1. How is glaucoma treated and managed?
remember to use your eye drop on the day of the eye
check-up
Glaucoma is controlled by lowering the eye pressure. This can
be achieved with eye drops or medications, laser treatment or
surgery. Treatment is individualized and regular monitoring is
required after successful control of the eye pressure. It is
important to know that pre-existing damage to the optic
nerve cannot be improved or reversed with treatment hence it
is important to have early eye screening to detect glaucoma.
Glaucoma treatment aims to preserve the remaining vision
and requires life-long monitoring. The eye specialist will
discuss the treatment options most suited for your condition.
do not miss your eye drops. If you are running out
eye drops, return to the clinic for a new prescription in
advance
Eagle Eye Centre has a comprehensive list of anti-glaucoma
medications available for controlling intraocular pressures
including the latest combination therapy eye drops. We
perform lasers for glaucoma including argon laser peripheral
iridotomy, laser iridoplasty, trans-scleral cyclophotocoagulation and laser suturelysis after trabeculectomy. Glaucoma
surgeries performed at EEC include - trabeculectomy with
anti-metabolites; phaco-trabeculectomies (combined cataract
and glaucoma surgery) with anti-metabolites; glaucoma bleb
needling with anti-metabolites; glaucoma (bleb) revision
surgeries; and glaucoma drainage implants.
How do I use my eye drops?
Compliance to eye drops plays a major role in success of
glaucoma treatment and control of the disease.
Use your eye drops as instructed
If you have more than 2 eye drops to instill at the
same time, wait for at least 5 minutes before instilling
the next eye drop
you can minimize absorption through the nasal
passages by placing your index finger against the
inner corner of your eye (against the nasal bone) for
30 seconds
excess eye drops should be cleaned from the skin with
a moistened tissue or towel
time your eye drop with certain activities or set an
alarm to help you remember to instill your eye drop
everyday
bring your medications along for each visit to the eye
doctor
Inform the doctor if you have any problems with the
eye drops
When should I get an eye check for
glaucoma?
Early detection and appropriate treatment can prevent blindness in glaucoma. If you have any of the following, it is advisable to have an eye check done by an eye specialist:
Age 40 years and older
have a family member or relative with glaucoma
on steroid medications
had previous injury to the eye
had previous surgeries to the eye
have diabetes
have high myopia or high hyperopia
blurred vision
intermittent eye pain
known to have inflammation of the eyes
Laser Treatment for angle closure
Patients who are found to have narrow or closed drainage
passages (angles) of the eye are at increased risk of developing
angle closure glaucoma. In the acute situation, the eye
pressure increases suddenly, rising to a very high level. This
occurs as the eye fluid is trapped behind the iris at the pupil
and closes the drainage passages (angles) of the eye. There is
hence obstruction of outflow of the eye fluid, leading to
buildup of the fluid in the eye and an increase in the eye
pressure. Laser peripheral iridotomy helps to reduce the risk of
this ocular emergency. The laser creates a small fluid channel
in the periphery of the iris allowing the fluid from behind the
iris to flow forward and through the drainage passages of the
eye thus preventing a sudden rise in eye pressure.
The laser is done as an outpatient procedure. The eye is
prepared with eye drops to constrict the pupil and to anaesthetize the eye. Some patients may experience a transient eye
ache or headache or dimming of vision with these eye drops.
Eye drops or medications may be given to lower the eye
pressure before the laser procedure. A contact lens will be
placed on the eye during the laser procedure. The laser is
usually painless and an aching sensation may be felt in some
patients. The patient is seated much like the eye examination
at the slit-lamp in the clinic. The eye pressure is checked again
after the laser.
The laser procedure is not a surgery and requires minimal
after care. Eye rubbing should be avoided. The vision may
appear cloudy for a few hours after the laser. Eye drops are
required for 1 to 2 weeks after the laser. There are no restrictions to daily activities. Some patients may experience glare
symptoms after the laser. The possible risks of the laser include
increased eye pressures, damage to the surrounding eye structures like to the corneal cells that can result in loss of corneal
clarity later. Please approach your eye specialist if you have any
questions on this procedure.
Eagle Eye Centre @ Mount Alvernia
Mount Alvernia Hospital
820 Thomson Road, #02-10/17, Medical Centre Blk B, Singapore 574623
Tel: 6456-1000 / 6-eagleye (6324-5393) Fax: 6456-1006
Eagle Eye Centre @ Mount Elizabeth
Mount Elizabeth Medical Centre
3 Mount Elizabeth, #08-02, Singapore 228510
Tel: 6836-0001 Fax: 6836-0002
Eagle Eye Centre @ Parkway East
Parkway East Medical Centre
319 Joo Chiat Place, #05-03, Singapore 427989
Tel: 6348-1000 Fax: 6348-1001
Eagle Eye Centre @ Mount Elizabeth Novena
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-22/23/24, Singapore 329563
Tel: 6570-1000 Fax: 6570-1001
Email: eec@eagleeyecentre.com.sg
Website: www.eagleeyecentre.com.sg
GLAUCOMA

2. Chronic diseases like diabetes and high blood pressure
Glaucoma
Glaucoma is a leading cause of irreversible blindness in the
world and accounts for 40% of blindness in Singapore. People
of different races and ages are affected by glaucoma. It is often
called the ‘silent thief of sight’ as patients often do not have
symptoms until in advanced disease. Early detection and
treatment will prevent irreversible visual loss and blindness
from glaucoma.
What is Glaucoma?
Glaucoma is an eye disease that affects the optic nerve. The
optic nerve transmits visual information from the eye to the
brain. In glaucoma, there is characteristic damage to the optic
nerve resulting in loss of vision.
Steroid medication use - prolonged steroid use (eye
drops or medications) can cause raised eye pressures in
certain individuals (steroid responders)
High myopia and hyperopia
Inflammation of the eye
Advanced cataracts
Previous eye surgeries
The peripheral vision is usually affected first as the optic nerve
is progressively damaged in glaucoma. This is usually symptomless and goes unnoticed as central vision remains normal.
Later the peripheral visual loss progresses towards the center
leading to tunnel vision and in advanced cases central vision is
lost. The patient hence notices blurred vision late in the disease
when irreversible damage has already occurred.
The Optic Nerve
is Damaged in
Glaucoma
What causes Glaucoma? Am I at risk
of Glaucoma?
The major risk factor for glaucoma is raised eye pressures
(intraocular pressure). This occurs when there is an imbalance
of fluid production in the eye and its drainage from the eye.
The eye pressure at which optic nerve damage occurs varies
between individuals. Even in a population normal range of eye
pressures optic nerve damage can still occur.
Other risk factors for glaucoma include:
Age; Glaucoma can occur at any age. The risk of
glaucoma increases with age. In Singapore, 3% of
those over 50 years old and 10% over 70 years old are
affected by glaucoma.
Peripheral Vision is progressively lost in Glaucoma
Is Glaucoma inherited?
Glaucoma can affect members in the same family. Those with
a family member or relative with glaucoma (Family History of
Glaucoma) is at an increased risk of glaucoma and should have
glaucoma eye screening by an eye specialist.
T
ypes of Glaucoma and their symptoms
The different types of glaucoma include open and closed angle
glaucoma, secondary glaucoma and congenital glaucoma.
Family History - a family member or relative with
glaucoma can increase your chance of having
glaucoma
Open angle glaucoma
The drainage passage (angle) of the eye is structurally open in
Open-angle glaucoma and accounts for the majority of
glaucoma. This type of glaucoma usually has no symptoms
and progresses slowly. Early eye screening is the only way to
detect this type of glaucoma.
Eye Injury - a serious eye injury can cause glaucoma
many years later
Closed angle glaucoma
Occurs when the drainage passage (angle) is narrow or closed.
There is obstruction to the outflow and drainage of the fluid
in the eye leading to increase in eye pressures. This rise in
pressure can occur suddenly and rapidly, leading to damage of
the optic nerve. Acute angle closure glaucoma is an ocular
emergency and requires prompt treatment. Symptoms
include severe eye pain associated with headache on the same
side, nausea and vomiting, blurred vision and haloes around
lights and redness of the eye.
Chronic angle closure glaucoma may be asymptomatic where
the pressure rise is gradual like open angle glaucoma. Individuals with narrow or occludable angles are at risk of developing
acute angle closure glaucoma. Laser treatment in such cases
help to reduce the risk of sudden rise in eye pressures. See Laser
treatment for angle closure.
Secondary Glaucoma
This type of glaucoma is associated with diseases of the eye –
previous eye injury or surgeries; inflammation of the eye;
advanced cataracts and use of steroid medications. It can also
be caused by medical conditions such as diabetes. Patients
may experience eye pain, halos around lights, blurred vision
and red eyes in these conditions.
Congenital Glaucoma
Congenital glaucoma is a rare eye disease that occurs at birth.
An eye examination is required if the infant’s eye is found to be
enlarged, loss of clarity of the cornea, tearing and is unusually
sensitive to light.
What tests are done during an eye examination to detect and monitor Glaucoma?
The vision (visual acuity), the eye pressure, the drainage
passages (angles) and the optic nerve are assessed. The visual
field test is performed to detect glaucoma damage to the optic
nerve. This test also helps the doctor determine if the
glaucoma is stable or worsening. Optic nerve imaging tests
maybe used to diagnose and monitor glaucoma.
Automated Humphrey
Visual Field Testing
at Eagle Eye Centre
At Eagle Eye Centre, we provide a comprehensive service for
glaucoma screening and management. We have the latest
automated visual field machines, anterior segment imaging
and optic nerve imaging technology to diagnose and
management glaucoma.
Optic Nerve
Coherence
Tomography At
Eagle Eye Centre
Besides managing high pressure glaucoma, we also manage
Normal Tension Glaucoma or Normal Pressure Glaucoma.
At Eagle Eye Centre, we have a developed program to
diagnose and manage Normal Tension Glaucoma - tests
include phasing eye pressure testing, questionnaires, posture
eye pressure testing and use of our imaging technology.
Our Glaucoma
Specialist
Performing an
Eye Pressure
Examination