Glaucoma

Here’s the part that makes glaucoma tricky: you can’t feel it happening. There’s no pain, no redness, no warning sign that tells you something is wrong. Glaucoma takes your peripheral vision first — the edges of what you see — so slowly that your brain fills in the gaps without you noticing. By the time you realize something’s off, significant and permanent damage may have already occurred.

That’s why we check for glaucoma at every comprehensive eye exam, even if you feel fine.

There’s No Magic Number for Eye Pressure

You may have heard that “normal” eye pressure is somewhere around 10 to 21. And that’s roughly true as a population average. But here’s what most people don’t realize: there is no single pressure number that’s safe for everyone.

Some people have pressures of 22 or 23 and their optic nerves are perfectly healthy — they may never develop glaucoma. Other people have pressures of 15 or 16 and are losing vision. That’s called normal-tension glaucoma, and it’s more common than you’d think.

So how do we decide if your pressure needs to be lowered? We look at the whole picture:

• Your optic nerve — What does it look like right now? Is there thinning or damage visible on exam or on our imaging scans (OCT)?
• Your visual field — Is there any measurable loss of peripheral vision?
• Your pressure trend — One reading doesn’t tell us much. We track your pressure over multiple visits to understand your baseline and whether it’s changing.
• Your corneal thickness — Thinner corneas can cause pressure readings to look artificially low. We measure this so we’re interpreting your numbers accurately.
• Your risk factors — Family history, age, race (glaucoma is significantly more common and more aggressive in Black and Hispanic patients), and other health conditions all factor in.

We put all of this together to determine what your target pressure should be — the level where your optic nerve is most likely to stay stable. That target is different for every patient. And if your nerve looks healthy and stable at your current pressure, we may simply monitor you closely rather than start treatment right away.

SLT Laser — Why It’s Become a First-Line Treatment

For a long time, the standard first step for treating glaucoma was a daily eye drop. That’s changing. Selective Laser Trabeculoplasty (SLT) has become a first-line treatment for open-angle glaucoma — meaning it’s often what we recommend before drops, not after they’ve failed.

Why the shift? A landmark clinical trial (the LiGHT study) showed that patients who started with SLT had the same — or better — pressure control as patients who started with drops, with fewer medications needed over time and no increase in complications.

Here’s what makes SLT appealing:

• It’s done right in the office in about five minutes. You sit at a machine that looks like the one we use to check your eyes, and the laser is applied through a special lens. Most patients feel little to nothing.
• No daily medication to remember. This is a bigger deal than it sounds. Eye drops have to be used every single day, at the right time, with proper technique. Studies show that a huge percentage of patients miss doses, use drops incorrectly, or stop altogether. SLT eliminates that compliance problem.
• It’s gentle and repeatable. Unlike older laser treatments, SLT doesn’t cause scarring to the drainage tissue. If the effect wears off over time — which it can — we can repeat it.
• Fewer side effects. No stinging, no redness from preservatives, no medication interactions. Some patients have mild inflammation for a day or two after the procedure, but that’s typically it.

SLT isn’t the right choice for every type of glaucoma or every patient. But for many people with open-angle glaucoma, it’s an excellent place to start.

Eye Drops — More Options Than You Might Think

Eye drops are still a mainstay of glaucoma treatment, and sometimes they’re the best fit — either on their own, after SLT, or in combination with laser. There are many different types of drops available today, and they work by either helping fluid drain out of the eye more efficiently or reducing the amount of fluid the eye produces.

Here’s what matters most: if one drop doesn’t work for you, we have options. If it stings, causes redness, is too expensive, or you’re struggling to keep up with multiple drops at different times of day — tell us. We’ll adjust. The best glaucoma medication is the one you’ll actually use consistently, and we’d rather change your plan than have you quietly stop using it.

When Drops and Laser Aren’t Enough

For some patients, SLT and drops don’t lower pressure sufficiently, or glaucoma continues to progress despite treatment. When that happens, there are surgical options. Minimally invasive glaucoma surgery (MIGS) has transformed what’s available — these are smaller, safer procedures that can be done at the time of cataract surgery or on their own, with faster recovery than traditional glaucoma surgery.

We’ll cover MIGS in detail on its own page, but know that if we ever get to the point where laser and drops aren’t doing enough, there are effective next steps — and we’ll walk you through all of them.

What to Expect at Your Glaucoma Evaluation

If we’re evaluating you for glaucoma — or monitoring glaucoma you’ve already been diagnosed with — here’s what a typical visit includes:

• Pressure measurement (tonometry) — quick and painless, usually with a small puff of air or a gentle contact instrument.
• Optic nerve evaluation — your doctor looks at the nerve directly through a dilated pupil and reviews detailed imaging scans (OCT) that measure nerve fiber thickness down to the micron.
• Visual field testing — you’ll look into a machine and click a button when you see flashing lights in your peripheral vision. It’s not the most exciting 5 minutes of your day, but it gives us critical information about whether you’re losing any side vision.
• Gonioscopy — a painless test where we use a special lens to look at your eye’s drainage angle. This tells us what type of glaucoma you have.
• Corneal thickness measurement (pachymetry) — done once, usually at your first visit, to calibrate how we interpret your pressure readings.

We know that’s a lot of testing. But glaucoma is a condition where the details matter — and every measurement helps us make better decisions about your care.