The major role in glaucoma diagnosis is played by:
- intraocular pressure measurement, considering the thickness of the cornea (pachymetry) in order to assess real intraocular pressure
- assessment of the optic disc
- OCT examination of the optic disc
- automated visual field examination
- gonioscopy – assessment of the iridocorneal angle
An automated perimetry machine is available. Indications for the examination: glaucoma, optical nerve, retina and choroid diseases. The examination shows losses in the visual field and involves patients detecting a test light moving over a defined background.
Intraocular pressure (IOP) measurement:
We use both the applanation tonometer and non-contact one.
- APPLANATION TONOMETRY is a contact method using a Goldmann applanation tonometer to measure OIP. The measurement is preceded by inserting anaesthetic drops and fluorescent dye into the conjuctival sac.
- NON-CONTACT TONOMETRY (PUFF) is a method using a puff of air. It does not require topical anaesthesia and is characterised by the rapidity of measurement.
Assessment of the optic disc
Assessment includes the size, shape, hue and symmetry of the optic disc depression and retinal-nerve ring. In glaucoma, a progressive loss of nerve fibres causes the retinal-nerve ring to close and gradually disappear and the central depression of the optic disc to expand. Amongst objective methods used for optic disc assessment, we offer colour imaging of the fundus of the eye and optical coherence tomography of the disc II – OCT, which allows highly accurate observation of the optic disc by conducting a series of repeatable measurements.
This is used to assess the filtration angle, or the anterior chamber angle. It is conducted after the insertion of anaesthetic drops into the conjuctival sac using a Goldmann goniolens, also known as a gonioscope. The examination differentiates closed angle glaucoma from secondary glaucoma, e.g. pigmentary glaucoma, and is used in pseudoexfoliative glaucoma (PEX).
Pachymetry is a measurement of the thickness of the cornea, an indirect indicator of endothelium integrity. It is highly useful in glaucoma as it allows a reliable measurement of IOP.
ANTI-GLAUCOMA OPERATIONS – ENDOSCOPIC CYCLOPHOTOCOAGULATION (ECP)
Glaucoma treatment with the application of endoscopic cyclophotocoagulation consists in inserting the probe of the diameter of approximately 1mm into the eyeball and coagulation of the epithelium of the ciliary body that is responsible for secretion of so-called aqueous humour. Aqueous humour fulfils very important functions – among others, nourishes and maintains the proper tension of the eyeball, however, its excess may lead to increased intraocular pressure. Increased pressure has a very negative influence of the optic nerve that disappears as a result of compression.
Simplifying, this is what the ailment called glaucoma consists in.
The surgery of endoscopic cyclophotocoagulation has the features of almost perfect therapeutic method:
- EFFECTIVE – it belongs to one of the most effective methods of surgical treatment of glaucoma. In many patients after the surgery further pharmacological treatment was not necessary.
- SAFE – it is very low-invasive and safe method for the patients.
- SIMPLE – due to using the endoscope the doctor can see the ciliary body (normally invisible) and lasers it under control of vision.
- Possible to be applied in each form of glaucoma.
- Allows for possible application of other therapeutic methods – sometimes decreasing the pressure after performing the ECP procedure is not sufficient for complete safety of the optic nerve. Contrary to many other methods, the ECP procedure does not restrict a doctor in further procedures and enables the application of each other method of treatment, either pharmacological or surgical one.
Indications to the ECP surgery always take place in the situation when:
- Pharmacological control of glaucoma is not possible.
- The patient suffers from stabilized glaucoma but he/she wants to eliminate pharmacological treatment.