GLAUCOMA: SILENT BLINDNESS

This patient is a good case to illustrate the importance of regular eye examinations, NOT just to get glasses or contact lenses. This gentleman is in his 50's. He presented merely to get glasses for computer and reading. He said he doesn't like to go to doctors. He see's 20/20 at distance without glasses and I was easily able to help with a great solution for computer and reading at work.

Normal intraocular pressure is 15mmHg. His measured pressures were 36mmHg! His true pressure is even higher than that because his corneas are very thin, causing me to read the pressures lower than they truly are. That kind of pressure damages the optic nerve, killing nerve fibers, and causing blind spots throughout the visual field that eventually coalesce to cause complete blindness.

The first picture is of a normal optic nerve (not his). The next one shows the "cupping" that occurs as nerve fibers die. He had significant cupping, or optic nerve damage. The bottom photo illustrates the visual field results we get when we test someone with glaucoma. I am having this patient back for a visual field test under his health insurance, and no doubt his field will look much worse than this!

This patient is relatively young and I am going to have to battle to keep him seeing his entire life. He will have to take multiple eyedrops aggressively and quite possibly will need sight-threatening surgery in the future. He will need to follow-up with me every 3 months for me to watch his nerve, his visual field, and his pressures very closely.

If I had caught this patient earlier, damage would have been much less, treatment and follow-ups would not have to be so aggressive, and chances of keeping him seeing the rest of his life would be much better. I can relate to his statement "I don't like going to doctors". But going to doctors and having to treat a disease is better than being blind and dependent on others for half of your life.

Half the people in the United States that have glaucoma don't know they have it. It is important for those fortunate people who don't need glasses to have their eyes checked periodically, just to make sure there are no problems that can be easily managed. Good vision can give a false sense of security and we shouldn't take it for granted!