Glaucoma caught before woman loses her eyesight

“May West”* had not seen an eye doctor in 10 years. Not since she had cataract surgery on both eyes, greatly improving her vision at that time. She thought she had good eyesight and therefore didn’t need to see an optometrist for annual eye exams.

But in January 2022, the 85-year-old woman visited Steve Langsford, O.D., at Miramar Eye Specialists in Oxnard, California. The previous November, her left eye became really red and she noticed her vision in that eye was a little less clear, she told Dr. Langsford.

Dr. Langsford took West through a thorough eye health and vision exam. Her vision looking straight ahead was less than ideal. Then he checked her side, or peripheral, vision and found she had difficulty seeing peripherally as well, especially in one eye. When he checked the pressure in each eye, it was high. “For the right eye, the pressure number was 26, and for the left eye, the pressure number was 30,” he said. “We like those numbers to be in the teens, for most people. So, those were definitely higher than we like to see.”

There are a handful of ways optometrists can check eye pressure; all are painless. With one common test, you lean your head against a tonometry machine that quickly administers a puff of air in each eye, which allows the machine to measure the pressure. With another version of a tonometry test, the doctor will use drops to numb your eyes and then put a probe gently against your eye to measure the pressure.

Next, Dr. Langsford examined the back of West’s eyes at the optic nerve — that’s the pathway in the back of the eye from the eyeball to the brain. For this test, he dilated West’s eyes so he could better examine the optic nerves.

“Her optic nerves looked like they had changed over time because of high pressure,” he said. Putting all of these test results together, Dr. Langsford strongly suspected West had glaucoma in both eyes.

Glaucoma occurs when fluid pressure builds up inside the eye. That pressure can start to damage the optic nerve. It most often happens after age 40 and is more common in older adults. It’s one of the leading causes of blindness in people over 60.

Glaucoma is usually painless, so people don’t typically realize they have glaucoma until their eyesight begins to deteriorate significantly. Individuals usually start to lose their side or peripheral vision first, but it can also affect central vision. Any vision you lose from glaucoma you cannot get back, so it’s critical to catch it early and stop it in its tracks.

“There's no surgery that’s going to restore the vision that was lost,” Dr. Langsford said. “So, it’s all about preventing future loss and maintaining what they have.”

West’s lost vision would never return, but with proper treatment, she and her doctors could stop the glaucoma from getting worse.

Dr. Langsford immediately put medicated eye drops in West’s eyes to help reduce the pressure. He then arranged for her to meet with a glaucoma surgeon.

Her doctors decided she didn’t need surgery, but she began using medicated eye drops every day to reduce her pressure into the teens where it should be. She will need to continue to properly use the eye drops every day for the rest of her life to prevent the pressure from increasing and to keep her remaining vision.

She will also need to have comprehensive eye exams every year in addition to other follow-up visits to make sure the medicine continues to work and that she doesn’t develop other eye conditions. Incidentally, that redness West was worried about? It was likely a harmless burst blood vessel and had nothing to do with her vision loss or glaucoma, but it did get her to evaluate and monitor her vision. She realized that her vision had not been improving in November and December, even though the redness went away.

When using any medicated eye drops, Dr. Langsford recommends patients shake the bottle before using — the medication in the liquid saline solution can settle to the bottom, so if you don’t shake the bottle, you might only get saline in your eye, not the medication. (Saline is a mix of harmless water and salt that acts as a “carrier” for the medicine.)

He also recommends that you sit or lie down to put in the eye drops, so you don’t lose your balance when you close your eyes. After you put in a drop, you should gently close your eye for at least one minute to make sure the medicine gets absorbed properly, he explained.

A comprehensive eye exam with an optometrist every year is important to catch vision problems early. Through an eye exam, a doctor of optometry can directly view inside the eye, including the retina, blood vessels and the optic nerve. Early detection is the key to preventing irreversible vision loss.

But these exams can detect other problems beyond the eyes. By looking at the eyes, eye doctors can detect more than 270 serious health conditions, including diabetes, brain tumors, high blood pressure, autoimmune diseases, sexually transmitted diseases and even some kinds of cancer.

In addition, our vision changes as we get older, so frequent exams are even more important as we age. Some medications can have eye-related side effects, so it’s important for your optometrist to keep watch.

And like glaucoma, other eye conditions can develop over time without any pain and only subtle vision changes. But with an annual exam, an optometrist can notice those changes

To learn more about glaucoma, visit https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/glaucoma

*Not her real name.

Steve Langsford, O.D.

Dr. Stephen “Steve” Langsford has practiced in the Ventura and Santa Barbara area since 1996, including five years at Miramar Eye Specialists Medical Group from 2001 to 2006.  He holds a Bachelor of Science degree in Visual Science, and earned his Doctor of Optometry degree at the Southern California College of Optometry (SCCO) (MB Ketchum University).

He performs comprehensive eye examinations to evaluate the health of patients’ eyes, as well as LASIK evaluations for those that would like to reduce their dependence on glasses. Dr. Langsford is fully trained and licensed to diagnose and treat many ocular diseases and conditions such as cataracts, glaucoma, conjunctivitis, allergies, etc.