Andrew A. Dahl, MD, is a board-certified ophthalmologist. Dr. Dahl's educational background includes a BA with Honors and Distinction from Wesleyan University, Middletown, CT, and an MD from Cornell University, where he was selected for Alpha Omega Alpha, the national medical honor society. He had an internal medical internship at the New York Hospital/Cornell Medical Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
An eye doctor (ophthalmologist) can usually detect those individuals who are at risk for glaucoma (because of, for example, a narrow
drainage angle or increased intraocular pressure) before nerve damage occurs. The doctor also can diagnose patients who already have glaucoma by observing their nerve damage or visual field loss. The following tests, all of which are painless, may be part of this evaluation.
Tonometry determines the pressure in the eye by measuring the tone or firmness of its surface. Several types of tonometers are available for this test, the most common being the applanation tonometer. After the eye has been numbed with anesthetic
eyedrops, the tonometer's sensor is placed against the front surface of the eye. The firmer the tone of the surface of the eye, the higher the pressure reading.
Pachymetry is a relatively new test being used for the diagnosis and treatment of glaucoma. Pachymetry determines the thickness of the cornea. After the eye has been numbed with anesthetic
eyedrops, the pachymeter tip is touched lightly to the front surface of the eye (cornea). Recent studies have shown that corneal thickness can affect the measurement of intraocular pressure. Thicker corneas may give falsely high eye pressure readings and thinner corneas may give falsely low pressure readings. Furthermore, thin corneas may be an additional risk factor for glaucoma.
Gonioscopy is done by numbing the eye with anesthetic drops and placing a special type of contact lens with mirrors inside the eye. The mirrors enable the doctor to view the interior of the eye from different directions. The purpose of this test is to examine the drainage angle and drainage area of the eye. In this procedure, the doctor can determine whether the angle is open or narrow and find any other abnormalities within the angle area. As indicated earlier, individuals with narrow angles have an increased risk for a sudden closure of the angle, which can cause an acute angle-closure glaucomatous attack. Gonioscopy can also determine if anything, such as abnormal blood vessels, might be blocking the drainage of the aqueous fluid out of the eye.
Ophthalmoscopy is an examination in which the doctor uses a handheld device to look directly through the pupil (the opening in the colored iris) into the eye. This procedure is done to examine the optic nerve (seen as the optic disc) at the back of the eye. Damage to the optic nerve, called cupping of the disc, can be detected in this way. Cupping, which is an indentation of the optic disc, can be caused by increased intraocular pressure. Additionally, a pale color of the nerve can suggest damage to the nerve from poor blood flow or increased intraocular pressure. Special cameras can be used to take photographs of the optic nerve to compare changes over time.
Visual Field testing actually maps the visual fields to detect any early (or late) signs of glaucomatous damage to the optic nerve. This test can be grossly done by having the patient look straight ahead with one eye covered and count the fingers shown by the examiner from the side. More typically, however, visual fields are measured by a computerized assessment. For this procedure, one eye is covered and the patient places his or her chin in a type of bowl. Then, when the patient sees lights of various intensities and at different locations, he or she pushes a button. This process produces a computerized map of the visual field, outlining the areas where the eye can or cannot see.
Other, more sophisticated tests may also be employed. All of these tests need to be repeated at intervals to assess the progress of the disease and the effect of the treatment.