Glaucoma Monitoring

The target pressure

At diagnosis, a target pressure is set: the level at which, for this eye at this stage of damage, further loss is unlikely. An eye with mild damage might have a target in the high teens; an eye with advanced damage, low teens or below. Every monitoring visit checks whether the pressure is at target and, more importantly, whether the nerve is stable at that pressure. If it is not, the target is lowered and treatment increased.

What happens at a visit

• Vision and pressure measurement, ideally at different times of day across visits, since pressure fluctuates
• A review of your drops: which ones, how often, and honestly whether doses are being missed, because missed doses are the most common cause of progression
• Examination of the optic nerve and, at intervals, the drainage angle
• OCT of the nerve fiber layer, compared statistically with all previous scans to detect a trend
• Visual field testing, compared with the baseline and with previous tests, with a change confirmed on repeat before it is acted upon
• A decision: continue, adjust, or escalate

How often

Newly diagnosed patients and those whose treatment has just changed are seen every one to three months until control is established. Stable early glaucoma is monitored every six to twelve months, with OCT and fields yearly. Moderate and advanced disease is seen every three to six months with more frequent testing, because there is less nerve left to lose. Glaucoma suspects and ocular hypertension are monitored every six to twelve months.

Working with your optometrist

Many patients have routine pressure checks and examinations with their optometrist between visits here, with OCT and fields performed with us and results shared both ways. This keeps monitoring convenient without losing the specialist oversight of the imaging trend. We keep your optometrist informed.

Your part

Use the drops as prescribed, every day, and tell us if cost, side effects or forgetting are a problem, because there are alternatives, including laser, that solve each of those. Keep the appointments even when your vision feels fine, since it will feel fine until it does not. Bring your drops to each visit. Tell relatives to be checked.