The laser is done as an outpatient procedure. The eye is prepared with eye drops to constrict the pupil and to anaes-thetize the eye. Some patients may experience a transient eye ache or headache or dimming of vision with these eye drops. Eye drops or medications may be given to lower the eye pressure before the laser procedure. A contact lens will be placed on the eye during the laser procedure. The laser is usually painless and an aching sensation may be felt in some patients. The patient is seated much like the eye examination at the slit-lamp in the clinic. The eye pressure is checked again after the laser.

The laser procedure is not a surgery and requires minimal after care. Eye rubbing should be avoided. The vision may appear cloudy for a few hours after the laser. Eye drops are required for 1 to 2 weeks after the laser. There are no restric-tions to daily activities. Some patients may experience glare symptoms after the laser. The possible risks of the laser include increased eye pressures, damage to the surrounding eye struc-tures like to the corneal cells that can result in loss of corneal clarity later. Please approach your eye specialist if you have any questions on this procedure.

Eagle Eye Centre @ Mount AlverniaMount Alvernia Hospital

820 Thomson Road, #02-10/17, Medical Centre Blk B, Singapore 574623Tel: 6456-1000 / 6-eagleye (6324-5393) Fax: 6456-1006

Eagle Eye Centre @ Mount ElizabethMount Elizabeth Medical Centre

3 Mount Elizabeth, #08-02, Singapore 228510Tel: 6836-0001 Fax: 6836-0002

Eagle Eye Centre @ Parkway EastParkway East Medical Centre

319 Joo Chiat Place, #05-03, Singapore 427989 Tel: 6348-1000 Fax: 6348-1001

Eagle Eye Centre @ Mount Elizabeth NovenaMount Elizabeth Novena Specialist Centre

38 Irrawaddy Road, #08-22/23/24, Singapore 329563Tel: 6570-1000 Fax: 6570-1001

Email: eec@eagleeyecentre.com.sgWebsite: www.eagleeyecentre.com.sg

How is glaucoma treated and managed?

When should I get an eye check forglaucoma?

Laser Treatment for angle closurePatients who are found to have narrow or closed drainage passages (angles) of the eye are at increased risk of developing angle closure glaucoma. In the acute situation, the eye pressure increases suddenly, rising to a very high level. This occurs as the eye fluid is trapped behind the iris at the pupil and closes the drainage passages (angles) of the eye. There is hence obstruction of outflow of the eye fluid, leading to buildup of the fluid in the eye and an increase in the eye pressure. Laser peripheral iridotomy helps to reduce the risk of this ocular emergency. The laser creates a small fluid channel in the periphery of the iris allowing the fluid from behind the iris to flow forward and through the drainage passages of the eye thus preventing a sudden rise in eye pressure.

Early detection and appropriate treatment can prevent blind-ness in glaucoma. If you have any of the following, it is advis-able to have an eye check done by an eye specialist:

Age 40 years and olderhave a family member or relative with glaucomaon steroid medicationshad previous injury to the eyehad previous surgeries to the eyehave diabetes have high myopia or high hyperopiablurred vision intermittent eye pain known to have inflammation of the eyes

remember to use your eye drop on the day of the eye check-up

do not miss your eye drops. If you are running outeye drops, return to the clinic for a new prescription in advance

Inform the doctor if you have any problems with the eye drops

Glaucoma is controlled by lowering the eye pressure. This can be achieved with eye drops or medications, laser treatment or surgery. Treatment is individualized and regular monitoring is required after successful control of the eye pressure. It is important to know that pre-existing damage to the optic nerve cannot be improved or reversed with treatment hence it is important to have early eye screening to detect glaucoma. Glaucoma treatment aims to preserve the remaining vision and requires life-long monitoring. The eye specialist will discuss the treatment options most suited for your condition.

Eagle Eye Centre has a comprehensive list of anti-glaucoma medications available for controlling intraocular pressures including the latest combination therapy eye drops. We perform lasers for glaucoma including argon laser peripheral iridotomy, laser iridoplasty, trans-scleral cyclophotocoagula-tion and laser suturelysis after trabeculectomy. Glaucoma surgeries performed at EEC include - trabeculectomy with anti-metabolites; phaco-trabeculectomies (combined cataract and glaucoma surgery) with anti-metabolites; glaucoma bleb needling with anti-metabolites; glaucoma (bleb) revision surgeries; and glaucoma drainage implants.

How do I use my eye drops?Compliance to eye drops plays a major role in success of glaucoma treatment and control of the disease.

Use your eye drops as instructed

If you have more than 2 eye drops to instill at the same time, wait for at least 5 minutes before instilling the next eye drop

you can minimize absorption through the nasal passages by placing your index finger against the inner corner of your eye (against the nasal bone) for 30 seconds

excess eye drops should be cleaned from the skin with a moistened tissue or towel

time your eye drop with certain activities or set an alarm to help you remember to instill your eye drop everyday

bring your medications along for each visit to the eye doctor

GLAUCOMA

Glaucoma

What causes Glaucoma? Am I at riskof Glaucoma?

What tests are done during an eye exam-ination to detect and monitor Glaucoma?

There is obstruction to the outflow and drainage of the fluidin the eye leading to increase in eye pressures. This rise in pressure can occur suddenly and rapidly, leading to damage of the optic nerve. Acute angle closure glaucoma is an ocular emergency and requires prompt treatment. Symptoms include severe eye pain associated with headache on the same side, nausea and vomiting, blurred vision and haloes around lights and redness of the eye.

Chronic angle closure glaucoma may be asymptomatic where the pressure rise is gradual like open angle glaucoma. Individu-als with narrow or occludable angles are at risk of developing acute angle closure glaucoma. Laser treatment in such cases help to reduce the risk of sudden rise in eye pressures. See Laser treatment for angle closure.

Secondary GlaucomaThis type of glaucoma is associated with diseases of the eye – previous eye injury or surgeries; inflammation of the eye; advanced cataracts and use of steroid medications. It can also be caused by medical conditions such as diabetes. Patients may experience eye pain, halos around lights, blurred vision and red eyes in these conditions.

Congenital GlaucomaCongenital glaucoma is a rare eye disease that occurs at birth. An eye examination is required if the infant’s eye is found to be enlarged, loss of clarity of the cornea, tearing and is unusually sensitive to light.

The vision (visual acuity), the eye pressure, the drainage passages (angles) and the optic nerve are assessed. The visual field test is performed to detect glaucoma damage to the optic nerve. This test also helps the doctor determine if the glaucoma is stable or worsening. Optic nerve imaging tests maybe used to diagnose and monitor glaucoma.

Automated HumphreyVisual Field Testingat Eagle Eye Centre

At Eagle Eye Centre, we provide a comprehensive service for glaucoma screening and management. We have the latest automated visual field machines, anterior segment imaging and optic nerve imaging technology to diagnose and management glaucoma.

Optic NerveCoherenceTomography AtEagle Eye Centre

Besides managing high pressure glaucoma, we also manage Normal Tension Glaucoma or Normal Pressure Glaucoma. At Eagle Eye Centre, we have a developed program to diagnose and manage Normal Tension Glaucoma - tests include phasing eye pressure testing, questionnaires, posture eye pressure testing and use of our imaging technology.

Our GlaucomaSpecialistPerforming anEye PressureExamination

Peripheral Vision is progressively lost in Glaucoma

Chronic diseases like diabetes and high blood pressure

Steroid medication use - prolonged steroid use (eye drops or medications) can cause raised eye pressures in certain individuals (steroid responders)

High myopia and hyperopia

Inflammation of the eye

Advanced cataracts

Previous eye surgeries

The peripheral vision is usually affected first as the optic nerve is progressively damaged in glaucoma. This is usually symp-tomless and goes unnoticed as central vision remains normal. Later the peripheral visual loss progresses towards the center leading to tunnel vision and in advanced cases central vision is lost. The patient hence notices blurred vision late in the disease when irreversible damage has already occurred.

Is Glaucoma inherited?Glaucoma can affect members in the same family. Those with a family member or relative with glaucoma (Family History of Glaucoma) is at an increased risk of glaucoma and should have glaucoma eye screening by an eye specialist.

Types of Glaucoma and their symptomsThe different types of glaucoma include open and closed angle glaucoma, secondary glaucoma and congenital glaucoma.

Open angle glaucomaThe drainage passage (angle) of the eye is structurally open in Open-angle glaucoma and accounts for the majority of glaucoma. This type of glaucoma usually has no symptoms and progresses slowly. Early eye screening is the only way to detect this type of glaucoma.

Closed angle glaucomaOccurs when the drainage passage (angle) is narrow or closed.

Glaucoma is a leading cause of irreversible blindness in the world and accounts for 40% of blindness in Singapore. People of different races and ages are affected by glaucoma. It is often called the ‘silent thief of sight’ as patients often do not have symptoms until in advanced disease. Early detection and treatment will prevent irreversible visual loss and blindness from glaucoma.

What is Glaucoma?Glaucoma is an eye disease that affects the optic nerve. The optic nerve transmits visual information from the eye to the brain. In glaucoma, there is characteristic damage to the optic nerve resulting in loss of vision.

The major risk factor for glaucoma is raised eye pressures (intraocular pressure). This occurs when there is an imbalance of fluid production in the eye and its drainage from the eye. The eye pressure at which optic nerve damage occurs varies between individuals. Even in a population normal range of eye pressures optic nerve damage can still occur.

Other risk factors for glaucoma include:

The Optic Nerveis Damaged inGlaucoma

Age; Glaucoma can occur at any age. The risk of glaucoma increases with age. In Singapore, 3% of those over 50 years old and 10% over 70 years old are affected by glaucoma.

Family History - a family member or relative with glaucoma can increase your chance of having glaucoma

Eye Injury - a serious eye injury can cause glaucoma many years later