Many people report that they received their glaucoma diagnosis abruptly, during a routine eye exam, or while updating their prescription glasses. Many also report receiving no explanation from their doctors about what glaucoma is or what comes next. To help people make sense of their new condition, New Mexico-based optometrist Elisabeth Hottel, O.D. discusses what to expect with a new glaucoma diagnosis.*

Understanding glaucoma (1:31)

Glaucoma affects the optic nerve, your eye-brain connection, and is typically managed by lowering eye pressure to reduce stress on the nerve. Inadequate oxygen can also strain the optic nerve. Don’t be surprised, Hottel says, if your eye doctor suggests you get evaluated for sleep apnea, which can disrupt oxygen delivery to the eye. 

As we learn more about the disease, tests that seem unrelated may be recommended. She advises asking your doctor questions about your diagnosis and treatment options and getting another opinion if you feel uneasy. 

Glaucoma tests (2:50)

A comprehensive glaucoma eye exam primarily consists of:

• Testing eye pressure, which may show you’re at risk for glaucoma, and 
• Examining the optic nerve, which can reveal an abnormal appearance (indicating nerve damage), making you a glaucoma suspect, even with normal eye pressure.

From suspect to diagnosis (3:55)

Glaucoma involves the gradual deterioration of the optic nerve, causing loss of peripheral (side) vision.

• If you have an irregular optic nerve but no loss of vision, you’ll likely be monitored.
• If you then lose vision, you’ll receive a formal glaucoma diagnosis.

New diagnosis (4:30)

A new glaucoma diagnosis requires many follow-up appointments. While inconvenient, Hottel says, multiple appointments are necessary to establish your baseline average pressure since eye pressure can vary from day to day and throughout each day.

A series of other tests will likely be done to determine the type of glaucoma you have for the best treatment match.

Other glaucoma tests (5:46)

Other tests that your ophthalmologist may perform include:

• A central corneal thickness test. Even with the same eye pressure, an eye with a thicker cornea will result in a higher eye pressure reading than a thinner cornea.
• A gonioscopy. This involves a lens being placed on your cornea to determine whether your eye’s drainage angle is open or closed. Numbing eye drops are used before such tests so there’s no discomfort.
• A more advanced visual field test will be performed to assess changes in peripheral vision and make any treatment adjustments. (You must look straight ahead for accurate results.)
• Two types of optic nerve status tests. One method involves taking general images of the nerve to look for changes over time, while another measures nerve thickness at the edge of the eye versus the center. 

How often will you see your doctor? (11:53)

Generally, since glaucoma is chronic and lacks a cure, careful monitoring is a lifelong process. 

For glaucoma suspects and those newly diagnosed, appointments will be more frequent to gather baseline information and ensure proper treatment. Initial appointments could be weekly or biweekly, even with mild glaucoma. 

After that, follow-up visits might be every three to six months, depending on eye pressure manageability, optic nerve status, underlying conditions, how quickly peripheral vision is changing, etc.

Stay hopeful; it’s treatable (13:22)

Today, there are many treatment options:

• Eye drops, a common initial treatment 
• Laser therapy, for when eye drops aren’t sufficient
• Eye implants (shunts) for redirecting excess fluid
• Other surgeries

A glaucoma diagnosis can feel scary, but Hottel encourages viewers to remember that glaucoma tends to progress slowly. “Have that hope and see your doctor,” she encourages viewers. Unlike some other eye conditions, glaucoma is treatable, and you can delay progression by sticking to your treatment, follow-up visits, and regular comprehensive exams.

*Dr. Elisabeth. (2023, February 26). You Were Diagnosed With Glaucoma–WHAT NOW?!? (What To Expect From Tests And Treatment) [Video file]. YouTube. Retrieved from https://www.youtube.com/watch?v=D-tKtMWHNS4