Glaucoma Care in Fresno

Glaucoma is a group of eye diseases that damage the optic nerve, which carries what the eye sees to the brain. It's a leading cause of permanent blindness, and the most common type gives no warning: it doesn't hurt, and it takes away side vision so gradually that most people don't notice until a lot is gone. Vision lost to glaucoma can't be brought back. But found early and treated, glaucoma can usually be controlled, and further loss slowed or stopped.

Our doctors use advanced imaging, including OCT and visual field testing, to find glaucoma early. Treatment ranges from eye drops and selective laser trabeculoplasty (SLT) to minimally invasive glaucoma surgery (MIGS) and traditional filtration surgery.

Why glaucoma happens

The eye constantly makes a clear fluid that drains out through a spongy channel where the iris meets the cornea, called the drainage angle. When the fluid drains too slowly, pressure inside the eye can rise and damage the optic nerve. Glaucoma can also happen when eye pressure is normal.

Types of glaucoma

• Open-angle glaucoma is the most common type. The drainage angle is open, but fluid drains too slowly. It develops slowly and painlessly.
• Angle-closure glaucoma happens when the iris blocks the drainage angle. It can come on gradually, or suddenly, as an emergency (see the warning signs below).
• Normal-tension glaucoma damages the optic nerve even though eye pressure is in the normal range.
• Secondary glaucoma has another cause, such as an eye injury, inflammation, steroid medicines, diabetic eye disease, or pigment from the iris clogging the drain (pigmentary glaucoma).
• Childhood glaucoma is rare, and comes from a problem with the eye's drainage present from birth or early childhood.

Who's at risk

Anyone can get glaucoma, but your risk is higher if you:

• are over 60
• have a parent, brother or sister with glaucoma
• are of African, Hispanic or Asian descent
• have high eye pressure
• have diabetes or high blood pressure
• are very nearsighted or farsighted
• have had an eye injury
• have used steroid medicines, especially steroid eye drops, for a long time
• have thin corneas

Symptoms, and when it's an emergency

Open-angle glaucoma usually has no symptoms until it's advanced, which is why regular eye exams matter so much. When people do notice it, the first sign is often patchy blind spots in their side vision.

Sudden angle-closure glaucoma is an emergency. If you have sudden, severe eye pain, a headache, blurred vision, rainbow-colored halos around lights, a red eye, or nausea and vomiting, call us right away at (559) 449-5050, or go to the nearest emergency room.

How we test for glaucoma

Glaucoma testing is painless, and part of a comprehensive eye exam:

• Eye pressure (tonometry): a quick, painless measurement.
• An optic nerve exam, through dilated pupils.
• OCT (optical coherence tomography): a scan that measures the layer of nerve fibers around the optic nerve. It can show damage before you'd notice any change in your vision.
• Visual field testing, which maps your side vision to find blind spots.
• Gonioscopy, a look at the drainage angle, to tell open-angle from angle-closure glaucoma.
• Pachymetry, which measures how thick your corneas are.

If you have glaucoma, or are at high risk, these tests are repeated regularly, so that any change is caught and treated early.

Treatment

Treatment lowers eye pressure enough to protect the optic nerve. Your doctor will recommend a plan based on the type of glaucoma you have, how advanced it is, and your health.

Prescription eye drops

Most treatment starts with daily eye drops that lower eye pressure, either by helping fluid drain or by making the eye produce less of it. Common types include prostaglandin analogs (such as latanoprost), beta blockers (such as timolol), alpha agonists (such as brimonidine) and carbonic anhydrase inhibitors (such as dorzolamide). Drops only work if you use them every day as prescribed. If they cause side effects or are hard to keep up with, tell your doctor: there's usually an alternative. Beta blockers for glaucoma.

Selective laser trabeculoplasty (SLT)

A quick laser treatment, done in the office, that helps the eye's own drainage work better. It can be the first treatment or used alongside drops, and it can reduce the number of drops you need.

Laser iridotomy

For narrow drainage angles or angle-closure glaucoma, a laser makes a tiny opening in the iris so that fluid can flow freely.

Minimally invasive glaucoma surgery (MIGS)

Tiny devices or very small incisions improve the eye's drainage, with a faster recovery than traditional surgery. MIGS can often be done at the same time as cataract surgery.

Filtration surgery and drainage implants

When eye pressure stays too high despite other treatment, a trabeculectomy creates a new drainage channel for the fluid, or a small tube implant carries fluid out of the eye.

Living with glaucoma

Glaucoma is usually lifelong, but with early diagnosis and steady treatment, most people with glaucoma can protect their eyes against serious vision loss. Keep every follow-up appointment, use your drops as prescribed, and tell any doctor who treats you that you have glaucoma, since some medicines can raise eye pressure. Treating and controlling glaucoma.

Glaucoma questions

Can glaucoma be cured?

No, and vision it has already taken can't be restored. But treatment can slow or stop further damage, which is why finding it early matters so much.

How often should I be checked?

The American Academy of Ophthalmology recommends a baseline eye exam at 40, and regular exams after that as your eye doctor advises. If you're at higher risk, you may need them earlier and more often, and people being treated for glaucoma are usually seen several times a year. How often to get an eye exam.

Does glaucoma testing hurt?

No. The pressure check takes a few seconds, and the scans and the visual field test don't touch your eye.

If my eye pressure is high, do I have glaucoma?

Not necessarily. Some people have higher-than-average pressure without any damage to the optic nerve. That's called ocular hypertension. It raises the risk of glaucoma, so your doctor will watch it closely, and may treat it.