Common Glaucoma Tests

If you have been diagnosed with glaucoma or are considered a glaucoma suspect, certain tests may be performed at regular intervals to help diagnose or monitor your condition. Commonly performed glaucoma tests are described in detail below.

Visual fields

The eye’s visual field is the entire area that can be seen while looking at a specific point, from the center to the far periphery in all directions. Certain diseases- particularly glaucoma, retinal disease, and neurologic disorders- can cause loss of certain parts of the visual field, typically in patterns fairly specific to the type of disease. Testing the eyes’ visual fields can therefore provide very useful information towards diagnosing or monitoring treatment of numerous conditions.

Visual field testing is conducted in the office using the Humphrey® Field Analyzer/HFA II-i, a computerized device capable of performing accurate, relatively quick exams. The testing procedure is as follows:

• Dilation is usually NOT required for this test.
• Information, such as your name, age, and certain ocular measurements, is entered into the computer.
• Each eye is tested individually. The eye not being tested is covered with a patch.
• Sit at the device with your forehead and chin comfortably positioned against rests.
• The technician performing the test will give you instructions, and will ask you to look directly ahead at a fixation target throughout the entire procedure.
• The device will begin to present a pattern of flashing lights. When you see a light you will press the button on the controller in your hand. Press the button only when you truly see the light- do not pay attention to sounds made by the computer.
• Most test programs will adjust the pace to your personal response speed- do not feel rushed. If you begin to feel tired or are uncomfortable, the test can be paused at any point. Simply ask the technician for a break.
• When the test is complete you are free to go. Results will be mailed to you after your doctor has reviewed them, and will be discussed at your next visit.
• This test typically takes about 20 to 30 minutes to complete.

Ocular Coherence Tomography (OCT)

Ocular coherence tomography (OCT) uses laser light to image the structures of the eye, including the retina, optic disc, cornea, and iris. This technology functions somewhat like radar, using light instead of radio waves. Light passes into the eye where it is either absorbed or reflected by tissue. Different structures reflect different amounts of light, which is then received by a detector within the OCT instrument. The patterns of reflected light are analyzed by computer and assembled into very detailed images. The device “optically sections” the structures, providing images which appear very similar to microscopic cross-sections obtained by surgically slicing tissues. The latest version of OCT technology, known as spectral domain OCT, can resolve structures down to approximately five microns, smaller than a human red blood cell.

OCT has numerous applications within the eye. It is most commonly used to image the retina, the multi-layered light-sensitive tissue in the back of the eye. OCT has revolutionized the diagnosis of retinal diseases, as it can very accurately identify the exact location of pathology within or between the many layers of the thin retina. Additionally, the effects of treatment can be directly monitored simply by repeatedly scanning the retina with OCT.

In glaucoma, OCT can help identify thinning of the retinal nerve fiber layer, the thin sheet of nerve tissue which spreads out from the optic nerve and which is damaged in the disease. Thinning of this layer, along with characteristic changes in optic nerve appearance, suggests glaucoma. Repeated OCT scans performed over a number of years can identify progressive nerve fiber thinning, the hallmark of glaucoma damage. At Fishkind, Bakewell & Maltzman we use the Zeiss Cirrus® spectral domain OCT, the current state-of-the-art in OCT scanning. Testing is performed very simply:

• Dilation is usually NOT required for this test.
• Information, such as your name, age, and certain ocular measurements, is entered into the computer.
• Sit at the device with your forehead and chin comfortably positioned against rests.
• The technician performing the test will give you instructions, and will ask you to look into the device at a blinking fixation target.
• You will be asked not to blink for appoximately three seconds as each eye is scanned. You may notice some dim blinking light from within the device.
• When the test is complete you are free to go. Results will be mailed to you after your doctor has reviewed them, and will be discussed at your next visit.
• This test typically takes about 15 to 20 minutes to complete, but does vary with the number of scans required.

Optic nerve photography

The optic nerve can appear abnormal in a number of disorders, most commonly glaucoma. A change in the appearance of the nerve over time can indicate progression or worsening of disease. In our practice we use a state-of-the-art stereoscopic fundus camera, the Nidek 3Dx®, to take accurate, repeatable, stereo-paired photographs of the optic nerve and retina. Stereo pairs allow for three-dimensional viewing, providing more detail than a standard, single-image photograph. The procedure is performed as follows:

• Dilation IS REQUIRED for this test. If you do not like to drive with your eyes dilated, you may want to arrange for someone to drive you to the office.
• Information, such as your name, age, and certain ocular measurements, is entered into the computer.
• The eye not being tested may be covered with a patch.
• Sit at the device with your forehead and chin comfortably positioned against rests.
• The technician performing the test will give you instructions, and will ask you to look into the device at a blinking fixation target.
• The camera will be focused and you will be asked to hold very still and to not blink for a few seconds as the photo is taken. The flash may seem very bright, but is not harmful.
• When the test is complete you are free to go. Disposable sunshades will be provided, if necessary. Results will be mailed to you after your doctor has reviewed them, and will be discussed at your next visit.
• This test usually takes about 30 to 50 minutes to complete, depending upon how quickly your eyes dilate.