What Is a Glaucoma Specialist?

By Jason Wanner, DO

A glaucoma specialist is a physician who focuses their medical and surgical practice on the diagnosis and treatment of glaucoma. Health care and the professionals who care for patients have really blossomed and changed dramatically over the years. When we take a closer look at physicians there are more specialists and sub-specialists than one can imagine.

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.

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 a fellowship. Ophthalmologists who do not choose to do a fellowship are referred to as general ophthalmologists.

Fellowships in ophthalmology include glaucoma, oculoplastics, cornea and external disease, refractive, uveitis, pediatric, vitreo-retinal, ocular oncology, ophthalmic pathology, and neuro-ophthalmology. Glaucoma specialists are ophthalmologists who have gone on to do additional training in a glaucoma fellowship program. Glaucoma fellowships focus on the diagnosis as well as the medical and surgical treatments of glaucoma.

When a glaucoma specialist finishes their fellowship, they have several different paths they can take out in practice. The majority of glaucoma specialists go into private practice. This can be in a solo practice, group ophthalmology practice, or a multi-specialty practice. Some glaucoma specialists work in academics. They work in a university setting and typically split their time between research/other academic pursuits and time with patients. Still other glaucoma specialists may pursue other paths such as working for a pharmaceutical company, medical technology company, insurance company, or in the government.

Glaucoma specialists in private practice spend the majority of their time in direct patient care. This consists of office visits, laser surgeries and operating room surgeries. Initial consultation with a glaucoma specialist includes gathering a lot of historical data and performing a physical examination as well as performing glaucoma special testing. The historical data includes family history of glaucoma, any previous eye diseases, eye surgeries, or eye injuries. The physical exam focuses on the optic nerve appearance, anterior chamber angle structures, eye pressures, and corneal thickness.

Special glaucoma tests include visual field testing and nerve fiber analysis testing. The visual field testing can demonstrate depression in the field of vision from glaucoma. The nerve fiber analysis testing can demonstrate thinning of the nerve fibers that carry vision from the eye to the brain.

Glaucoma specialists utilize many medications to manage glaucoma. In addition to medications both laser surgeries and operating room surgeries can be utilized for glaucoma management. Laser surgeries for glaucoma include laser trabeculoplasty (laser to the anterior chamber angle trabecular meshwork), peripheral iridotomies (for narrow angles/angle closure glaucoma), and Cyclophotocoagulation (laser to the ciliary body to decrease aqueous production).

Operating room surgeries include trabeculectomy (creating a new drainage system through a scleral flap), glaucoma tube shunts (placing a tube into the anterior chamber of the eye that drains posteriorly to a plate), and minimally invasive anterior chamber surgeries (multiple procedures that are surgeries in the angle of the anterior chamber).

Hopefully this article sheds some light on the training glaucoma specialists undergo and what glaucoma specialists do after their training.