Edison, NJ Ophthalmologist Dr. Hitesh K. Patel On Glaucoma Diagnosis & Treatment

June 30, 2010 - PRLog -- Edison, NJ Ophthalmologist, Dr. Hitesh K. Patel Discusses Glaucoma Diagnosis & Treatment

Glaucoma is a group of eye diseases that lead to damage of the optic nerve (the bundle of nerve fibers that carries information from the eye to the brain), which can then lead to vision loss and possibly blindness. Optic nerve damage usually occurs in the presence of high eye (intraocular) pressure; however, it can occur with normal or even less than normal eye pressure.

In the U.S., approximately 2.2 million people age 40 and older have glaucoma, and of these, as many as 120,000 are blind. An estimated 3.3 million Americans could have glaucoma by the year 2020. Vision experts believe that half of those affected by glaucoma may not know it, since there are usually no symptoms in its early stages. By the time an individual notices something is wrong, the disease has already caused considerable damage. Vision lost to glaucoma cannot be regained. Although there is no cure, medications and surgery can help slow the disease’s progression.

The most common type of glaucoma is “open-angle glaucoma”. Each day, the eye produces about 1 teaspoon of aqueous humor − a clear fluid that provides nutrients to, and carries waste products away from, the lens and cornea. Ordinarily, fluid production and drainage are in balance. In people with open-angle glaucoma who have higher-than-normal intraocular pressure levels, ophthalmologists suspect that a partial blockage traps the aqueous humor. As more aqueous humor is produced than is removed, the blockage causes an increase in IOP. When IOP remains elevated or continues to rise, fibers in the optic nerve are compressed and eventually die, leading to a gradual loss of vision.

Glaucoma usually occurs in both the eyes, but extra fluid pressure often begins to build in only one eye first. Early visual changes are very slight and do not affect the central vision; but, over time, parts of peripheral vision (the top, sides, and bottom areas of vision) can be lost.

People with advanced open-angle glaucoma can have 20/20 vision when looking straight ahead but may have blind spots (Scotomas) for images located outside the center of the visual field. Eventually, the fibers needed for central vision may be lost as well.

Unlike the open-angle form, closed-angle glaucoma sometimes occurs as acute attacks, as intraocular pressure rises rapidly to a dangerous level. Signs of an attack include severe pain in the eye, nausea and vomiting, blurred vision, and rainbow-colored halos around lights.

If your doctor suspects that you have glaucoma, he or she may perform a series of tests to detect any signs of damage. Tests include:

1)   Tonometry
2)   Test For Optic Nerve Damage
3)   Visual Field Test
4)   Pachymetry

5)   Other Tests: To distinguish between open-angle glaucoma and angle-closure glaucoma, your eye doctor may use a technique called Gonioscopy (go-ne-OS-kuh-pe), in which a special lens with an angled mirror is placed on the eye to inspect the drainage angle. Another test, Tonography, can measure how fast the fluid drains.

To establish a diagnosis of glaucoma, several factors must be present. These usually include elevated intraocular pressure, areas of vision loss and damage to the optic nerve.

How is Glaucoma Treated?
Glaucoma is a chronic disorder that cannot be cured. Open-angle glaucoma often can be treated safely and effectively with medication or surgery, though lifelong therapy is almost always necessary. Decisions on when to start treatment are based on evidence of optic nerve damage, visual field loss, and risk factors (such as elevated intraocular pressure, or "IOP", increasing age, and African-American or Hispanic background). The overall aim in the treatment of glaucoma is to prevent damage to the optic nerve by lowering IOP and maintaining it at a level that is unlikely to cause further nerve damage.

Glaucoma can be treated with eye-drops, pills, laser surgery, eye operations or a combination of these methods.

Two forms of medications are used to treat glaucoma:  Eye drops and oral drugs. They work by either slowing the production of aqueous fluid within the eye or by improving the flow through the drainage meshwork.

LASER SURGERY (Laser Trabeculoplasty):
Laser surgery helps fluid drain out of the eye, for people with open-angle glaucoma. Although it may be done at any time, the procedure is often done after trying medicines. Trabeculoplasty can be done if patients want to avoid the expense and the hassle of using drops.

Laser surgery may be performed in your doctor's office or in an eye clinic. Although laser surgery reduces eye pressure, its benefits may wear off over time. About half of all patients show increased eye pressure two years after laser surgery. Conventional surgery may be required if medicine and laser surgery have failed to control your eye pressure.

Iridotomy is the treatment for closed-angle glaucoma. Using a laser (laser iridotomy) or surgical instrument (peripheral iridectomy), the surgeon makes a small opening in the iris to reduce eye pressure and allow fluid drainage into the anterior chamber.

Filtering surgery (most commonly called a trabeculectomy) treats several types of glaucoma. This procedure allows fluid to drain more easily and reduces eye pressure. Most people are able to discontinue all anti-glaucoma medicines after trabeculectomy, but some people may need more surgery. Although trabeculectomy is a relatively safe procedure, about 1/3 of patients develop cataracts within five years after surgery.

People over 40 or those with a family history of glaucoma should be screened yearly, because they will experience no symptoms in the initial stages of glaucoma and therefore would be unaware of the disorder’s progression.

For more information on the diagnosis and treatment for glaucoma, visit www.pateleyeassociates.com or contact Patel Eye Associates at (732) 985-5009.

Dr. Hitesh K. Patel is the founder of "Patel Eye Associates" and "Patel Eye Care and Rehabilitation Foundation". His practice focus is cataract and Lasik surgery. In addition, he treats diabetic retinopathy and glaucoma medically and with lasers. He also does routine eye exams. Dr. Patel has been in practice for 12 years in the Northeast.

Dr. Patel did his residency at UMDNJ and The Cleveland Clinic Foundation. His internship was completed at the The Crozer Chester Medical Center. Dr. Patel completed his medical degree at Jefferson Medical College in Philadelphia in 1993, and finished at the top his class. His undergraduate degree (B.S.) was done at The Pennsylvania State University in 1993, with distinction. Dr. Patel finished his high school as Valedictorian at Neshaminy High School in Pennsylvania.