glaucoma

Eye pressure measurement

Eye pressure measurement

The measurement of intraocular pressure can be done by different methods, sitting or lying down. Nowadays, the so-called non-contact tonometers are often in use. They allow the internal pressure to be determined by the measurement of a defined air pulse and of corneal deformation. (see also research glaucoma)

Measurement of the dynamic intraocular pressure conditions with the Pascal Contour Tonometer:

The result of the examination provides decisive information on the perfusion of the eye, the most important protective factor against glaucoma. With this measurement, we can tell you even more precisely, if there is a risk of glaucoma and if a treatment is necessary.

Functional tests

Functional tests

Field of vision, perimetry
As a result of damage to the optic nerve, glaucoma causes (increasing) defects in the perception of the visual field outside central vision.
The task of "perimetry" is to use targeted examinations to examine different areas of the visual field and, as early as possible, to detect a decrease in the sensitivity of these areas or to control the course of visual field defects.

Methods

• Goldmann perimetry
• Automatic perimetry
• FDT ("Frequency doubling technology")

This visual field examination allows a particularly sensitive diagnosis for the early detection of glaucoma-related defects. It specifically tests the retinal sites that are affected early in glaucoma.

Laser measurement of the eye

Laser measurement of the eye

As a precaution, we offer you a special program, which we would like to introduce to you. These benefits are not included in the scope of benefits of the statutory health insurance.

Non-contact measurement of corneal thickness
The measurement of "normal" eye pressure (10-20 mmHg) does not exclude the diagnosis of glaucoma. To note is the corneal thickness when measuring intraocular pressure. A cornea that is thicker than the "norm" gives the fasle information of a higher intraocular pressure. Too thin a cornea covers up an incresased pressure.

Glaucoma screening diagnostics

Glaucoma screening diagnostics

We are happy to advise you about our preventive care program. More information can be found here:

Prevention of glaucoma

Operations

Operations

If adequate lowering of the intraocular pressure by drugs (e.g., drops, tablets) is not successful or possible, we recommend glaucoma surgery. Its purpose is to improve the outflow of aqueous fluid or to reduce the formation of aqueous fluid.

The procedure is performed either in local anesthesia by drip anesthesia or injection of an anesthetic under the conjunctiva or next to the eyeball or in general anesthesia. Each patient will be informed separately about the proposed procedure, its effects and possible side effects / risks as well as its advantages and disadvantages.

There are various surgical procedures, the essentials of which we will list below. The glaucoma operations are ophthalmological standard procedures. They are performed under the surgical microscope, some using laser technology. We will explain the advantages and disadvantages of the various procedures in a personal discussion.

The following information is taken from the information sheet "Operation des Grünen Stars" (Editor: Prof. K. Ulsenheimer (Medical Law), Founding: Prof. W. Weißauer, Specialist: Prof. T. Kohnen, Authors: Prof. M. Diestelhorst, Prof. T. Kohnen, Diomed in Thieme Compliance GmbH):

• "Iridectomy: a small opening gets surgically created In the periphery of the iris by a precision knife, , which improves the outflow of the aqueous fluid over the chamber angle.The iridectomy is used mainly with narrow angle (narrow-angle glaucoma) and with an increasment of acute intraocular pressure ("glaucoma case")
• Iridotomy: a small opening gets created In the periphery of the iris, this time form the outside by laser beams, which improves the outflow of aqueousfluid through the chamber angle. Unlike surgical iridectomy, the eye does not need to be opened. The iridotomy is mainly used in narrow angle of the the eye and in case of an increasment of acute intraocular pressure (glaucoma case).
• Filtration Surgery/Trabeculectomy: A new drainage path is created under the conjunctiva through a very small opening in the dermis and an iris window (iridectomy) is created in this area. This allows the aqueous fluid to be drained more easily from the eye to the eye socket.
• Goniotomy, Trabeculotomy, Goniocurettage: e.g. In congenital glaucoma, a fine needle-like knife or similar instrument / trabectome is used to cut tissue / membranes in front of the trabecular meshwork to improve drainage of the eye water from the anterior segment.
• Viscocanalostomy/-canaloplasty: Similar to chamber angle surgery (# 4), a gel-like substance / plastic filament is injected / clamped into the drainage channel to improve the outflow of aqueous fluid.
• Cyclo-cryo-photocoagulation: A part of the ciliary body that forms the aqueous fluid is desquamated by a cold stick (cyclocryocoagulation) or by laser energy (cyclophotoagulation). As a result, less eye water is formed in the subsequent period. This method is often performed on secondary glaucoma, e.g. as a result of existing eye inflammation, thrombosis in the eye or vascular changes (diabetes) arise.
• Selective laser trabeculoplasty laser surgery (SLT): After anesthesia of the cornea and the placement of a contact lens, the chamber angle in selected sections is treated with low-dose laser light. This procedure is suitable for low increasement in intraocular pressure  "(end of quote) and is often recommended even before a drip therapy. SSLT laser therapy uses very short light pulses with low energy and aims only at the specific melanin or pigment cells in the eye. These cells are then renewed via a regenerative, self-healing process of the body; in this natural way the aqueous drainage is restored. The treatment can be performed on an outpatient basis and usually lasts no more than five minutes. Due to the green laser light pulses, which are very short (0.000000003 seconds) and extremely low dose, the laser energy is only selectively transferred to the pigment cells in the eye. Through a regenerative, self-healing process of the body, these cells are renewed. The surrounding tissue and the rest of the eye remain completely untouched and undamaged. The drainage is no longer blocked, consequently the aqueous fluid can flow freely again and the intraocular pressure drops. Compared to other laser therapies, SLT is a gentle, non-invasive, tissue-sparing treatment that can be safely repeated. The SLT treatment is particularly useful when/with:
  ● Open-angle glaucoma, pseudoexfoliation glaucoma or pigment glaucoma
  ● you can not tolerate glaucoma drops or have difficulty dropping.
  ● you already have glaucoma drops and you want to combine the SLT.
  ● it is difficult for you to take regular check-ups and treatments.
  ●you have had an ALT (Argon Laser Trabeculoplasty) treatment and your eye pressure has risen again.
  
  What happens if SLT cannot lower eye pressure?
  SLT reduces eye pressure by up to 30% and affects 75 to 85% of treated patients. If the SLT does not work for you, your doctor will continue to use traditional drug therapy and specialized surgery.
  
  Furthermore, the following two options are cited from the above named work:
• "Implants: The aqueous fluid is discharged via a small implant (plastic tube) from the eye chamber into the eye socket and so the intraocular pressure lowered.
• Combination of Filtration Operation (#3, #4) and Cataract Operations: Modern surgical techniques allow cataract and glaucoma to operate simultaneously. Here, the clouded lens (cataract) is liquefied via a corneal incision by means of ultrasonic energy (phacoemulsification), aspirated and a new plastic lens is used to improve vision. If this procedure is suitable for your eyes, you will be informed separately. "(End of quote)