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.
Tonometry is an essential component of the global examination in all eye
check-ups and specifically for a glaucoma examination. A complete glaucoma
examination has a number of important components.
These tests together give a complete picture of the patient's ocular health
and therefore the risks for developing or controlling a given disease such as
cataracts, macular degeneration, or glaucoma. The following tests make up a
glaucoma examination:
medical and ocular history
visual acuity testing
refraction to measure the glasses or lens correction
tonometry testing for IOP
Slit lamp biomicroscope examination is the "stethoscope" of the eye doctor. This high-quality optical device allows the doctor to view the eyes in stereo under high
magnification while the patient places their chin on a rest and their forehead
against a bar to maintain consistent positioning. Numerous details can be
discerned by the trained observer, rendering possible a specific diagnosis,
including the etiology (or cause) of an individual patient's glaucoma.
gonioscopy to examine the aqueous humor outflow channels
peripheral visual field testing
Optic nerve head photography is taken by high-quality cameras
and recorded, usually digitally. This allows precise comparison from year to
year, permitting analysis of subtle anatomical changes over time.
Optic nerve head topography creates a precise digital image of the nerve thickness around
the optic nerve to within 1/1000 of a millimeter. Subtle loss of nerve thickness
indicates the progression of glaucoma.
Once the examinations have been completed, a decision is made as to whether
or not glaucoma treatment should be given, maintained at its current level, or
modified. If the patient is doing well, then glaucoma treatment may be withheld
or cut back. If the patient is doing poorly, then more treatment may be
recommended. There are several approaches to glaucoma treatment, any or all of
which may be appropriate for a given patient. These include but are not limited
to the following:
topical eye drop medications: beta blockers, prostaglandins, alpha
agonists, aqueous suppressants, and miotics
oral ocular hypotensive or pressure-lowering medications: most commonly acetazolamide (Diamox) or methazolamide (MZM).
laser treatment: SLT (selective laser trabeculoplasty) or
ALT (argon laser trabeculoplasty) for open-angle glaucoma and PI (peripheral iridotomy) for closed-angle glaucoma
filtering procedure: Traditional trabeculectomy surgery permits drainage of the aqueous humor in the front of the eye to a bubble or bleb on the conjunctiva, or clear surface over the white part of the eye. This surgery has been performed for centuries and has been
highly perfected under the outstanding control of the operating-room microscope
by skilled surgical hands.
shunting procedure: The eye doctor places a plastic tube and
emptying chamber into the eye in the operating room. Commonly used devices
include the Molteno shunt, the Express shunt, the Baerveldt valve, and the Ahmed
valve. This procedure accomplishes the same effect as the trabeculectomy but
generally lasts longer because the plastic tube avoids closure by normal
progressive tissue scarring.
outflow enhancement procedures: These include the viscocanalostomy or the canaloplasty operations that allow the drainage of
aqueous humor without a conjunctival bleb or plastic drainage device. Instead,
the natural drainage pathways in the anterior or front of the eye are opened
surgically, allowing more facile egress of aqueous into the channels of the
ocular surface and orbit, or eye socket.
Newer oral medication strategies to preserve or enhance optic nerve head function:
These include antioxidants such as ginkgo biloba or prescription neuro-protectants such as memantine (Namenda).
The bottom line for any patient, and particularly the patient who might be at
risk for glaucoma, is to have regular visits to your eye doctor. Patients over
the age of 50, or patients at risk of glaucoma over the age of 40, should have
regular annual eye examinations.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Glaucoma is a common eye condition in which the fluid pressure inside the eye rises because of slowed fluid drainage from the eye. If untreated, glaucoma may damage the optic nerve and other parts of the eye, causing the loss of vision or even blindness.
A cataract is an eye disease that causes the eye's lens to become cloudy and opaque with decreased vision. Causes of cataracts include diabetes, hypothyroidism, certain genetic illnesses, hyperparathyroidism, atopic dermatitis, and certain medications. Symptoms and signs include a decrease in vision and a whitish color to the affected eye. Treatment depends upon the patient's specific visual needs and may involve cataract surgery.
Toxoplasmosis (toxo) is a parasitic infection that causes flulike symptoms, swollen lymph nodes, and muscle aches and pains that may last from a few days to several weeks. Toxoplasmosis can be contracted by touching the hands to the mouth after gardening, cleaning a cat's litter box, or anything that came into contact with cat feces. Toxoplasmosis can also be contracted by eating raw or partly cooked meat, especially pork or lamb, or touching the hands to the mouth after contact with raw or undercooked meat.
Many common eye disorders resolve without treatment and some may be managed with over-the-counter (OTC) products. It's important to visit a physician or ophthalmologist is the problem involves the eyeball itself or the condition hasn't improved after 72 hours of use of an eye-care OTC product.
Uveitis is inflammation of the eye. Symptoms include blurred vision, eye pain, eye redness, and floating spots before the eyes. Treatment may involve prescription eyedrops, antibiotics, and wearing dark glasses.
Herpes of the Eye is developed by the herpes simplex 1 virus that usually lives around the nerve fibers in humans. Symptoms of herpes of the eye include pain in and around only one eye, redness rash or sores on the eyelids, redness of the eye, and swelling and cloudiness of the cornea.
Age-related macular degeneration (AMD) is a disease that gradually destroys the central vision. In people over 60, AMD is a leading cause of vision loss. Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula, leaking blood and fluid and causing rapid vision loss. In dry AMD, light-sensitive cells slowly break down in the macula, resulting in gradual vision loss. Pain is not associated with either form of AMD.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
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