Your Glaucoma Evaluation

Who should have one

Anyone told at a routine exam that their pressure or optic nerve looked suspicious; anyone with a family history of glaucoma; adults over 60, and Black and Hispanic adults over 40; patients with diabetes, high myopia or long-term steroid use; and anyone with symptoms of angle closure, such as intermittent eye ache with halos around lights. Patients already diagnosed have a version of this evaluation at each monitoring visit.

The tests, in order

• Vision and refraction, as a baseline
• Tonometry: eye pressure, measured by applanation, the standard clinical method, rather than an air puff
• Pachymetry: corneal thickness, because a thin cornea under-reads pressure and is itself a risk factor
• Gonioscopy: a mirrored contact lens placed briefly on the numbed eye to see the drainage angle and classify it as open or narrow, which determines the type of glaucoma and the treatment
• Optical coherence tomography: a scan of the optic nerve and the retinal nerve fiber layer, measured against a normal database, which detects damage before vision changes
• Visual field testing: a computerized map of your peripheral vision, taken one eye at a time by responding to lights, which shows the functional effect of any nerve damage
• Dilated examination of the optic nerve, assessing its cup, rim and any hemorrhages, and of the retina

What the results mean

The findings are combined rather than read in isolation. High pressure with a normal nerve and field is ocular hypertension, a risk state that may be watched or treated depending on how high the pressure is and other risks. A suspicious nerve with normal fields is a glaucoma suspect, followed with repeat imaging. Nerve fiber loss with a matching field defect is glaucoma, staged as early, moderate or advanced, and treated. A narrow angle changes the plan regardless of the other findings, because it can close.

Leaving with a plan

You will hear plainly what was found, what it means for your vision, and what happens next: a target pressure and a first treatment if glaucoma is diagnosed, or an interval for the next check if you are a suspect. The tests from this visit become the baseline against which every future visit is compared.