Once you have been diagnosed with glaucoma and started treatment, the most important part of your future care is making sure the glaucoma is stable and not getting worse. Most people who use their drops regularly do not lose vision, but glaucoma can get worse. If there are signs of glaucoma advancing, additional treatments may be needed and your target pressure may need to be decreased. There were several clues that your doctor used in making the initial diagnosis of glaucoma. These same clues are monitored to see if glaucoma is getting worse.
Regular Eye Exams
As a glaucoma patient, you will have a continued need for regular eye exams throughout the rest of your life. The purpose of these exams is to assess the health of your eye and look for signs of the glaucoma getting worse. The exams are also necessary to see if you are having side effects or problems with your medications. A glaucoma patient needs an exam at least every 6 months, and some patients with uncontrolled glaucoma may need to get checked every few weeks. On average a glaucoma patient should expect to have their eye pressure checked every 4 months.
Since all glaucoma treatments are designed to lower the eye pressure, a main reason for a visit with your eye doctor is to check the eye pressure–this way your doctor can determine if the treatments he has prescribed are helping. The eye pressure can be measured with several different measuring devices. Each of them is painless and takes only a minute for the test. Unfortunately, there are no accurate at home eye pressure measurement devices. The eye pressure fluctuates during the day. It is usually higher in the early morning and decreases later in the afternoon. If you have glaucoma you should have your eye pressure checked at least a few times each year, with some pressure readings in the morning and some in the afternoon to measure your personal pressure variability during the day. High fluctuation may be a risk factor for nerve damage. Because most pressure readings are done to see if a treatment is effective, it is important that you use any eye drops correctly on the day of your appointment. Tell the doctor if you have missed any eye drop doses recently, especially any missed doses on the day of your appointment.
To fully examine the inside of the eye including the optic nerve and retina your pupil will need to be enlarged with dilating drops. This is typically done once each year. The dilating drops may make your vision blurry for up to 4 hours, so it is best to have a friend or family member drive you home on the day of your dilated eye exam.
Refraction is the procedure where small lenses are placed in front of the eye to determine the correct prescription for glasses. A refraction is usually done at the first visit, and then at any time you need updated glasses. Most medical insurance companies do not cover refraction. Some people have separate VISION insurance that covers refractions and glasses every year or two. If you do not have vision insurance and you would like a refraction and a prescription for new glasses, there will be an additional charge for this service on the day of your glaucoma exam.
Because glaucoma causes optic nerve damage, your optic nerve needs to be carefully examined at least yearly. By looking at the nerve and comparing the nerve appearance to past nerve photographs, your doctor can determine if any progressive nerve damage is developing. Photos are usually done once a year to help determine if continuing nerve damage is occurring. Signs of nerve damage include small spots of blood (hemorrhages), thinning of the nerve layers around the nerve, increased size of the central “donut hole” (cupping), or thinning of the rim of the nerve.
Nerve Fiber Layer
The inside of the eye is covered with a thin carpet of nerve fibers. Glaucoma damage causes these small nerve fibers to degenerate. As degeneration occurs, the nerve fiber layer, or carpet inside the eye gets thinner. High technology tests have been developed that measure the thickness of the nerve layers inside the eye. The OCT or GDx tests take this measurement. They are usually done once a year to help determine if continued glaucoma damage is developing. These tests are painless and generally take less than 5 minutes to complete.
The final test that is done on a regular basis to monitor glaucoma is the visual field test. Most patients don’t look forward to taking this test as it is a little tedious. To be a good test taker you need to stay alert and keep your attention focused on the central target. Don’t look around trying to see the flashing lights, but keep staring straight ahead. As the lights flash in the peripheral vision some will be very bright and others very dim. If you think you see a light, then you should push the button. Don’t worry if you miss a few; the test is designed to measure the dimmest lights you can see. If you miss a few, the computer will retest any areas that need to be rechecked. Most glaucoma patients will do 2 tests within the first 6 months, and then repeat the test yearly. Patients with more advanced glaucoma damage may need to do the test more frequently, every 4-6 months.