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Notes on Glaucoma


Visual Field testing ( perimetry ) is useful but often the first test is unreliable.

Someone should stay in room with patient and have them look straight ahead. The test is worthless if patient is looking all around. The patient needs to be instructed on how to take the test. Give patient a photocopy of the results. If we don’t check the IOP then not likely to diagnosis early or  moderate glaucoma with no symptoms.

In patients with glaucoma, the IOP should be check on each visit.  Checking the IOP regularly is the best test we can do for glaucoma patients. Once is not enough.

Patients with African ancestry should have IOP checked starting at age 20 years. Pts with African ancestry often have a more aggressive disease and are more difficult to treat / control. Glaucoma often runs in families and therefore other family members need to be checked even if living overseas.

Patients with severe optic nerve damage need their IOP lower to prevent further progression ( damage ).

Patients should be taught how to apply drops. Azopt  and  Simbrinza drops ( suspension )  need to be shaken..

Adherence  / compliance  (using any medicine as prescribed ) is quite poor in glaucoma.

If you change the drops for a glaucoma pt ( treatment regiment ), then you must bring pt back several times to see what ‘s happening to IOP. All drops do not lower IOP in all patients. This can vary.

 Laser trabeculoplasty is not an emergency. Laser treatment will not cure glaucoma but sometimes helps to get IOP in a better range. The affects of laser trabeculoplasty often are not permanent.  The benefit from laser trabeculoplasty often become less with time. Patients usually will still need drops after laser surgery. Usually I am able to do laser  trabeculoplasty in P.G., Orange Walk, or Dangriga.

Would strongly recommend giving out the handout we prepared years ago on glaucoma ( and diabetes ). We need to have pt and family learn about their disease ( glaucoma). Most pts actually remember little of what the doctor told them.

Both optic disc photos and OCT ( RNFL ) can be helpful. The OCT test does not require any subjective response from the patient. Pt can be referred for both visual fields and OCT ( RNFL ). Give pt photocopy. 

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