Glaucoma is a group of eye diseases that cause progressive damage to the optic nerve. This damage is frequently associated with elevated intraocular pressure (IOP), or pressure inside the eye, which can compress and injure the nerve fibers. The condition often progresses without noticeable symptoms in its early stages, leading to it being called the “silent thief of sight.” Since vision loss from glaucoma is permanent, ongoing medical management is necessary to preserve remaining sight.
The Role of the Optometrist
The optometrist (Doctor of Optometry, O.D.) is the primary eye care professional most people see for routine examinations. They are highly trained to perform comprehensive eye exams that include screening for eye diseases like glaucoma. Their role is focused on the initial detection of potential problems and the regular assessment of eye health.
During a routine check-up, the optometrist performs tonometry to measure the intraocular pressure, a major risk factor for glaucoma. They also examine the appearance of the optic nerve head for signs of damage or thinning, using advanced tools like Optical Coherence Tomography (OCT) to analyze the nerve fiber layer. If any signs of the disease are detected, or if the patient is considered high-risk, the optometrist arranges a prompt referral to a medical specialist.
Optometrists are not medical doctors and do not perform surgical procedures, but they are often involved in co-managing the patient’s care. In some areas, they can prescribe initial topical medications, such as pressure-lowering eye drops, to stabilize the condition while the patient awaits a specialist appointment.
The Primary Treating Physician
The doctor who takes on the long-term management of glaucoma is the ophthalmologist, a medical doctor (M.D. or D.O.) who specializes in eye and vision care. Unlike optometrists, ophthalmologists are licensed to practice medicine and surgery, making them the appropriate providers for chronic disease management. A general ophthalmologist manages the majority of cases.
The ophthalmologist confirms the initial diagnosis using specialized tests, including visual field testing (perimetry) to map peripheral vision loss and gonioscopy to examine the eye’s drainage angle. The core of their treatment involves prescribing and managing topical medications, typically eye drops, which work by either reducing the production of aqueous fluid or increasing its outflow to lower the intraocular pressure. Establishing a stable long-term monitoring plan is a key responsibility, which involves regularly adjusting medication dosage or type based on the patient’s response and the stability of the optic nerve.
When medications alone are insufficient, general ophthalmologists are trained to perform minor in-office laser procedures, such as Selective Laser Trabeculoplasty (SLT). This procedure targets the eye’s drainage angle to enhance fluid outflow and is a common first- or second-line treatment option.
When Advanced Care is Necessary
In cases where the glaucoma progresses despite maximum medical or general laser therapy, or when the disease is aggressive from the outset, the patient is often referred to a fellowship-trained Glaucoma Specialist. This specialist is an ophthalmologist who has completed an additional one to two years of focused training on complex glaucoma diagnosis and treatment. Their specialized expertise is reserved for challenging cases that require interventions beyond standard care.
The Glaucoma Specialist is the surgeon who performs complex incisional surgeries designed to create new drainage pathways for the eye fluid. These procedures include trabeculectomy, which creates a small filtration site, and the implantation of tube shunts, devices that divert fluid to a reservoir beneath the conjunctiva.
They utilize Minimally Invasive Glaucoma Surgeries (MIGS), which are smaller procedures often performed in conjunction with cataract surgery, to lower pressure with less trauma. Their advanced skillset encompasses complex laser procedures, such as cyclophotocoagulation, which reduces fluid production by targeting the ciliary body. The involvement of the specialist ensures that patients with severe or refractory glaucoma have access to the most sophisticated surgical options available to prevent further irreversible vision loss.