Glaucoma

  • Medical Author:
    Andrew A. Dahl, MD, FACS

    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.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    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.

Quick GuideCommon Eye Problems and Infections

Common Eye Problems and Infections

What specialists treat glaucoma?

Ophthalmologists diagnose and medically and surgically treat glaucoma. An ophthalmologist is a medical doctor who has undergone additional training to specialize in diseases and surgery of the eye.

How do physicians diagnose glaucoma?

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 measures 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). 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. Once a doctor knows the thickness of a patient's cornea, he or she can more accurately interpret the patient's tonometry.
  • Gonioscopy is done by numbing the eye with anesthetic drops and placing a special type of contact lens with mirrors onto the surface of 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, such as increased pigment in the angle or long-standing damage to the angle from prior inflammation or injury. 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 whether the eye is subject to chronic angle closure, whether blood vessels are abnormal, or whether hidden tumors 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, a head-mounted device or a special lens and the slit lamp 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. Asymmetry in the degree of optic nerve cupping between the two eyes can be a sign of glaucoma, as can increase in optic nerve cupping over a period of time. 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. In order to find and follow glaucoma, visual fields are measured by a computer one eye at a time. One eye is covered and the patient places his or her chin in a type of bowl. Lights of various intensity and size are randomly projected around inside of the bowl. When the patient sees a light, he or she pushes a button. This process produces a computerized map of the visual field, outlining the areas where each eye can or cannot see. In glaucoma, there are characteristic changes in the visual field examination.
  • Confocal laser scanning systems and optical coherence tomography are noninvasive imaging systems that create a three-dimensional image of the optic nerve and retina to evaluate the degree of cupping and the thicknesses of the retinal nerve fiber layer and ganglion cell layers to better evaluate and quantify the presence of ocular damage from all types of glaucoma.
Medically Reviewed by a Doctor on 10/20/2016

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