Ep. 004: An Overview of Primary Open-Angle Glaucoma with Ashley San Filippo, MD

On this episode Dr. Steven Suh interviews Dr. Ashley San Filippo about primary open-angle glaucoma (POAG), the most common type of glaucoma. 

Glaucoma is a progressive disease of the optic nerve (the cable–like bundle of nerve fibers that transmits visual information from the eye to the brain) that may be associated with eye pressure build-up. 

There are two main types of glaucoma – open-angle and angle-closure (or narrow-angle).

Nearly three million people are affected by glaucoma in the United States. 

Risk factors for open-angle glaucoma: over age 40; family history; African or Hispanic heritage; have high eye pressure; had an eye injury; used long-term steroid medications; have corneas that are thin in the center; have diabetes.

Symptoms of POAG: there may be none! Initially it is a “silent” disease. This is why it is important to have your eyes examined periodically.

Peripheral (side) vision changes precede central vision loss as the disease progresses. 

The diagnosis of POAG can be confirmed in the eye doctor’s office. 

• High intraocular pressure (IOP) may or may not be present because some patients never have higher than normal IOP, which is somewhere between 10 and 22 mm Hg.  
• The optic nerve head (disc) has a characteristic appearance indicative of glaucomatous damage.
• Loss of side vision as measured by a visual field test.
• Optical coherence tomography (OCT) is a non-invasive imaging technique used to visualize and quantify the thickness of the nerve fiber layer of the retina and provides information on optic nerve head topography.
• Corneal thickness measurement (pachymetry) – checking for thin corneas.

Ocular hypertension is higher than ”normal” eye pressure without the other signs of glaucoma. This is one of the biggest risk factors for developing glaucoma so it is important to have regular follow-up exams with your eye care specialist. 

Treatment for POAG includes medicated eye drops, laser surgery, and traditional surgery. Usually eye doctors will start with eye drops. An in-office procedure called selective laser trabeculoplasty (SLT) has become a popular option as it can lower IOP and minimize your need for eye drops. Minimally invasive glaucoma surgeries (MIGS) may be performed in conjunction with cataract surgery and is used mainly for mild to moderate glaucoma. Traditional surgeries (trabeculectomy and tube shunt drainage surgeries) are reserved for more advanced disease. 

Marijuana is not an effective treatment for glaucoma.

Patients with glaucoma or who are suspicious for having glaucoma should follow the advice of their eye physician in terms of frequency of visits to ensure that they are getting all the appropriate tests to follow any changes that may be occurring. 

Read more about glaucoma at these links:  

https://www.aao.org/eye-health/diseases/what-is-glaucoma

https://www.midohioeye.com/glaucoma-columbus/

To find out more about Dr. San Filippo, go to her website or follow her practice on Facebook, Instagram, and Twitter.  

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of