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The doctor dilates my eyes and it is extremely painful.

Q: Each time I go to the eye doctor, the doctor dilates my eyes and it is extremely painful. Sometimes, the pain lasts for a couple of weeks after the visit. I take drops for glaucoma daily and know that my glaucoma exams are important. What could be causing this?
A: You should feel comfortable asking your doctor what s/he believes is causing this pain, and to work with you to figure out whether something can be done about it. It is possible that you have narrow angles in your eye and that your IOP is going up after dilation. If this is the cast, avoiding dilition may be the appropriate solution--and this should be the temporary soulution until this concern is resolved.

What is involved in a glaucoma screening?

Q: What is involved in a glaucoma screening? Does it take long? Will I need to be away from work for a long time following the screening?
A: A glaucoma screening can range from a quick puff of air in the eye to check pressure, to a very through exam that includes visual acuity, pressure checked by applination tonometry (the blue light actually touching the eye), slit lamp examination and an exam of the back of the eye (ophthalmoscopy). The exam, should not take more than a few minutes. Once completed, the individual can return immediately to prior activities.

Can an optometrist treat me for glaucoma?

A: The optometric profession has evolved over the past two decades. Enhanced education and training allows optometrists to treat and manage glaucoma in 49 of the 50 United States. Massachusetts is the only state in which optometrists cannot prescribe medications used in the therapy of glaucoma.

Rising Blood Pressure when Eye's are Dilated

Q: A relative of mine was told that her blood pressure went up when her eye was dilated. Since she has a heart problem, this caused difficulty. Under what circumstances would such a rise in blood pressure occur?
A: The use of phenylephrine (NeosynephrineŽ) which is used to dialate the pupil, can elevate blood pressure. We used to use 10%; now we use 2.5%. There have been reports of severe reactions such as stroke and heart attack immediately after being dilated; however, this is rare. Neosynephrine acts systemically by raising the blood pressure. Again, it is important that your eye doctor be informed of any medical problems or changes in your medical history at each appointment so that every effort can be made to avoid serious reactions.

How often should the optic nerve be examined?

Q: My husband has glaucoma in both eyes. He is 68 years old, does not have cardiovascular disease and had a central retinal vein occlusion in his left eye last July. He is now totally blind in that eye. We want to make sure he can keep the glaucoma in the right eye under control. In your estimation how often should my husband's optic nerve be checked to make sure we keep the glaucoma under control? How is the optic nerve being checked, by photography or can the ophthalmologist do this visually? Thank you very much.
A: The frequency of checking the optic nerve depends on how severe the glaucoma is, how much damage has been done to the optic nerve so far, and what the intraocular pressure is. Periodic photography is the best method for checking the optic nerve in this kind of case.

The Visual Field Test

Q: I was just classified as a suspect for glaucoma. I took the visual field test and I understand that you are to look at the center, which is a green and red object. However, was I only to focus on that green and red object without moving my head? I saw with the corner of my eye light objects and, of course, took my eye off the center and looked at it and pushed the button. I have to take the test again and would like to know if I am using the correct method.
A: There are a number of different machines for testing the visual field. You are supposed to focus on the target and not move your head so that the computer can determine whether or not you can see the lights appearing in your peripheral vision. When you are taking the test, it is easy for your eye to wander, but the technician administering the test should be with you to watch while you take the test and prevent you from looking around and encourage you in the proper way of taking the test. The technician should also give you complete instructions about how to take the test before you begin.

Can Scar Tissue Affect Testing?

Q: Due to a congenital cataract and several eye surgeries I had when I was a chlid, I developed secondary glouchoma. The pressure was stablized with medication and surgery. That was 8 years ago. I went to a new opthamologist recently and he said that he couldn't check the pressure in my diseased eye because there was too much scar tissue. Is it possible for an eye to be too hazy or scarred to be able to check the pressure?
A: Corneal scarring can interefere with eye pressure measurement. Techniques which might be helpful for this measurement include pneumotonometry or tonopen tonometry.

Air Tonometry pressure test question

Q: With the air tonometry pressure test is there a pressure level that may indicate a potential and/or future problem. Alao given 2 or 3 tests over a period of 4-6 months what is the typical range of pressure readings.
A: Air-puff tonometry is not as reliable as Goldmann tonometry.

What exactly should my doctor be checking for when he examines my eyes?

Q: My new doctor takes the pressure and looks at the optic nerve. This process takes about two minutes. What exactly should my doctor be checking for when he examines my eyes? This doctor explained this procedure by saying that all that examining is not needed any more.
A: A glaucoma examination consists of assessment of eye pressure, visual fields, and the optic nerve. Discussion with the patient should then ensue. Sometimes the exam takes a few minutes, other times considerably longer, particularly if testing needs to be evaluated. Patients should discuss these issues directly with their physicians.

When does my glaucoma test indicate I should see an opthamologist?

Q: I just recently returned from a glaucoma test given by an Optometrist. I was told my level was at a 23, where in the past, my level had been a 16. I am 55 years of age, with none of the other traits for glaucoma. Does this warrant further tests or should I wait for my next exam in a year? He also measured one optic center at .4 and the other at .2 saying this was another suspect variable? Should I see an Opthamalagist?
A: Elevation of eye pressure and asymmetry of the optic nerve appearance can be early signs of glaucoma. An examination by an ophthalmologist or glaucoma specialist is warranted to confirm or deny these findings.


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