Glaucoma Care in Titusville A Quiet Disease Deserves a Watchful Doctor.

Has anyone in your family had glaucoma, or has your eye pressure run high?

Your mother has it. Your brother was just started on drops. Or your last exam ended with the words "your pressure is a little high" and a suggestion to come back, and life got in the way. Maybe you already have glaucoma and you are tired of the drive to a specialist an hour away.

Glaucoma does not announce itself. The common kind brings no pain and no blur until some side vision is already gone, and what it takes does not come back. We would rather see you a year early than a year late. Come on in and let us have a look at the nerve.

What is glaucoma?

Glaucoma is damage to the optic nerve, the cable that carries what your eye sees to your brain. Most often the fluid inside the eye drains too slowly, the pressure climbs, and over years the nerve wears down under it. The damage cannot be undone, but with treatment it can usually be slowed or stopped.

Open-angle glaucoma is the kind we see most. The drain looks normal but works poorly, pressure creeps up, and side vision fades so gradually that most people never notice. Angle-closure glaucoma is rare and sudden: the drain shuts, pressure spikes within hours, and it brings severe eye pain, headache, nausea, halos around lights, and blur all at once. Call us the same day if that happens. There is also normal-tension glaucoma, where the nerve suffers even though the pressure reads normal, which is why we look at the nerve itself and never trust the number alone.

Anyone can get glaucoma. It is more likely after 40, when it runs in the family, with diabetes or high blood pressure, after an eye injury, and with long use of steroid medicines such as prednisone. If any of that sounds like you, a yearly look is worth the hour.

How do we test for glaucoma?

We test for glaucoma four ways: a pressure reading, a look at the optic nerve with your pupils dilated, an OCT scan of the nerve, and a visual field test of your side vision. Together they tell us whether the nerve is healthy and whether anything has changed since you last sat in our chair.

The OCT scan is the one patients ask about. OCT stands for optical coherence tomography. It uses light, not X-rays, to take a cross-section picture of the back of your eye and measure how thick the nerve fiber layer is around the optic nerve. Nothing touches your eye, the scan takes a few seconds, and we lay it beside your earlier scans. Thinning shows on that chart long before you would ever feel it, and that is what makes early treatment possible.

The visual field test maps your side vision. You look at a light in the center of a bowl and press a button each time a small light appears off to the side. It shows what glaucoma has taken, and over the years it shows whether treatment is holding. Between the two, we see both the shape of the nerve and how well it works.

At a glaucoma visit we check:

• Your eye pressure, the number most people know about
• The optic nerve, seen directly with your pupils dilated
• An OCT scan of the nerve fiber layer on our Solix and OptoVue scanners, set beside your earlier scans
• A visual field test of your side vision on the Octopus analyzer
• The drainage angle at the front of the eye, to tell open-angle from narrow-angle

How do we treat glaucoma?

For most patients, glaucoma treatment is a daily eye drop that lowers the pressure, and that is where it starts and where it stays. We choose the drop, check at a follow-up that it is doing its job, and change it if the pressure or the nerve says to. Some patients need two drops. A few need a pill as well.

The nerve tissue already lost does not grow back, so the aim is to hold the pressure where your nerve can live with it and keep the sight you have. That takes follow-up visits for the long run, more often at first and less once things settle, with a pressure check each time and the OCT and visual field repeated on a schedule we set together. We keep that schedule, and you will hear from us when it is time.

When drops are not enough, or a patient cannot keep up with them, a laser procedure or surgery can help the fluid drain or lower how much the eye makes. For narrow angles, a small laser opening in the iris keeps the drain from closing. We do not do those procedures ourselves. We send you to a surgeon we trust with your scans and fields ahead of you, and your follow-up care comes back to us once you have healed.

Who treats glaucoma at Aker Eye, and where?

Dr. Greg Aker is our glaucoma specialist. He is a Southern Diplomate in Glaucoma Management and a Diplomate of the American Board of Optometry, and he sees glaucoma patients at our Downtown office, 338 S Washington Ave, upstairs by the elevator. If you want the specialist, ask for him by name when you call.

Every one of us checks for glaucoma at every exam. Dr. Amanda Aker practices beside her father Downtown, and her residency at the Illinois College of Optometry was a year of ocular disease that included glaucoma care. Dr. Sarah Koehnemann, who first shadowed Dr. Aker as a Titusville high schooler and whose residency was also in ocular disease, and Dr. Jennifer Bradley see patients at Playalinda, 1114 S Washington Ave, on one floor. Whichever office you choose, any of us can bring Dr. Greg Aker in on a nerve that needs a second look.

Does insurance cover glaucoma treatment?

In most cases, yes. Glaucoma is a medical condition, so the visits, the pressure checks, the OCT scans, and the visual field tests go to your medical insurance, including Medicare, not to a vision plan, and your medical copay and deductible apply. The drops run through your pharmacy benefit like any prescription. Call us at (321) 269-2021 with your plan name and we will check your benefits before you come in, so nothing surprises you at the desk.