Glaucoma Diagnosis & Management in Shelton, WA

Glaucoma is a sneaky disease. By the time you notice your vision narrowing, the damage is already significant and permanent. The vision you lose to glaucoma doesn’t come back — but the vision you still have can almost always be preserved if we catch the disease early and treat it consistently.

Most people who have glaucoma don’t know they have it. The number is genuinely about half. That’s why we screen every patient over 40 at every comprehensive exam, and why we follow patients with glaucoma carefully over years and decades. Glaucoma management is the long game.

What is glaucoma, exactly?

Glaucoma is a group of diseases that damage the optic nerve — the cable that carries visual information from your eye to your brain. The most common form, primary open-angle glaucoma, develops slowly over years. The pressure inside your eye is higher than the optic nerve can tolerate, and over time the nerve fibers die off, starting with peripheral (side) vision and progressing inward.

Most people don’t notice anything until they’ve lost a meaningful amount of peripheral vision — bumping into doorways, missing things on the side, having trouble driving. By that point, significant nerve damage has already happened. That’s why early detection isn’t just helpful; it’s essential.

Who is at risk?

Anyone can develop glaucoma, but several factors increase risk significantly:

• Age over 60. Risk climbs steadily with age. By age 80, the prevalence is around 10%.
• Family history. Having a parent or sibling with glaucoma increases your risk substantially — sometimes 4 to 9 times higher.
• African ancestry. African Americans are at higher risk and tend to develop glaucoma earlier.
• Hispanic and Asian ancestry. Both groups have elevated risk for specific glaucoma types.
• Diabetes. Diabetes roughly doubles glaucoma risk.
• High eye pressure. Not everyone with high pressure develops glaucoma, but it’s the strongest treatable risk factor.
• Severe nearsightedness or farsightedness. Different mechanisms, but both increase risk.
• Past eye injury or eye surgery. Can elevate risk for secondary glaucoma.
• Long-term steroid use. Certain people are sensitive to steroid-induced pressure rise.

If two or more of these apply to you, please don’t skip annual eye exams. Even if your vision feels perfect.

How we diagnose glaucoma

There’s no single test for glaucoma. The diagnosis is built from a combination of findings, and the technology has gotten dramatically better in the past decade. Here’s what we use in our office:

Eye pressure measurement (tonometry)

The classic glaucoma test — we measure the pressure inside your eye. Normal range is roughly 10-21 mmHg, but glaucoma can occur at “normal” pressures and not everyone with high pressure has glaucoma. So pressure alone isn’t enough — it’s one data point among several.

Optic nerve evaluation

We look directly at the optic nerve, which lives at the back of your eye where it leaves the retina. Healthy optic nerves have a characteristic appearance; glaucomatous nerves are thinned, cupped, or asymmetric. An experienced optometrist can detect early glaucomatous changes by direct examination.

Optical Coherence Tomography (OCT)

This is the technology that has transformed glaucoma diagnosis. OCT measures the thickness of the nerve fiber layer around the optic nerve at micron-level precision. We can detect structural changes years before vision loss is measurable on a visual field test. We use OCT for both diagnosis and ongoing monitoring — tracking changes year over year tells us whether the disease is stable or progressing.

Visual field testing

This is the test that maps your peripheral vision. You watch a fixed point and click a button each time you see a flashing light at the edges of your vision. Visual field testing tells us whether glaucoma has caused functional vision loss yet, and it’s how we measure progression over time.

Retinal imaging

We use ultra-widefield retinal imaging to document the appearance of the optic nerve and surrounding retina. These images give us a permanent baseline to compare against in future visits.

We use these tests together. Any one of them in isolation can mislead; the combination gives us a much more accurate picture.

How we treat glaucoma

The goal of glaucoma treatment is to lower eye pressure enough to slow or stop further damage to the optic nerve. We can’t reverse the damage that’s already happened, but we can almost always preserve the vision you still have.

Eye drops

Prescription eye drops are the first-line treatment for most patients. There are several classes that work in different ways — reducing the eye’s production of fluid, increasing drainage, or both. We’ll start with whichever is most appropriate for your situation, monitor how well it’s working, and adjust as needed. Most patients on drops do well long-term.

Drops only work if you actually use them. The hard part of glaucoma treatment isn’t the medication; it’s remembering to take it every day, every year, for the rest of your life. We talk through this with patients and help find systems that make compliance easier.

Laser treatment (SLT)

Selective laser trabeculoplasty (SLT) is a brief, painless in-office procedure that improves the eye’s natural drainage. It can be a good option when drops aren’t lowering pressure adequately, or for patients who have trouble being consistent with daily drops. If SLT is appropriate for you, we’ll refer you to a glaucoma specialist and stay involved with your ongoing care.

Surgery

For glaucoma that’s progressing despite drops and laser treatment, surgical options are available. These range from minimally invasive procedures done at the time of cataract surgery to traditional glaucoma surgery. We coordinate referrals to glaucoma surgeons when surgery is indicated, and we provide all the pre-operative evaluation and post-operative follow-up care.

Why ongoing monitoring matters

Glaucoma isn’t a one-time diagnosis followed by a fix. It’s a chronic disease that needs to be tracked over years. We typically see glaucoma patients every 3 to 6 months, depending on how stable the disease is and how aggressive the treatment needs to be. At each visit:

• We re-measure eye pressure to make sure treatment is still working.
• We repeat OCT imaging and compare to your baseline. Are you stable? Progressing? The numbers tell us.
• We repeat visual field testing on a schedule.
• We discuss any changes in your medications or general health.
• We adjust treatment if needed.

Patients who stay engaged with their glaucoma care almost always preserve their vision long-term. Patients who skip visits or stop their drops because they “feel fine” are the ones who lose vision — usually slowly, sometimes catastrophically.

What to expect at your first glaucoma appointment

If you’ve been told you might have glaucoma, or you’ve been diagnosed elsewhere and need a new optometrist, here’s what your first visit looks like:

• Bring your records. Any prior OCT scans, visual field tests, or notes from previous eye doctors are extremely helpful. They give us a baseline to track progression against.
• Bring your medications. Both your eye drops and any general medications — some systemic medications affect eye pressure or interact with glaucoma drops.
• Bring your insurance card. Glaucoma diagnosis and management is billed to medical insurance, not vision plans. Apple Health, Medicare, and most major medical plans cover it.
• Glaucoma workups involve more testing than a routine eye exam — pressure check, OCT, visual field, optic nerve evaluation. Some of this can be split across visits if needed.
• Bring sunglasses if we’re dilating. If we need to dilate to evaluate the optic nerve, you’ll be light-sensitive for several hours afterward.

To schedule, call us at (360) 427-8324. If you have a family history of glaucoma and you’ve never been screened, please don’t wait — this is exactly the situation where early detection makes the difference.