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  1. 1. How is glaucoma treated and managed? remember to use your eye drop on the day of the eye check-up Glaucoma is controlled by lowering the eye pressure. This can be achieved with eye drops or medications, laser treatment or surgery. Treatment is individualized and regular monitoring is required after successful control of the eye pressure. It is important to know that pre-existing damage to the optic nerve cannot be improved or reversed with treatment hence it is important to have early eye screening to detect glaucoma. Glaucoma treatment aims to preserve the remaining vision and requires life-long monitoring. The eye specialist will discuss the treatment options most suited for your condition. do not miss your eye drops. If you are running out eye drops, return to the clinic for a new prescription in advance Eagle Eye Centre has a comprehensive list of anti-glaucoma medications available for controlling intraocular pressures including the latest combination therapy eye drops. We perform lasers for glaucoma including argon laser peripheral iridotomy, laser iridoplasty, trans-scleral cyclophotocoagulation and laser suturelysis after trabeculectomy. Glaucoma surgeries performed at EEC include - trabeculectomy with anti-metabolites; phaco-trabeculectomies (combined cataract and glaucoma surgery) with anti-metabolites; glaucoma bleb needling with anti-metabolites; glaucoma (bleb) revision surgeries; and glaucoma drainage implants. How do I use my eye drops? Compliance to eye drops plays a major role in success of glaucoma treatment and control of the disease. Use your eye drops as instructed If you have more than 2 eye drops to instill at the same time, wait for at least 5 minutes before instilling the next eye drop you can minimize absorption through the nasal passages by placing your index finger against the inner corner of your eye (against the nasal bone) for 30 seconds excess eye drops should be cleaned from the skin with a moistened tissue or towel time your eye drop with certain activities or set an alarm to help you remember to instill your eye drop everyday bring your medications along for each visit to the eye doctor Inform the doctor if you have any problems with the eye drops When should I get an eye check for glaucoma? Early detection and appropriate treatment can prevent blindness in glaucoma. If you have any of the following, it is advisable to have an eye check done by an eye specialist: Age 40 years and older have a family member or relative with glaucoma on steroid medications had previous injury to the eye had previous surgeries to the eye have diabetes have high myopia or high hyperopia blurred vision intermittent eye pain known to have inflammation of the eyes Laser Treatment for angle closure Patients who are found to have narrow or closed drainage passages (angles) of the eye are at increased risk of developing angle closure glaucoma. In the acute situation, the eye pressure increases suddenly, rising to a very high level. This occurs as the eye fluid is trapped behind the iris at the pupil and closes the drainage passages (angles) of the eye. There is hence obstruction of outflow of the eye fluid, leading to buildup of the fluid in the eye and an increase in the eye pressure. Laser peripheral iridotomy helps to reduce the risk of this ocular emergency. The laser creates a small fluid channel in the periphery of the iris allowing the fluid from behind the iris to flow forward and through the drainage passages of the eye thus preventing a sudden rise in eye pressure. The laser is done as an outpatient procedure. The eye is prepared with eye drops to constrict the pupil and to anaesthetize the eye. Some patients may experience a transient eye ache or headache or dimming of vision with these eye drops. Eye drops or medications may be given to lower the eye pressure before the laser procedure. A contact lens will be placed on the eye during the laser procedure. The laser is usually painless and an aching sensation may be felt in some patients. The patient is seated much like the eye examination at the slit-lamp in the clinic. The eye pressure is checked again after the laser. The laser procedure is not a surgery and requires minimal after care. Eye rubbing should be avoided. The vision may appear cloudy for a few hours after the laser. Eye drops are required for 1 to 2 weeks after the laser. There are no restrictions to daily activities. Some patients may experience glare symptoms after the laser. The possible risks of the laser include increased eye pressures, damage to the surrounding eye structures like to the corneal cells that can result in loss of corneal clarity later. Please approach your eye specialist if you have any questions on this procedure. Eagle Eye Centre @ Mount Alvernia Mount Alvernia Hospital 820 Thomson Road, #02-10/17, Medical Centre Blk B, Singapore 574623 Tel: 6456-1000 / 6-eagleye (6324-5393) Fax: 6456-1006 Eagle Eye Centre @ Mount Elizabeth Mount Elizabeth Medical Centre 3 Mount Elizabeth, #08-02, Singapore 228510 Tel: 6836-0001 Fax: 6836-0002 Eagle Eye Centre @ Parkway East Parkway East Medical Centre 319 Joo Chiat Place, #05-03, Singapore 427989 Tel: 6348-1000 Fax: 6348-1001 Eagle Eye Centre @ Mount Elizabeth Novena Mount Elizabeth Novena Specialist Centre 38 Irrawaddy Road, #08-22/23/24, Singapore 329563 Tel: 6570-1000 Fax: 6570-1001 Email: Website: GLAUCOMA
  2. 2. Chronic diseases like diabetes and high blood pressure Glaucoma Glaucoma is a leading cause of irreversible blindness in the world and accounts for 40% of blindness in Singapore. People of different races and ages are affected by glaucoma. It is often called the ‘silent thief of sight’ as patients often do not have symptoms until in advanced disease. Early detection and treatment will prevent irreversible visual loss and blindness from glaucoma. What is Glaucoma? Glaucoma is an eye disease that affects the optic nerve. The optic nerve transmits visual information from the eye to the brain. In glaucoma, there is characteristic damage to the optic nerve resulting in loss of vision. Steroid medication use - prolonged steroid use (eye drops or medications) can cause raised eye pressures in certain individuals (steroid responders) High myopia and hyperopia Inflammation of the eye Advanced cataracts Previous eye surgeries The peripheral vision is usually affected first as the optic nerve is progressively damaged in glaucoma. This is usually symptomless and goes unnoticed as central vision remains normal. Later the peripheral visual loss progresses towards the center leading to tunnel vision and in advanced cases central vision is lost. The patient hence notices blurred vision late in the disease when irreversible damage has already occurred. The Optic Nerve is Damaged in Glaucoma What causes Glaucoma? Am I at risk of Glaucoma? The major risk factor for glaucoma is raised eye pressures (intraocular pressure). This occurs when there is an imbalance of fluid production in the eye and its drainage from the eye. The eye pressure at which optic nerve damage occurs varies between individuals. Even in a population normal range of eye pressures optic nerve damage can still occur. Other risk factors for glaucoma include: Age; Glaucoma can occur at any age. The risk of glaucoma increases with age. In Singapore, 3% of those over 50 years old and 10% over 70 years old are affected by glaucoma. Peripheral Vision is progressively lost in Glaucoma Is Glaucoma inherited? Glaucoma can affect members in the same family. Those with a family member or relative with glaucoma (Family History of Glaucoma) is at an increased risk of glaucoma and should have glaucoma eye screening by an eye specialist. T ypes of Glaucoma and their symptoms The different types of glaucoma include open and closed angle glaucoma, secondary glaucoma and congenital glaucoma. Family History - a family member or relative with glaucoma can increase your chance of having glaucoma Open angle glaucoma The drainage passage (angle) of the eye is structurally open in Open-angle glaucoma and accounts for the majority of glaucoma. This type of glaucoma usually has no symptoms and progresses slowly. Early eye screening is the only way to detect this type of glaucoma. Eye Injury - a serious eye injury can cause glaucoma many years later Closed angle glaucoma Occurs when the drainage passage (angle) is narrow or closed. There is obstruction to the outflow and drainage of the fluid in the eye leading to increase in eye pressures. This rise in pressure can occur suddenly and rapidly, leading to damage of the optic nerve. Acute angle closure glaucoma is an ocular emergency and requires prompt treatment. Symptoms include severe eye pain associated with headache on the same side, nausea and vomiting, blurred vision and haloes around lights and redness of the eye. Chronic angle closure glaucoma may be asymptomatic where the pressure rise is gradual like open angle glaucoma. Individuals with narrow or occludable angles are at risk of developing acute angle closure glaucoma. Laser treatment in such cases help to reduce the risk of sudden rise in eye pressures. See Laser treatment for angle closure. Secondary Glaucoma This type of glaucoma is associated with diseases of the eye – previous eye injury or surgeries; inflammation of the eye; advanced cataracts and use of steroid medications. It can also be caused by medical conditions such as diabetes. Patients may experience eye pain, halos around lights, blurred vision and red eyes in these conditions. Congenital Glaucoma Congenital glaucoma is a rare eye disease that occurs at birth. An eye examination is required if the infant’s eye is found to be enlarged, loss of clarity of the cornea, tearing and is unusually sensitive to light. What tests are done during an eye examination to detect and monitor Glaucoma? The vision (visual acuity), the eye pressure, the drainage passages (angles) and the optic nerve are assessed. The visual field test is performed to detect glaucoma damage to the optic nerve. This test also helps the doctor determine if the glaucoma is stable or worsening. Optic nerve imaging tests maybe used to diagnose and monitor glaucoma. Automated Humphrey Visual Field Testing at Eagle Eye Centre At Eagle Eye Centre, we provide a comprehensive service for glaucoma screening and management. We have the latest automated visual field machines, anterior segment imaging and optic nerve imaging technology to diagnose and management glaucoma. Optic Nerve Coherence Tomography At Eagle Eye Centre Besides managing high pressure glaucoma, we also manage Normal Tension Glaucoma or Normal Pressure Glaucoma. At Eagle Eye Centre, we have a developed program to diagnose and manage Normal Tension Glaucoma - tests include phasing eye pressure testing, questionnaires, posture eye pressure testing and use of our imaging technology. Our Glaucoma Specialist Performing an Eye Pressure Examination