Generally, glaucoma can be diagnosed through a comprehensive examination of the eyes. In this exam there are many different steps that test for vision, pressure, and overall health of the eyes. Before any tests begin your doctor will numb your eyes through a procedure called pachymetry. After the numbing, the preliminary test for glaucoma involves measuring the pressure inside the eye with an instrument called a tonometer. The next basic steps to the exam are a visual field test, for your peripheral vision, and a visual acuity test, for your distance vision. Your doctor can also check for optic nerve damage through a dilated eye exam.
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Eye doctors-either an ophthalmologist or optometrist-diagnose glaucoma by checking for vision loss with an eye chart and with visual field testing. They also perform tonometry, a standard test to measure the fluid pressure inside the eye, and will use a special lens to examine the angle of the eye. Then, after using special eye drops to dilate (widen) your pupil, your doctor will look directly inside your eye to inspect the optic nerve for signs of damage.
UCLA Health answeredFamily history and regular eye exams for at-risk patients (particularly African Americans) are vital to pick up signs of glaucoma, which tends not to show early visual symptoms; instruments used by eye-care professionals are required to determine presence of the condition. Symptoms of glaucoma can include eye pain, particularly if it is severe and associated with nausea and headache, or redness.
Diagnosis of glaucoma might begin at your primary care doctor's office when he or she asks about vision or eye symptoms, but a thorough workup usually requires further tests with an ophthalmologist, or eye doctor. Tests include looking at the optic nerve disc at the back of the eye, testing visual fields with one or more types of perimetry technology, measuring the pressure within the eye, and sometimes measuring the thickness of the cornea as well. For some types of glaucoma additional exams may also include measuring the angle of closure between the chambers of the eye. Although there is evidence that early detection and management of increased ocular pressure is beneficial in preventing glaucoma, there are currently no recommendations by the U.S. Preventive Services Task Force (USPSTF) for glaucoma screening.
To establish a diagnosis of glaucoma, several factors must be present, including an elevated intraocular pressure (except in normal tension glaucoma), areas of vision loss, and damage to the optic nerve. In glaucoma, the optic disk shows visible signs of damage. The optic disk is the area where all of the nerve fibers come together at the back of the eye before exiting the eyeball. An optic disk that has been affected by glaucoma appears indented or excavated, as if someone scooped out part of the center of the disk. This condition is known as cupping. The normal contour and color of the disk may also be affected by the loss of nerve fibers.
Tonometry: Tonometry is the measurement of intraocular pressure (IOP, or the pressure inside the eye) and can be carried out with several different instruments. In general, Goldmann applanation tonometry (with the blue light) is used in hospitals and non-contact (air puff) tonometry is used in optometric (optician and ophthamalogical) practices. Goldmann applanation tonometry involves the administration of local anesthetic drops (with a yellow dye called fluorescein) to allow the instrument to touch the front of the eye. The drops may sting, but the procedure itself is completely painless. It is generally considered to be the most accurate method of measuring the pressure. In non-contact tonometry, a puff of air is blown at the eye from the instrument. This does not require any form of anesthetic and is generally considered to be somewhat less accurate.
Ophthalmoscopy: The appearance of the optic disc can be examined by an ophthalmologist (eye doctor) using an ophthalmoscope (a special lighted instrument) or by the use of a slit lamp. An ophthalmoscope enables the doctor to look directly through the pupil to the back of the eye. This allows the examiner to assess the degree of cupping of the optic disc, check nerve fiber damage, and the health of the retina.
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Regular eye examinations by your ophthalmologist are the best way to detect glaucoma. A glaucoma screening that checks only the pressure of the eye is not sufficient to determine if you have glaucoma. The only sure way to detect glaucoma is to have a complete eye examination.
During your glaucoma evaluation, your ophthalmologist will:
- Measure your intraocular pressure (tonometry)
- Inspect the drainage angle of your eye (gonioscopy)
- Evaluate whether or not there is any optic nerve damage (ophthalmoscopy)
- Test the peripheral vision of each eye (visual field testing, or perimetry)
Photography of the optic nerve or other computerized imaging may be recommended. Some of these tests may not be necessary for everyone. These tests may need to be repeated on a regular basis to monitor any changes in your condition.
Laura Fine, MD, Ophthalmology, answeredTo diagnose glaucoma (a group of eye diseases that cause vision loss through damage to the optic nerve), the ophthalmologist evaluates pressure in the eye through tonometry. Normal pressure is 8 to 21 millimeters of mercury (mm Hg), but people with eye pressure in this range may still develop the disease. Conversely, those who have slightly elevated pressure may not be destined to get glaucoma; how much stress the optic nerve (nerve fibers that transmit visual impulses to the brain) can withstand differs for each person and each eye, largely due to genetic factors.
A thorough evaluation of the optic nerve should be part of a routine eye exam. This is best done with a dilated pupil (black hole in the center of the eye). The doctor uses both a slit lamp (instrument that magnifies internal structures of the eye with the aid of a slit beam of light) and an ophthalmoscope (instrument for examining the deep interior of the eye) to look for any deterioration of the nerve. If the optic disc, the front surface of the optic nerve, is affected by glaucoma, the doctor may observe a characteristic called cupping: the disc may appear indented, and its color -- normally pinkish yellow -- may turn pale and more yellow because the advancing disease has hindered blood flow to the optic nerve.Helpful? 1 person found this helpful.
Early detection and treatment of glaucoma are important for controlling the condition and preventing blindness.
A doctor evaluating possible glaucoma will take a medical history and do a physical exam. If your doctor suspects glaucoma, he or she will refer you to an eye specialist (ophthalmologist).
The eye specialist will check your eyes to help find out if you have the disease and how severe it is. He or she will look for certain signs of damage in the eye by checking things like:
- Eye structure. Ophthalmoscopy, gonioscopy, slit lamp exam, and optic coherence tomography all check the structures of the eye.
- Eye pressure. Tonometry measures the pressure in the eye (intraocular pressure, or IOP).
- Vision tests. These include tests to check for visual acuity and loss of side and central vision ( perimetry testing ).
- Cornea thickness. Tests such as ultrasound pachymetry measure the thickness of the clear front surface of the eye ( cornea ). Cornea thickness, along with intraocular pressure, helps determine your risk for glaucoma.
After glaucoma is diagnosed, eye exams are done on a regular basis to monitor the disease.
Your doctor may also do a low-vision evaluation to help find ways you can make the most of your remaining vision and maintain your quality of life.
If you are younger than 40 and have no known risk factors for glaucoma, the American Academy of Ophthalmology (AAO) recommends that you have a complete eye exam every 5 to 10 years. This includes tests that check for glaucoma. The AAO suggests more frequent routine eye exams as you age, even if you aren't at increased risk for glaucoma.
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