerned about glaucoma you should be evaluated by an ophthalmologist in your area.
