Normal Optic Nerve
Optic Nerve Damage

The Delaware Eye Institute offers our patients specialized care and treatment for glaucoma. All of our ophthalmologists and optometrists are expertly trained in the diagnosis and treatment of glaucoma. We have the staff, facilities and tools necessary for the successful treatment of any medical or surgical glaucoma problems.

Glaucoma is a leading cause of blindness in the United States, especially for older people. But loss of sight from glaucoma ispreventable if you get treatment early enough. Please view our videos to learn more about this disease.

For those patients with advanced glaucoma disease that does not respond to simple treatment with topical drops, Delaware Eye Institute is fortunate to have a Board Certified, Fellowship trained glaucoma specialist, Dr. Anan Mantravadi. He travels down from the Wills Eye Hospital in Philadelphia to see patients in our Rehoboth Beach facility. He is expertly trained in all aspects of surgical treatment for advanced glaucoma. Please click on his link below to learn more about him.

Glaucoma FAQ

What is glaucoma?

Glaucoma is a leading cause of blindness in the United States, especially for older people. But loss of sight from glaucoma is preventable if you get treatment early enough. Please view our videos to learn more about this disease.

Glaucoma is a disease of the optic nerve. The optic nerve carries the images we see to the brain. Many people know that glaucoma has something to do with pressure inside the eye The higher the pressure inside the eye, the greater the chance of damage to the optic nerve.

The optic nerve is like an electric cable containing a huge number of wires. Glaucoma can damage nerve fibers, causing blind spots to develop.
Often people don't notice these blind areas until much optic nerve damage has already occurred. If the entire nerve is destroyed, blindness results.
Early detection and treatment by your ophthalmologist are the keys to preventing optic nerve damage and blindness from glaucoma.

What causes glaucoma?

Clear liquid, called the aqueous humor, flows in and out of the eye. This liquid is not part of the tears on the outer surface of the eye. You can think of the flow of aqueous fluid as a sink with the faucet turned on all the time.

If the "drainpipe" gets clogged, water collects in the sink and pressure builds up. If the drainage area of the eye- called the drainage angle - is blocked, the fluid pressure within the inner eye may increase, which can damage the optic nerve.

What are the different types of glaucoma?

Chronic open-angle glaucoma: This is the most common glaucoma. It occurs as a result of aging. The "drainpipe," or drainage angle of the eye, becomes less efficient with time, and pressure within the eye gradually increases.
If this increased pressure results in optic nerve damage, it is known as chronic open-angle glaucoma. Over 90% of adult glaucoma patients have this type of glaucoma.

Chronic open-angle glaucoma can damage vision so gradually and painlessly that you are not aware of trouble until the optic nerve is already badly damaged.

Angle-closure glaucoma: Sometimes the drainage angle of the eye may become completely blocked.

It is as though a sheet of paper floating near a drain suddenly drops over the opening and blocks the flow out of the sink. In the eye, the iris may act like the sheet of paper closing off the drainage angle.

When eye pressure builds up rapidly, it is called acute angle-closure glaucoma.

The symptoms include:

  • Blurred vision;
  • Severe eye pain;
  • Headache;
  • Rainbow halos around lights;
  • Nausea and vomiting.

If you have any of these symptoms, call your ophthalmologist immediately. Unless an ophthalmologist treats acute angle-closure glaucoma quickly, blindness can result.

A more gradual and painless closing of the angle is called chronic angle-closure glaucoma. It occurs more frequently in people of African and Asian ancestry.

How is glaucoma detected?

There are three major signs that can alert an eye doctor that a patient has glaucoma:

  • Optic nerve damage
  • Visual field loss
  • Elevated intraocular pressure

A patient who is diagnosed with glaucoma has at least two of these three signs. To discover this, your eye doctor will evaluate your eyes using some of these tests:

  • Tonometry to measure the pressure in the eye
  • Gonioscopy to inspect the drainage angle (fluid pathway) of the eye
  • Perimetry to evaluate your side fields of vision, not simply your "straight ahead" vision
  • Ophthalmoscopy to examine the optic nerve
  • Photographs of the inside of the eye to record the appearance of the optic nerve

There is a range of what is considered normal pressure, and every person is different. So a high tonometry reading does not always mean a person has glaucoma. But it does indicate that your eye doctor will want to do additional tests to check the health of your eye.

One dependable method of evaluating the eye is to check a person's field of vision. A "visual field test" can show if there are areas missing from a person's view. These may be caused by damaqe to the optic nerve due to glaucoma.

Who is at risk for glaucoma?

High pressure alone does not mean that you have glaucoma. Your ophthalmologist puts together many kinds of information to determine your risk for developing the disease.

The most important risk factors include:

  • Age;
  • Near-sightedness;
  • African ancestry;
  • A family history of glaucoma;
  • Past injuries to the eyes;
  • A history of severe anemia or shock.

Your ophthalmologist will weigh all of these factors before deciding whether you need treatment for glaucoma, or whether you should be monitored closely as a glaucoma suspect.

This means your risk of developing glaucoma is higher than normal, and you need to have regular examinations to detect the early signs of damage to the optic nerve.

How is glaucoma treated?

As a rule, damage caused by glaucoma cannot be reversed. Eye drops, pills and laser and surgical operations are used to prevent or slow further damage from occurring.

With any type of glaucoma, periodic examinations are very important to prevent vision loss. Because glaucoma can worsen without your being aware of it, your treatment may need to be changed over time.

Medicines: Glaucoma is usually controlled with eye drops taken several times a day, sometimes in combination with pills. These medications decrease eye pressure, either by slowing the production of aqueous fluid within the eye or by improving the flow leaving the drainage angle.

For these medications to work, you must take them regularly and continuously. It is also important to tell all of your doctors about the eye medications you are using.

Glaucoma medications can have side effects. You should notify your ophthalmologist immediately if you think you may be experiencing side effects.

Some eye drops may cause:

  • A stinging sensation;
  • Red eyes;
  • Blurred vision;
  • Headaches;
  • Changes in pulse, heartbeat or breathing.:

Pills sometimes cause;

  • Tingling of fingers and toes;
  • Drowsiness;
  • Loss of appetite;
  • Bowel irregularities;
  • Kidney stones;
  • Anemia or easy bleeding.

Laser surgery: Laser surgery treatments may be effective for different types of glaucoma. The laser is usually used in one of two ways.

In open-angle glaucoma, the drain itself is treated. The laser is used to enlarge the drain (trabeculoplasty) to help control eye pressure.

In angle-closure glaucoma, the laser creates a hole in the iris (iridotomy) to improve the flow of aqueous fluid to the drain.

Operative surgery: When operative surgery is needed to control glaucoma, your ophthalmologist uses miniature instruments to create a new drainage channel for the aqueous fluid to leave the eye. The new channel helps to lower the pressure.

Though serious complications of modern glaucoma surgery are rare, they can occur, as with any surgery. Surgery is recommended only if your ophthalmologist feels that it is safer to operate than to allow optic nerve damage to continue.

What is your part in treatment?

Treatment for glaucoma requires a "team" made up of both you and your doctor. Your ophthalmologist can prescribe treatment for glaucoma, but only you can make sure you take your eye drops or pills.

Never stop taking or change your medications without first consulting your ophthalmologist. Frequent eye examinations and tests are critical to monitor your eyes for any changes. Remember, it is your vision, and you must do your part to maintain it.

Loss of vision can be prevented

Regular medical eye exams may help prevent unnecessary vision loss. You should have an examination:

Every 3 to 5 years -

  • If you are age 39 and over.

Every 1 to 2 years -

  • If a family member has glaucoma;
  • If you are of African ancestry;
  • If you have had a serious eye injury in the past;
  • If you are taking steroid medications.


Medication Tips

  • Ask your doctor to write down an exact schedule for taking your medication, especially if you're taking more than one.
  • Find out whether "four times a day" means every six hours, or four times during the time you're awake.
  • Ask your doctor what to do if you accidentally forget a dose; the instructions may vary from medication to medication.
  • Learn about the medications you are taking and the best ways to use them and whether they need special treatment (e.g., refrigeration).
  • If you take a combination of drops and ointment, always apply the drops first.
  • Schedule your dosages around your routines (e.g., upon waking, eating, retiring).
  • Keep your medications visible; it's easier to remember to take them.
  • Keep medications in a clean place. For example, if you carry them in your purse, put them in a plastic bag to keep them clean.
  • Take your medications with you when you're away from home. Carry them with you if you check your baggage.
  • If you forget a dose, do not automatically double your next application. Instead, follow your doctor's specific instructions.:
  • If you can't remember whether you took your medication, simply use one dose at your next scheduled time.
  • Tell each of your doctors about the various medications you are taking; glaucoma medications may interact with drugs prescribed for other conditions.
  • Call your eye doctor if you notice any unusual changes in your eyes or your vision.
  • Schedule regular checkups and follow through with them.
  • Take care of your whole self - your eyes and the rest of you.


The Silent Thief of Sight

Diagnosis of Glaucoma

Treatment of Glaucoma

Advanced Glaucoma Procedures