Understand the diagnostic process for Glaucoma. Learn about the various tests used to measure eye pressure, check the optic nerve, and map your field of vision.
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Diagnosis and Tests
Diagnosing this condition requires more than just a simple pressure check. Because it is a complex group of diseases, a specialist must look at several different factors to get a complete picture. The goal of the diagnostic process is to determine if damage is present, how severe it is, and what the target pressure should be to prevent future loss. Modern clinics use a combination of physical exams and digital imaging to provide the most accurate assessment possible.
Tonometry is the procedure used to measure the pressure inside your eye. This is a fundamental part of every eye exam.
While high pressure is a major red flag, it is only one piece of the puzzle.
Perimetry is a test that measures your peripheral or side vision. During this test, you look into a machine and click a button every time you see a small flash of light in your periphery. This creates a map of your visual field.
Ophthalmoscopy is the examination of the back of the eye where the optic nerve is located. The specialist uses a bright light and a magnifying lens to look at the shape and color of the nerve. They are specifically looking for a sign called cupping. As nerve fibers die, the small depression in the center of the nerve becomes larger. By documenting the cup to disc ratio, the specialist can monitor if the nerve is changing over months or years. This is one of the most direct ways to see if the condition is progressing.
Gonioscopy is a specialized test used to determine if the drainage angle where the iris and cornea meet is open or closed. The specialist places a special lens with a mirror on the surface of your eye. This allows them to see directly into the angle. Knowing whether the angle is wide open, narrow, or completely blocked is vital for choosing the right management path. This test is essential for distinguishing between open angle and angle closure types.
Pachymetry is a simple and quick test that measures the thickness of your cornea, the clear front window of your eye. The thickness of the cornea can actually affect the accuracy of your pressure readings. A very thin cornea may result in an artificially low pressure reading, while a thick cornea may show a higher reading than what is actually inside the eye. Knowing your corneal thickness helps the specialist interpret your pressure data with much greater precision.
Optical Coherence Tomography, or OCT, is a non-invasive imaging test that uses light waves to take cross section pictures of your retina and optic nerve. It is often described as an ultrasound that uses light instead of sound.
In modern eye care, specialists use digital photography to keep a permanent record of your optic nerve. High resolution photos of the back of the eye allow for side by side comparisons between visits. This visual history is invaluable. If a doctor sees a small hemorrhage or a change in the nerve’s appearance in a photo, they can adjust the management plan immediately. This level of documentation ensures that even the smallest changes are caught early.
During a thorough exam, the specialist will often use drops to dilate or widen your pupils. This allows much more light into the eye and provides a much wider view of the internal structures. When the pupil is wide, the specialist can see the entire retina and the full extent of the optic nerve head. While dilation makes you sensitive to light and your vision blurry for a few hours, it is the best way to ensure no other eye health issues are being missed.
Once all the tests are completed, the specialist will analyze the data to set a target pressure for your eye. This is the pressure level that is believed to be safe enough to prevent any further nerve damage.
This personalized approach ensures that the management is as effective as possible for your unique situation.
Early diagnosis provides the best opportunity to slow disease progression and preserve vision. Because glaucoma damage is permanent, identifying the condition before advanced vision loss occurs is essential.
Accurate diagnosis ensures that management is appropriate, timely, and aligned with individual risk and disease characteristics.
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No, the eye is either numbed with drops or a quick puff of air is used, so it is a very comfortable process.
Blind spots often start in the periphery where you don’t notice them; the test finds them before you do.
No, it uses light waves and does not involve any radiation, making it completely safe and painless.
Usually once or twice a year, though more frequent checks may be needed if your condition is not stable.
If your eyes are dilated, your vision will be blurry and you will be sensitive to light, so it is better to have a driver or wait.
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