so how is glaucoma diagnosed and how do
you test for glaucoma
well by the end of this video you'll
know all of those answers and you'll
know what to expect at the time of your
next exam so let's take a look
[Music]
hey everybody welcome to dr. eye health
I am dr. Joseph Allen and I'm here to
help you learn all about the eyes vision
and vision products so if you're new
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also at any point throughout the video
check out the show notes links below for
further information about anything that
we mentioned today also note that this
video is part of a complete video series
on glaucoma so if you're new here that's
great but don't miss out on all the
other good videos and content about
glaucoma and to find that playlist I
have included a link down in the
description below so now there's many
different things that an eye doctor will
consider and think about
before diagnosing somebody with glaucoma
the first thing that everyone starts to
think about when you hear glaucoma is
high elevated high pressures and yes
that is truly so when you go to an eye
doctor whether it be something for like
pinkeye or something just like a routine
eye exam the doctors gonna check your
eye pressures know when we check your
eye pressures a couple different ways
you do this but the most famous way is
probably with the non-contact
denominator that's that one with the air
puff you know the air puff test the one
that everybody hates and probably has
PTSD from now this instrument blows a
puff of air at the eye and measures the
response time of the cornea and they can
tell basically kind of what the eye
pressure is but again nobody liked it
they actually originally made that
instrument to replace a different test
which we use a little blue light and a
plastic little probe that actually comes
close to your eye and measures your eye
pressures that instrument is called a
golden inton ometer and is really the
gold standard for all glaucoma testing
and so if you do have a diagnosis of
glaucoma there's a good chance you're
gonna see the blue tipped Goldman
tonometry test the other one that I
really like especially for just
screening and testing and a routine exam
is one called an eye care I have no
financial interest in any of these
instruments or the companies that make
them but the eye care is a newer
instrument that's very gentle toward the
eyes it basically has a rounded plastic
little probe that reaches out and just
barely touches the eye but it's so quick
and so gentle that you really don't feel
it it kind of tickles their eyelashes if
you blink halfway through but it only
takes a few seconds doesn't require eye
drops or anything like that I love
now I pressure is usually considered
normal when it's between a mark of 10 to
21 millimeters of mercury however it
does vary from person to person so a lot
of times if you do have a diagnosis of
glaucoma your doctors gonna say oh the
pressures are good they're bad I'd say
be sure to ask them what exactly the
pressures are and you yourself can even
make a note and kind of track your
pressures over time now as an eye doctor
certainly eye pressure is important but
it's certainly not the most important
when it comes to diagnosing glaucoma
because there are some types of glaucoma
with normal eye pressures now what's
really important is for the doctor to
evaluate the health of the optic nerve
in the back of the eye and to evaluate
the optic nerve the best the doctor
needs a dilated view of that optic nerve
so I do recommend dilated eye exams for
my patients for that reason now when a
doctor looks at the optic nerve and says
yeah this could be glaucoma the doctor
often times will take a photograph of
the optic nerve so that they can use it
as a future reference to measure and
find if that that nerve is changing
beyond just taking photographs of the
nerve they may also use an instrument
called an Oct which stands for optical
coherence tomography that instrument the
Oct is excellent because it actually
uses infrared light to give basically
like a map of the optic nerve or the
retina inside the back of the eye and
this actually is kind of like getting a
really high definition ultrasound of the
eye and it actually will measure out the
thickness or prema to quantify the
amount of individual nerves that are
entering in the eye through the optic
nerve so this is an excellent way full
up for the doctor to get kind of a
snapshot of the health of the optic
nerve as well as using those numbers and
that map to follow the progression and
how the optic nerve is functioning over
time both photographs of the nerve in
the back of the eye and the Oct may be
used usually once per year the other
instrument you're most likely gonna see
at any doctor's office for glaucoma is
something called an automated visual
field and
aye sir and this instrument is is really
important because again glaucoma can
cause loss of somebody's peripheral side
vision so this instrument will help
actually map out if any visual or
functional vision loss has occurred and
again this is important not just so the
doctor knows what your vision is like
but they can use this to help stage the
severity of the disease and monitor for
progression now the downside is that
this instrument and this test is
probably the worst most frustrating test
in all I care for as useful it is it is
very frustrating to do as a patient it
can become a long test actually the
worse you do longer the test takes you
usually test one eye at a time and again
it measures your side vision by flashing
little bright lights off to your side
all while you're looking straight ahead
at a single fixation target usually kind
of a dim yellow light and while the
instrument flashes these bright lights
off to your sides
these lights are varied by intensity and
location and when you see the light you
click a button and the instrument
reported to that answer and then it
gives off a printout sheet for the
doctor to evaluate know what stinks
again is at this test you have to have a
really good focus you have to kind of
try to sit still if you start moving
around if you become a comfortable or
tired or maybe your eye starts to teared
from dryness it can be really
frustrating and even for the doctor a
lot of the times we'll get the results
we're like this isn't a really good test
then we end up having to repeat it again
and again now again this vision this
test is frustrating it as it is is
honestly one of the most useful tests
for glaucoma it's pretty standard and
when this test in you know you think all
this test really stinks I wish I only
had to do it once no a lot of the times
we end up having to repeat this test
several times throughout the year now I
know it kind of stinks it's not the most
fun it's basically the most boring video
game ever made however I do think that
if you're taking this test you want to
take it seriously you want to try to be
comfortable and pay attention the whole
time because
better the better you do on that test
the better results the doctor gets
hopefully they'll be able to take better
care of your glaucoma and maybe you
won't need to repeat it as often now the
other two tests that you will most
commonly see for glaucoma and any eye
clinic one is called peak Kimmi tree and
that's where we use an instrument that
comes really close to the eye after we
numb it with some numbing medication the
instrument touches the eye and measures
the thickness of the cornea that's that
front window structure on the front part
of the eye because several studies have
confirmed that a thinner cornea on the
front part of the eye versus average is
more associated with a higher risk of
developing glaucoma and having damage
from glaucoma wear a thicker cornea is
more correlated with kind of a more
protective effect and a lower risk of
glaucoma then there's an instrument
called a using what's called Gani osku P
now this procedure we use a little
mirror that's pretty much a specialized
contact lens and again will numb the eye
and it will actually place this special
contact lens on the eye and we'll look
through it it has these little mirrors
built in so that the doctor can actually
look into the mirror and observe the
drainage structure of the eye we're
gonna look for if there's any sort of
proteins or maybe pigments stuck in the
eye or it helps us evaluate for
something like angle closure glaucoma
if a person's at risk for that so
actually we have covered most of the
different tests that are used in the
diagnosis of glaucoma however there are
a couple others that we don't see quite
as often or haven't become quite
standard in the diagnosis or the
management of glaucoma and one of those
is called corneal hysteresis that
instrument is very similar to they pay
chemistry one that we just mentioned but
instead of measuring the thickness of
the cornea it measures the stiffness or
how well it bounces back and there's
studies that correlate the those results
to how well somebody actually has risk
how high of a risk somebody is for
glaucoma as well as how somebody
responds to medications there's also an
instrument that I really like which is
electrodiagnostic testing either a vep a
visually evoked potential and then
there's ER GS an electoral retinol gram
these have been around for quite some
time but they've never really quite been
made so available to just regular eye
clinics mostly they've been in academic
settings but in the last maybe ten years
or so a new brand called die OPS's I
have no financial interest in this
company but they made an instrument that
makes it a lot easier to run these type
of tests and so the are becoming more
available I actually did some research
using this instrument when I was a
student getting my doctorate but what's
great is that there are there is
evidence saying that with
electrodiagnostic testing you can
actually detect glaucoma before vision
loss occurs almost by up to seven years
so it's an excellent instrument if you
can find a clinic that has one the
downside is that it is a little bit
finicky you have to know how to set it
up you have to know how the test is run
and the doctor has to know how to
evaluate the results and so yeah that's
another test that can be repeated in
multiple times but otherwise yeah those
are really the most types of testing
you'll see for glaucoma
so I health question of the day which
type of tests have you seen already is
there any that you really like or really
hate go ahead and connect with us in the
comment section below alright everyone
thanks so much for watching make sure to
remember that this video is part of a
complete series all about glaucoma so
make sure to check out the link to that
I'll hook it up here in the YouTube card
as well as in the description below
otherwise again this is doctor Joseph
Allen here from doctor eye health
bringing you the best tips in education
about the eyes and vision if you would
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coherence tomography up optical Tolman
optical coherent that three times fast
optical coherence tomography optical
coherence tomography optical coherence
tomography