Glaucoma or intraocular pressure problems
Assessment, Management (both laser and medical eye drop treatment) and Follow-up for detailed monitoring:
Glaucoma is a common eye condition seen in the over-60’s which is usually detected at routine optician visits as it is initially asymptomatic. This disease is due to the intraocular pressure (IOP) being too high for the health of the optic nerve, seen at the very back of the eye in the centre of the retina. Untreated, it is a potentially blinding condition, because pressure-excavation and damage to the delicate optic nerve is wholly irreversible. Management therefore relies on detection, effective lowering of intraocular pressure, and regular checks of pressure, eye and visual fields to detect change and initiate further treatment if necessary. Nowadays there are many excellent anti-glaucoma eye medications which come in eyedrop form and are used 1-3 times daily. Sometimes laser treatment (there are several different types and treatments available for different glaucoma types) is necessary, and very occasionally formal glaucoma drainage surgery if the IOP remains uncontrolled. I perform regular glaucoma assessments on private and NHS patients, and can recommend newer effective anti glaucoma medication which your GP practice will re-prescribe.
Things to know
Regular threshold visual field testing of each eye separately is necessary occasionally several times a year to detect progression: if this is done at your own opticians, bringing a copy with you will be helpful.
Regular instilling of the eyedrops, exactly as prescribed, is critical in effective control; as is instilling drops on the day of the consultation just as usual – please don’t omit drops on the day of consultation. Please ensure you never run out of drops at home.
The Albyn does not use the rather unpleasant air-puff IOP measurement, but Goldman Aplanation Tonometry which involves a drop of anaesthetic to the eye and is entirely painless – and very accurate. A Humphrey threshold visual field test is the preferred field test type, and this is performed at the Albyn. Several local opticians also have this type of visual field machine.
Private medical insurance companies are increasingly reluctant to fund glaucoma monitoring, although this is critical to detect if there is any progression of the glaucoma and hence need for further treatment: if your optician performs this monitoring, I request that you be re-referred to me if any change is detected, or there is concern.
You must inform the DVLA if you have a diagnosis of glaucoma: they will arrange formal testing of your visual function (visual acuity and binocular fields etc) in order to allow continued safe driving.
Mr. Christopher Scott
MB ChB FRCOphth
BMI Albyn Hospital
21-24 Albyn Place