AFFILIATED EYE SURGEONS | GLAUCOMA CARE
Glaucoma Diagnosis & Treatment in Northern New Jersey
Glaucoma is the leading cause of irreversible blindness worldwide — but with early detection and proper management, most patients preserve functional vision for life. Our
board-certified ophthalmologists provide comprehensive glaucoma care at three convenient Northern New Jersey
locations.
Protecting Vision from the Silent Thief
Glaucoma is often called 'the silent thief of sight' — and the name is apt. In its most common form, glaucoma causes no pain, no redness, and no obvious visual symptoms in its early stages. By the time patients notice vision loss, significant and irreversible optic nerve damage has often already occurred. This is why regular comprehensive eye exams — including optic nerve evaluation and intraocular pressure measurement — are so essential, particularly for patients with risk factors.
At
Affiliated Eye Surgeons, our board-certified ophthalmologists have been diagnosing and managing glaucoma for decades. We offer the full spectrum of glaucoma care — from early detection through advanced monitoring, medication management, in-office laser treatment (SLT), and minimally invasive glaucoma surgery (MIGS) for patients who need more than drops or laser alone. Our goal is simple: to protect the vision you have today and preserve it for decades to come.
What Is Glaucoma?
Glaucoma is a group of progressive eye diseases characterized by damage to the optic nerve — the cable that carries visual information from the eye to the brain. In most cases, this damage is caused or worsened by elevated intraocular pressure (IOP): fluid builds up inside the eye when the eye's natural drainage system becomes less efficient, increasing pressure that gradually injures the delicate optic nerve fibers.
As optic nerve fibers are destroyed, permanent blind spots develop — typically beginning in the peripheral (side) visual field. Because central vision is preserved until late in the disease, and because the brain compensates for peripheral blind spots, most patients with glaucoma have no awareness of vision loss until the condition is quite advanced. This is why glaucoma is diagnosed most reliably through a comprehensive eye exam — not by waiting for symptoms.
Glaucoma is the leading cause of irreversible blindness worldwide, affecting more than 70 million people globally. In the United States, an estimated 3 million people have glaucoma — and more than half do not know it.
Types of Glaucoma
Primary Open-Angle Glaucoma (POAG)
The most common form, accounting for approximately 90% of all glaucoma in the United States. In POAG, the eye's drainage angle remains open and appears normal, but the trabecular meshwork (the spongy drainage tissue) gradually becomes less efficient over time. Fluid builds up slowly, IOP rises, and optic nerve damage accumulates — all without any symptoms. POAG is a chronic condition that requires lifelong monitoring and management.
Angle-Closure Glaucoma
Occurs when the drainage angle between the iris and cornea becomes blocked. This can happen slowly (chronic angle-closure) or suddenly (acute angle-closure glaucoma), which is a medical emergency. Acute angle-closure causes rapid, severe eye pain, headache, nausea, blurred vision, and halos around lights — and requires immediate treatment to prevent permanent vision loss.
Normal-Tension Glaucoma
A form of open-angle glaucoma in which optic nerve damage occurs despite intraocular pressure remaining within the statistically normal range. It is believed to involve vascular factors that reduce blood flow and oxygen delivery to the optic nerve. Patients of Japanese descent are at particularly elevated risk. Treatment still focuses on further lowering IOP even when it is in the normal range, as doing so slows progression.
Secondary Glaucoma
Glaucoma that arises as a result of another eye condition or systemic factor — including prior eye injury or trauma, inflammation (uveitic glaucoma), steroid medications (steroid-induced glaucoma), pseudoexfoliation syndrome, or pigment dispersion syndrome. Management involves treating both the underlying cause and the elevated pressure.
Who Is at Risk for Glaucoma?
Anyone can develop glaucoma, but certain factors significantly increase risk:
Age over 60
Risk increases dramatically with age. Adults over 60 are 6 times more likely to develop glaucoma than younger adults.
Family history
Having a first-degree relative (parent, sibling, or child) with glaucoma increases risk 4 to 9 times above the general population. Glaucoma has a strong genetic component.
Race and ethnicity
African Americans are 5 times more likely to develop glaucoma and are at higher risk of earlier onset and more rapid progression. Hispanic and Latino populations also have elevated risk. People of East Asian descent are at higher risk for angle-closure glaucoma.
Elevated intraocular pressure (ocular hypertension)
IOP consistently above 21 mmHg increases risk even in the absence of current optic nerve damage.
Thin corneas
Central corneal thickness below 555 microns is an independent risk factor for glaucoma progression.
High myopia (nearsightedness)
Highly myopic eyes have structurally different optic nerves that may be more vulnerable to pressure-related damage.
Diabetes
Patients with diabetes have approximately double the risk of developing glaucoma.
Prior eye injury
Trauma to the eye can damage the drainage structures and lead to secondary glaucoma years after the original injury.
Long-term steroid use
Prolonged use of corticosteroid eye drops, oral steroids, or inhaled steroids can elevate IOP and trigger steroid-induced glaucoma.
How Glaucoma Is Diagnosed
Glaucoma diagnosis requires a comprehensive evaluation that goes beyond a basic eye exam. At
Affiliated Eye Surgeons, we use the following diagnostic tests to detect glaucoma at its earliest stages and monitor its progression over time:
Intraocular Pressure (IOP) Measurement
Tonometry measures the fluid pressure inside the eye. Elevated IOP is a major risk factor, though not all patients with high IOP develop glaucoma and some glaucoma patients have normal IOP.
Optic Nerve Examination
A dilated fundus exam allows direct visualization of the optic nerve head. Signs of glaucomatous damage include increased cup-to-disc ratio, notching of the rim tissue, and disc hemorrhages.
OCT (Optical Coherence Tomography)
Advanced imaging that measures the thickness of the retinal nerve fiber layer and ganglion cell complex with micron-level precision. OCT can detect structural damage years before it becomes visible on visual field testing. Serial OCT scans track progression over time.
Visual Field Testing (perimetry)
Maps the full extent of the patient's peripheral and central vision to identify blind spots characteristic of glaucomatous damage. Visual fields are repeated periodically to monitor for new or expanding defects.
Gonioscopy
A specialized lens examination of the drainage angle to classify the type of glaucoma and assess the risk of angle closure.
Corneal Thickness Measurement (pachymetry)
Thin corneas are an independent glaucoma risk factor and also affect the accuracy of IOP measurements.
Glaucoma Treatment Options
The goal of all glaucoma treatment is the same: to lower intraocular pressure enough to stop optic nerve damage from progressing. The appropriate treatment depends on the type and severity of glaucoma, your IOP target, and your individual circumstances. At Affiliated Eye Surgeons, we offer the full spectrum of treatment options:
Prescription Eye Drops — First-Line Treatment
SLT — Selective Laser Trabeculoplasty
LPI — Laser Peripheral Iridotomy
MIGS — Minimally Invasive Glaucoma Surgery
Traditional Glaucoma Surgery
Medicated eye drops are the most common initial treatment for open-angle glaucoma. They work by either reducing the amount of fluid the eye produces or improving the drainage of fluid from the eye. There are several classes of glaucoma eye drops, including prostaglandin analogs (the most commonly prescribed, used once daily at bedtime), beta-blockers, alpha agonists, and carbonic anhydrase inhibitors. Many patients require more than one type of drop to achieve their target pressure.
Adherence is essential — glaucoma drops only work when used consistently as prescribed. Missed doses allow IOP to rise, potentially accelerating optic nerve damage. If you are experiencing side effects or difficulty with your drop regimen, speak with your ophthalmologist — alternatives are available.
SLT is a highly effective in-office laser procedure for open-angle glaucoma. Using a low-energy laser, the trabecular meshwork — the eye's drainage tissue — is stimulated to improve fluid outflow and reduce intraocular pressure. Unlike older laser treatments, SLT does not thermally burn or scar the drainage tissue, making it repeatable and leaving the option open for future laser or surgical treatment.
Key facts about SLT:
- Performed in the office in approximately 5 minutes per eye
- No incisions, no injections — only numbing eye drops required
- Lowers IOP by an average of 20-30%, comparable to many eye drops
- Can be used as first-line treatment instead of drops, or added when drops alone are insufficient
- Effects typically last 3 to 5 years and the procedure can be repeated
- Avoids the daily adherence burden and potential side effects of chronic eye drops
SLT is often an excellent option for patients who prefer not to use daily drops, have difficulty with drop adherence, or experience side effects from glaucoma medications. Multiple major clinical trials — including the LiGHT trial — have shown that SLT as first-line therapy is as effective as drops with a favorable safety profile.
DALK is the preferred surgical treatment for conditions affecting the front layers of the cornea — most commonly advanced keratoconus and corneal stromal scarring. In DALK, the surgeon removes the corneal epithelium and stroma (the front layers) down to the level of Descemet membrane, while preserving the patient's own healthy endothelium (inner cell layer). Healthy donor tissue replaces the removed layers and is secured with sutures.
Because the patient's own endothelium is preserved, DALK carries significantly lower rejection risk than full-thickness PKP. There is no risk of endothelial rejection — the only foreign tissue is the donor stroma, which is immunologically less reactive. DALK is technically more challenging than PKP and requires an experienced corneal surgeon, but the outcomes and safety profile make it the procedure of choice for eligible keratoconus patients.
Key advantages of DALK:
- Lower rejection risk than PKP — no endothelial rejection possible
- Preferred for keratoconus — preserves the patient's healthy inner corneal layer
- Sutures can be removed over time to optimize vision and reduce astigmatism
- If rejection does occur, it affects only the donor stroma — generally treatable without losing the graft
PKP is a full-thickness corneal transplant in which the entire cornea — all five layers — is removed and replaced with a full-thickness donor button. PKP was the standard corneal transplant technique for decades and remains an important procedure for cases where all layers of the cornea are diseased or where the anatomy makes lamellar techniques technically impossible.
PKP has excellent long-term outcomes but involves a longer, more complex recovery than lamellar procedures. Sutures remain in place for 12 to 18 months or longer, during which time vision gradually improves. Rejection rates are higher than lamellar techniques (approximately 10 to 20% over the lifetime of the graft), and the graft requires lifelong monitoring. Despite these considerations, PKP remains the appropriate choice for many patients with complex corneal disease.
PKP is a full-thickness corneal transplant in which the entire cornea — all five layers — is removed and replaced with a full-thickness donor button. PKP was the standard corneal transplant technique for decades and remains an important procedure for cases where all layers of the cornea are diseased or where the anatomy makes lamellar techniques technically impossible.
PKP has excellent long-term outcomes but involves a longer, more complex recovery than lamellar procedures. Sutures remain in place for 12 to 18 months or longer, during which time vision gradually improves. Rejection rates are higher than lamellar techniques (approximately 10 to 20% over the lifetime of the graft), and the graft requires lifelong monitoring. Despite these considerations, PKP remains the appropriate choice for many patients with complex corneal disease.
Why Choose Affiliated Eye Surgeons for Glaucoma Care?
Decades of Glaucoma Management Experience
Our ophthalmologists have been managing glaucoma across Northern New Jersey for over 30 years. Glaucoma is a lifelong condition — and having a practice with the continuity, experience, and full range of treatment options to manage it through every stage matters enormously to long-term outcomes.
Advanced Diagnostic Technology
We use OCT nerve fiber layer analysis, Humphrey visual field testing, and pachymetry to detect glaucoma at the earliest possible stage and monitor for progression with objective measurements over time. Serial data — comparing scans and fields year over year — is what allows us to distinguish stable disease from progression and adjust treatment accordingly.
SLT as a First-Line Option
We actively offer SLT as a first-line treatment alternative to drops for appropriate patients — not just as a last resort before surgery. For patients who prefer to reduce or avoid daily medications, or who have difficulty with drop adherence, SLT is a proven and convenient option that we can offer in the office in a single visit.
MIGS at the Time of
Cataract Surgery
The success of a
corneal transplant depends as much on what happens after surgery as on the procedure itself.
Our team provides structured long-term follow-up — monitoring graft health, managing steroid therapy, removing sutures at the appropriate time, and fitting specialty contact lenses once the cornea has stabilized. For keratoconus patients who undergo DALK, we coordinate seamlessly with our
scleral lens fitting program to optimize post-operative vision.
Comprehensive Long-Term Monitoring
Glaucoma management is not a one-time event — it is a lifetime commitment to regular monitoring and treatment adjustments.
Our practice provides structured follow-up with serial OCT, visual fields, and IOP measurement at appropriate intervals, and we adjust treatment plans proactively when progression is detected.
Three Convenient Locations
Glaucoma requires consistent, regular follow-up. With offices in
Morristown,
West Orange, and
Denville, staying on schedule with your monitoring visits is straightforward — whichever location is most convenient for you.
Frequently Asked Questions
What is glaucoma?
Glaucoma is a group of progressive eye diseases in which the optic nerve — which carries visual information from the eye to the brain — is gradually damaged, most often as a result of elevated intraocular pressure. As optic nerve fibers are lost, permanent blind spots develop, typically starting in the peripheral visual field. Because early glaucoma has no symptoms and the brain compensates for peripheral blind spots, most patients are unaware of vision loss until the condition is quite advanced. Glaucoma is the leading cause of irreversible blindness worldwide.
What causes glaucoma?
The most common cause is elevated intraocular pressure (IOP), which occurs when the eye's natural drainage system becomes less efficient, causing fluid to build up inside the eye. However, glaucoma can also occur at normal pressure levels — called normal-tension glaucoma — likely due to vascular factors affecting optic nerve blood flow. Risk factors include age over 60, family history, African or Hispanic ancestry, elevated IOP, thin corneas, high myopia, diabetes, prior eye injury, and long-term steroid use.
What are the types of glaucoma?
The most common type is primary open-angle glaucoma (POAG), which develops slowly and silently over years. Angle-closure glaucoma occurs when the drainage angle becomes blocked — it can develop gradually or suddenly; acute angle-closure is a medical emergency causing severe pain, nausea, and sudden vision changes. Normal-tension glaucoma causes optic nerve damage at normal pressure. Secondary glaucomas result from other conditions such as eye injury, inflammation, or steroid medications.
Can glaucoma be cured?
Glaucoma cannot currently be cured and optic nerve damage that has already occurred cannot be reversed. However, with early detection and proper treatment to control intraocular pressure, progression can be slowed or halted, preserving the vision a patient has. This is why regular eye exams are so important, particularly for patients with risk factors. Patients diagnosed early and treated consistently have an excellent prognosis for maintaining functional vision for their lifetime.
What is SLT laser treatment for glaucoma?
SLT (selective laser trabeculoplasty) is an in-office laser procedure that improves drainage of fluid from the eye by stimulating the trabecular meshwork with low-energy laser pulses. It lowers intraocular pressure by an average of 20 to 30%, comparable to many glaucoma eye drops. Unlike older laser treatments, SLT does not scar the drainage tissue and can be repeated. It takes approximately 5 minutes per eye, requires no incisions, and only numbing eye drops are needed. SLT is a proven first-line alternative to daily drops for many patients with open-angle glaucoma.
What are MIGS procedures for glaucoma?
MIGS (minimally invasive glaucoma surgery) refers to a group of newer surgical techniques that lower intraocular pressure using micro-scale devices or incisions — with less risk and faster recovery than traditional glaucoma surgery. They work by enhancing the eye's natural drainage pathways and are most effective for mild to moderate glaucoma. MIGS is often performed at the same time as cataract surgery. Examples include trabecular micro-bypass stents (iStent, Hydrus) and goniotomy. MIGS offers a favorable balance between pressure reduction and safety compared to traditional filtering surgery.
Will I go blind from glaucoma?
Blindness from glaucoma is not inevitable. With early detection and consistent treatment, most patients with glaucoma retain functional vision for their lifetime. The key is regular monitoring and adherence to treatment — whether drops, laser treatment, or surgery. Patients diagnosed early and followed consistently have a very good prognosis. The risk of significant vision loss increases when glaucoma is diagnosed late or treatment is inconsistent — which is why not skipping eye exams is so important.
Is glaucoma hereditary?
Yes. Having a first-degree relative with glaucoma significantly increases risk — estimates suggest a 4 to 9 times higher risk compared to the general population. If you have a family history of glaucoma, regular comprehensive eye exams beginning in your 40s are strongly recommended, even if you have no symptoms. Glaucoma genes have been identified and genetic testing may be available for families with strong histories of early-onset disease.
How is glaucoma monitored over time?
Glaucoma monitoring involves regular intraocular pressure measurements, visual field testing (perimetry) to detect any new peripheral vision loss, and OCT imaging to measure optic nerve fiber layer thickness over time. Changes on any of these tests may indicate progression and prompt treatment adjustment. Most stable glaucoma patients are monitored every 3 to 6 months. The comparison of serial measurements over years is what allows detection of slow progression — a single isolated test cannot diagnose progression on its own.
