Prophylactic examinations for glaucoma are the basic ophthalmological examinations, regardless of the patient's age. Glaucoma can develop at any time in life. Children are examined differently than adults, but proper diagnosis includes a set of tests that must always be performed.

Preventive examinations for glaucomashould be performed by everyone, because it is one of the most dangerous eye diseases, which often may not give any symptoms for a long time. Untreated glaucoma leads to irreversible blindness due to the gradual loss of the optic nerves. The greatest risk in the case of glaucoma is the fact that patients see an ophthalmologist only when the disease is advanced enough to begin to notice disturbing signals.

At first, the patients do not notice any obvious symptoms of the disease. They do not feel pain in their eyes, they do not have impaired eyesight. Most often, the disease is detected during a routine visit to an ophthalmologist. It happens that during the examination it turns out that the patient is almost blind, which he did not even realize before. This is because, in glaucoma, the loss of vision is extremely slow and begins in the peripheral parts of the visual field. The slow progress of the disease means that the patient gets used to worse vision and does not notice the progressive changes. He does not feel bad with them only when the disease begins to cover the center of the visual field, where visual acuity is the highest. Then, however, it is too late to start effective treatment and to undo the changes that have occurred.

Glaucoma: the importance of regular examinations

You cannot prevent glaucoma, but you can significantly reduce its potential effects and avoid blindness. However, it will be possible through early detection of the disease. You should also go to the check-ups at the ophthalmology clinic when your eyesight seems to be good and there are no symptoms. During the examination, the doctor will also perform preventive examinations for glaucoma. In the case of this disease, prevention consists in examining the patient in terms of his subjective well-being. By the time the first symptoms appear, it is too late.What is the correct diagnosis for glaucoma?

Does glaucoma have symptoms?

Check-up at the ophthalmologist

During the follow-up visit to the ophthalmologist, ask for a preventive examination for glaucoma. It is enough to undergo such an examination once a year. Its purpose is to detect potential glaucomatous changes in the optic nerves and to enable early treatment initiation. The sooner it is started, the greater the chance of successfully stopping the ongoing changes and maintaining the possibility of good vision for the rest of your life.

The basic ophthalmological examination for glaucoma is a detailed assessment of the optic nerve disc. It is made with a slit lamp and a special Volk lens.

Apart from visual assessment and eye examination, the ophthalmologist should also measure the intraocular pressure during the checkup. Its increased value is always a warning signal. However, this does not mean that normal pressure completely excludes glaucoma, as it can also develop with normal pressure.

Necessary additional tests

When visiting an ophthalmologist, you should also ask for a referral for an additional examination. Basic examination allows only to detect glaucoma which is already in advanced form. Its early stages are not visible, and it should be remembered that treatment is most effective at this time.

The most important tests that must be performed in the diagnosis of glaucoma

  • HRT or tomography of the optic disc . It is performed using the HRT (Heidelberg Retinal Tomography) laser scanning ophthalmoscope. The test is performed to quantify the amount of nerve tissue in the optic nerve, and to compare the obtained value over time.
  • GDx i.e. the thickness measurement of the retinal nerve fiber layer . The test is performed using GDx laser scanning polarimetry (Glaucoma Diagnostics). The currently recommended device is the GDx Pro, which enables automatic statistical analysis of the progress of glaucoma changes.
  • GCL / GCC or measurement of the thickness of the layer of retinal ganglion cells using optical coherence tomography OCT(Optical Coherence Tomography). The test makes it possible to assess the number of ganglion cells. This is a very important test because the loss of these cells causes glaucoma-related blindness. GCL is a modern study, recently introduced into clinical practice.
  • AS-OCT i.e. tomography of the anterior segment of the eyeball(AnteriorSegment-Optical Coherent Tomography) with the ability to assess the depth of the anterior chamber, the configuration of the iris base and the width of the anterior chamber angle in full light and dark conditions.
  • Glaucomatous OCT . OCT can also assess the appearance of the optic disc and the layer of nerve fibers, but based on my many years of experience in glaucoma diagnostics, I can say that the results obtained with the HRT and GDxPro machines are much more reliable and comparable. The results obtained with the use of OCT cameras from different companies often differ greatly.
  • FDT - the field of view examination by the method of double-frequency perimetry FDT Matrix . This test measures the sensitivity of the retina. It is one of the most important tests performed in the diagnosis of glaucoma because it shows the degree to which the patient's vision is at risk. Field of view tests performed with other devices are often insufficient due to their lower sensitivity. The FDT method is recommended as the one that allows you to detect any irregularities as soon as possible.
  • Pachymetry, i.e. corneal thickness measurement, is a complementary test . It tells about the risk of developing glaucoma (thin cornea=higher risk), and allows you to make a special correction to the value of the measured intraocular pressure. When the cornea is thin, the pressure is higher than that of the apparatus.

With your test results, go to an ophthalmologist who specializes in glaucoma. Your doctor will re-examine your eyes and evaluate the results of any additional tests. On the basis of a comprehensive examination, the doctor makes a diagnosis, carefully assesses the risk of developing the disease, starts treatment or not, and appoints the next follow-up visit. It is not enough to just do the tests and evaluate them yourself. The assessment of the results obtained with the use of modern research methods is very difficult, even for an experienced specialist, and the results are often ambiguous and require periodic repetition of tests. Often times, the physician needs a longer time to look at test results and their variability in order to make the right decision about how to deal with the patient.

Glaucoma

Glaucoma develops slowly, often asymptomatically. Glaucoma is usually detected by accident, during an eye examination with an ophthalmologist or the selection of glasses. What are the causes of this disease and how to recognize the first symptoms of glaucoma? Listen to our expert prof. Iwona Grabska-Liberek, head of the department of ophthalmology at the Clinical Hospital W. Orłowski in Warsaw

About the authorBarbara, MD, PhDPolaczek-Krupa, specialist in eye diseases, Centrum Opulystowa Targowa 2, Warsaw

Dr. Barbara Polaczek-Krupa, MD, initiator and founder of the T2 Center. She specializes in modern diagnostics and treatment of glaucoma - this was also the subject of her PhD thesis defended with honors in 2010.

Dr. med. Polaczek-Krupa has been gaining experience for 22 years, since she started working at the Ophthalmology Clinic of CMKP in Warsaw, with which she was associated in 1994-2014. During this period, she obtained two degrees of specialization in ophthalmology and the title of doctor of medical sciences.

In the years 2002-2016 she worked at the Institute of Glaucoma and Eye Diseases in Warsaw, where she gained knowledge and medical experience by consulting patients from all over Poland and abroad.

For years, as part of cooperation with the Medical Center of Postgraduate Education, he has been a lecturer at courses and trainings for doctors specializing in ophthalmology and primary he alth care.

He is the author or co-author of numerous publications in scientific journals. Member of the Polish Ophthalmology Society (PTO) and the European Glaucoma Society (EGS).

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Eye diseases and vision disorders