Glaucoma Symptoms

Video Transcript

"OKay, well, let's talk about the signs of glaucoma. You know, we kind of already established that the bulk of cases, patients don't have symptoms for glaucoma. So, we're going to talk about the signs. The signs are the things your eye doctor will see whenever you go in to your visit. So, there's three really, there's many important things, but there's three really critical things that we're looking at when we're trying to decide if a patient is at risk for glaucoma. One of those things is to check the pressure in the eye and make sure the eye pressure is in the normal range. Typically, most patient's pressure is somewhere between 12 and 22 millimeters of mercury. That's the unit that we use to describe the pressure. And so that, we're kind of looking for pressures in that range, for the bulk of people that's a normal range. Then the other thing we want to do, it's really important, is to look within the eye, at the back of the eye. So, we're going to physically going to look through the pupil, through the eye, at the inside the eye at this back wall in this structure called the optic nerve. And so, remember the nerve is the place that sends the signals to the eye that lets us know we're seeing things and that's also the area that's going to be damaged in people who have glaucoma. So, when we look in, we can use some different devices to look in, but we'll physically look in the eye at the optic nerve. Now, this image here, is actually my image of the optic nerve. So, that's what I would see if I were to look in your eye, through your pupil, at your optic nerve. That's sort of the view that we would get. So this structure here, this is the nerve. And so, we want to look at the nerve and make sure it has an appropriate color that we're looking for, we want to make sure that it has the right size that we're looking. And so, patients that have glaucoma have a particular finding with this nerve. They have a finding that looks as if that, a part of that nerve called called the cup, is larger than it is in other individuals. So, one of the things that we do when we look in the eye is establish a number of two that tells us how large that cup is, how large that area in the nerve is. And so that grading system we use is somewhere between .1 and .9 and for the bulk of patients, they're nerve size, their cup size, is going to be somewhere between a .2 and a .6. There's a large range there, and within that range, most patients fall within about .3, .4, right in there. So, second issue I want to look at, is look at the nerve I want to establish a number to how big it is. Patients who have a nerves that are large, larger than a 6, they tend to have a higher risk for glaucoma. Or other individuals that might have a higher risk for glaucoma, are individuals that have nerves of different size. Where the size in one nerve, the cup size in one nerve, is slightly larger than the other one. So, if there's an asymmetry between the two nerves of about twenty percent, that increases the risk for glaucoma. Then the third thing we want to look at is a measurement of how well the patient sees in a periphery. And we do that using a device called a visual field. That tells us how, to what extent the patient can see in that periphery and how well they respond to certain tensities of light. So, signs of glaucoma include either the pressure being over, typically, 22. Or, the nerve being larger than a 6 or having the 20% difference between the eyes. Or, thirdly, having a problem in the peripheral vision test. So, having any one finding of those three out of the normal range, in my opinion, makes that person have a higher risk for glaucoma."