Glaucoma specialist in San Antonio

At a glance

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What is glaucoma?

Glaucoma is damage to the optic nerve, the nerve that carries images from your eye to your brain. In medical terms, it’s an optic neuropathy, and as it progresses it causes loss of your visual field, usually beginning with the side vision. Because the central vision is often preserved until late in the disease, many people don’t notice anything until significant damage has occurred. More than 3 million Americans have glaucoma, and it’s one of the leading causes of blindness in the United States.

Glaucoma has several causes. In many cases, the pressure inside the eye (intraocular pressure, or IOP) is too high, but some people develop glaucoma at a “normal” pressure. Eye pressure is one important risk factor, not the whole story: there isn’t one pressure level that causes glaucoma or protects you from it. That’s why a glaucoma evaluation looks at much more than pressure, especially the health of your optic nerve. Today, glaucoma can sometimes be detected even before you lose any side vision.

Types of glaucoma

Open-angle glaucoma

The most common type. The eye’s drainage system looks open, but fluid doesn’t flow through it well, usually at the level of the trabecular meshwork. The pressure can be high or normal; when it’s normal, it’s called normal-tension (or low-tension) glaucoma. It has two sub-types: primary open-angle glaucoma, where the exam shows no other abnormal findings, and secondary open-angle glaucoma, which includes pigmentary and pseudoexfoliation glaucoma.

Angle-closure glaucoma

Less common, and it can cause a rapid pressure rise, severe pain, and fast vision loss, which is a medical emergency. It happens when the angle where the iris and cornea meet is too narrow, which blocks the drainage channel (Schlemm’s canal). A very wide pupil or a thickening lens from a cataract can narrow the angle further, so it becomes more common with age. Narrow angles and angle closure are treated with a quick in-office laser called YAG laser iridotomy (see below).

Congenital glaucoma

Rare but serious, it affects babies, usually at birth or in the first few years, when the eye’s drainage system doesn’t develop properly. Signs include enlarged eyes and chronic tearing. Early detection and treatment are essential, and surgery is often needed to protect the baby’s vision.

Other secondary glaucomas

Some glaucomas have an identifiable cause, such as long-term corticosteroid use or an eye injury (see risk factors below).

Symptoms of glaucoma

Symptoms depend on the type:

• Open-angle glaucoma usually causes no pain and no early symptoms. It gradually erodes peripheral vision, and you may notice blind spots or “tunnel vision” only late in the disease.
• Acute angle-closure glaucoma can come on suddenly with severe eye pain, headache, blurry vision, and nausea.
• Early narrow-angle glaucoma often has no symptoms at all.

When to call us right away: severe eye pain, a sudden loss of vision, headache, nausea, or new blind spots. These can be signs of acute angle-closure glaucoma, which needs quick treatment to avoid permanent vision loss.

Who is at risk?

Anyone can develop glaucoma, but the risk is higher with:

• Age. Risk rises with age, especially after 60.
• Family history. If a parent, brother, or sister has glaucoma, your risk is about four to nine times higher. Glaucoma is hereditary.
• African-American ancestry. The risk is roughly five times higher, and the disease often appears in the 40s, earlier than in other groups. Detailed exams are recommended starting at age 40, or sooner with a family history.
• Hispanic ancestry, especially after age 60.
• Asian ancestry. East Asians (for example, Chinese, Vietnamese, and Japanese people) have a higher risk of angle-closure glaucoma because of differences in eye structure, such as shallower front chambers.
• Long-term corticosteroid use. Steroids in any form, including pills, drops, injections, inhalers, and nasal sprays, can raise eye pressure in some people. A 1997 study in JAMA found a higher risk of ocular hypertension and open-angle glaucoma in adults using inhaled steroids. If you use steroids long term, have regular eye exams.
• Eye injury. Trauma can damage the drainage system and cause traumatic glaucoma, immediately or many years later.
• High myopia (nearsightedness).
• High blood pressure.
• Thin central corneas (less than about 0.5 mm). A thin cornea can make your eye pressure read lower than it really is, and may be a marker for less structural support near the optic nerve. As a research fellow in the Genetics Laboratory of Dr. Janey L. Wiggs at Massachusetts Eye and Ear/Harvard Medical School, Dr. Triana worked on research into genetic variants linked to thin corneas. 

How often should you be checked?

The American Academy of Ophthalmology suggests a baseline exam at age 40 for healthy adults, then an exam every 2 to 4 years from ages 40 to 54, every 1 to 3 years from 55 to 64, and every 1 to 2 years after 65. If you have glaucoma risk factors, you may need exams earlier and more often, and the right schedule can only be set after an exam by an ophthalmologist.

A vision screening only checks how well you see. A complete eye exam also checks your eye pressure, the health of your optic nerve (structure), and your visual field (function), which is what finds early glaucoma.

How we diagnose glaucoma

We use several tests together to detect and monitor glaucoma:

• Tonometry measures your eye pressure after numbing drops.
• Optic nerve exam (ophthalmoscopy) is a close look at the optic nerve with a slit lamp and magnifying lens, and one of the most important steps in finding glaucoma.
• Visual field testing (perimetry) maps your side vision using virtual reality goggles and software.
• Gonioscopy examines the drainage angle with a mirror lens.
• Pachymetry measures corneal thickness, which affects how to interpret your eye pressure.
• Nerve fiber layer analysis (a type of optical coherence tomography, or OCT) checks the nerve fiber layer and can detect damage before you lose vision.
• Pattern electroretinography (pERG) measures the electrical activity of the retina and can detect disease before nerve damage or vision loss.
• Optic nerve photos. We take color photos of your optic nerve to track changes over time.

What to expect. If you have risk factors, photos will likely be obtained and testing is scheduled on one of our testing days (2nd and 4th Tuesday afternoon of each month or Friday morning – testing is usually scheduled separately from visits), since it can last up to an hour. If you have glaucoma, we monitor you using specific guidelines. 

Ocular hypertension and “glaucoma suspects”

Ocular hypertension means your eye pressure is higher than normal (above about 21 mm Hg) without any signs of glaucoma, such as optic nerve damage or visual field loss. It raises your risk of developing glaucoma over time, so it needs regular monitoring. Treatment may include pressure-lowering drops or, if you use them, stopping corticosteroids with your doctor’s guidance. In some mild cases, treatment isn’t needed right away.

Can glaucoma be cured?

No. Glaucoma can’t be cured, and there’s currently no way to repair or regenerate a damaged optic nerve. The goal of treatment is to lower eye pressure, which is the only proven way to slow or stop the disease and prevent further vision loss. Because glaucoma is lifelong, it needs ongoing care. Researchers are studying stem cell therapy and other nerve-protecting treatments, but these are still experimental.

Glaucoma treatment: three ways to lower eye pressure

1. Eye drops

Drops are the most common first treatment. They work by reducing the amount of fluid your eye makes or by helping it drain faster, which lowers pressure and protects the optic nerve. Use them exactly as prescribed, because skipping doses can let pressure spike, and apply them correctly so they work well with fewer side effects. If you run out early or have side effects, tell us instead of stopping.

2. Laser treatments

Selective laser trabeculoplasty (SLT). A gentle laser targets certain cells in the eye’s drainage system (the trabecular meshwork) to improve fluid outflow and lower pressure. It’s often recommended when drops aren’t controlling pressure, when side effects are a problem, or when patients want to rely less on medication. The procedure is quick and is performed in our office. Because it’s done in the our office, there is not separate surgery-center facility fee. Most patients have little to no recovery time. The effect can last months or years, may slowly wear off, and in most cases SLT can be repeated.

YAG laser iridotomy. For narrow angles or angle closure, a laser creates a small hole in the peripheral iris. That lets fluid flow between the back and front of the eye, lets the iris fall back from the drainage angle, and prevents or relieves angle closure. It’s a common, quick in-office treatment, and most people return to normal activities right away. Dr. Jones performs this procedure on Friday mornings. Doctors perform more iridotomies to prevent serious problems in people with narrow angles than to treat emergencies, and acute angle closure often shows up in emergency rooms first.

Micropulse diode cyclophotocoagulation (MP-CPC). A newer laser that lowers pressure by treating the ciliary body, the part of the eye that makes fluid. It uses quick bursts of laser energy instead of a steady beam, which reduces harm to nearby tissue. It’s often chosen for severe or hard-to-treat glaucoma when drops or SLT haven’t worked, and it’s typically considered before surgery. It’s performed in an operating room at the American Surgery Center: you receive medicine through an IV and then a numbing injection next to the eye, and your eye is patched overnight. Most people recover quickly with little pain, and it can be repeated if needed.

3. Surgery

Trabeculectomy. A common surgery for glaucoma that isn’t controlled by medicines or laser. A small flap is made in the sclera (the white of the eye) so fluid can drain into a small space under the conjunctiva called a “bleb,” where it’s slowly absorbed. It’s very effective at lowering pressure. Risks include infection, bleeding, and pressure that goes too low, so careful follow-up is important.

Tube shunts. A small, flexible tube drains fluid from inside the eye to a plate that sits under the conjunctiva on the outside of the eye. They’re especially useful for advanced glaucoma, eyes that have had previous surgery, and secondary glaucomas. Risks include infection, tube exposure, and tube problems, and your ophthalmologist monitors the implant over time.

Minimally invasive glaucoma surgery (MIGS). Several newer options lower pressure with less risk and a quicker recovery than traditional surgery. They’re often performed along with cataract surgery, but some can be done on their own. Examples include:

• iStent and Hydrus stents, tiny devices placed in the eye’s drainage system so fluid can pass through the trabecular meshwork into Schlemm’s canal. Hydrus is a larger stent that expands the canal. Note: Dr. Jones prefers to utilize MIGS procedures that do not leave devices in the eye when possible.
• Xen Gel Stent, a gelatin-based implant that opens a new path for fluid to leave the eye. It creates a bleb, which must be maintained for the stent to keep working.
• Canaloplasty, which uses a micro-catheter to flush and enlarge the eye’s natural drainage canal.
• Goniotomy, which makes a small opening in the drainage angle to remove blocked tissue and improve drainage. This is Dr. Jones’ preferred MIGS procedure. It can be performed with cataract surgery or as a stand alone procedure. 

Glaucoma and cataract surgery

Many people with glaucoma also have cataracts. If you do, your cataract surgery and glaucoma care can be coordinated, and some MIGS procedures can be performed at the same time as cataract surgery. In some eyes with narrow angles, removing the cataract can also help open the drainage angle. Dr. Jones is fellowship-trained in glaucoma and performs all of our cataract surgery. Learn about cataract surgery · Premium lens options (Note: premium lenses may not be suitable for some glaucoma patients; we’ll tell you honestly if a standard lens is the better choice.)

What are the risks of glaucoma surgery?

Glaucoma surgery is generally safe, but, as with any surgery, there are risks, and it isn’t possible to list every possible complication. The most common ones include:

• Pain
• Infection
• Bleeding
• Loss of vision, or, very rarely, loss of the eye
• Surgery not lowering the eye pressure enough
• The need for more surgery
• Double vision
• The need for glasses or contacts
• A droopy eyelid

We make every effort to avoid complications, and if a problem occurs, we take steps to manage it. Our goal is the best possible result, but, like any medical procedure, no specific outcome can be guaranteed. If you have questions about your surgery, please ask.

Living with glaucoma

• Take your drops as prescribed and keep every appointment. Check-ups show whether your treatment is working and let us adjust it.
• Protect your eyes. Wear safety glasses when you need to.
• Be careful with head-down positions. Some yoga poses that put your head below your heart, such as downward dog, headstand, and plow, can temporarily raise eye pressure. Dr. Jones presented early research on this at the Association for Research in Vision and Ophthalmology (ARVO) in 2004. If you have glaucoma, ask us before starting yoga. Poses that keep your head level, gentle stretching, and breathing exercises are generally safer.
• Exercise and eat well, and ask us which activities are right for you.
• Supplements. Nicotinamide riboside (NR), a form of vitamin B3, has become popular for glaucoma. It increases levels of NAD+, which cells need for energy, and early studies suggest it may help protect retinal ganglion cells, but more research is needed. Supplements don’t replace your treatment, so talk with us before adding one.
• Marijuana and CBD don’t play a proven role in glaucoma treatment. Read more

Supporting a parent or loved one with glaucoma

Learn about their condition, go with them to appointments if they’d like, and encourage them to stick with their drops and treatment plan. Help with daily tasks when needed, make their home safe (good lighting, clear walkways), and notice any changes in their vision. Patience and good communication help a lot.

Questions to ask your glaucoma doctor

• What are my treatment choices?
• How will you check whether my glaucoma is getting worse?
• I run out of my drops early. What can I do?
• What are the possible side effects of my treatment?
• Do I need to make any lifestyle changes or take precautions?
• Can I do aerobic exercise and lift weights?
• Are there safe complementary treatments?
• Does marijuana or CBD play a role in treatment?

Glaucoma specialist or eye doctor?

A glaucoma specialist is an ophthalmologist who completed a residency in ophthalmology and then an extra fellowship devoted to glaucoma. That training prepares them for complex cases and surgeries, such as tube shunts and stents. Optometrists also play an important role in glaucoma, monitoring patients and managing medications, and they often co-manage patients with ophthalmologists, especially for simple cases and after surgery. Dr. Jones completed a clinical glaucoma fellowship at Massachusetts Eye and Ear/Harvard Medical School.

Why choose San Antonio Eye & Face Institute for glaucoma

• Fellowship-trained glaucoma care. Dr. Jones completed a clinical glaucoma fellowship, and Dr. Triana a research fellowship in glaucoma genetics, at Massachusetts Eye and Ear/Harvard Medical School.
• Advanced testing, including virtual reality visual fields, nerve fiber layer analysis, and pERG, which can detect disease before vision loss.
• In-office laser treatment for SLT and YAG laser iridotomy, and surgical options from MP-CPC to MIGS.
• One team for glaucoma and cataracts, so your care is coordinated.
• Physician-owned. You see your doctors, not a rotating roster, from your first exam to your last follow-up.
• Se habla español.

Cost and insurance

Medicare and most insurance plans cover medically necessary glaucoma testing and treatment, and your deductible and copay will apply. Call us and we’ll check your benefits so there are no surprises. See insurance we accept

Request a Glaucoma Evaluation
Call (210) 485-1488

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Frequently asked questions

What is glaucoma? Glaucoma is a group of eye diseases that damage the optic nerve, the nerve that carries images from the eye to the brain. It often causes no symptoms early on and gradually erodes side (peripheral) vision, which is why it is called the silent thief of sight. It is one of the leading causes of blindness in the United States.

What are the symptoms of glaucoma? The most common type, open-angle glaucoma, usually causes no pain and no symptoms until a lot of vision is lost. Acute angle-closure glaucoma can come on suddenly with severe eye pain, headache, blurry vision, and nausea, and it is a medical emergency.

Is glaucoma an emergency? Chronic glaucoma is not, but acute angle-closure glaucoma is. If you have severe eye pain, a sudden loss of vision, headache, or nausea, get medical help right away, because quick treatment is needed to avoid permanent vision loss.

Can glaucoma be cured? No. Glaucoma cannot be cured, and damage to the optic nerve cannot currently be repaired. Treatment focuses on lowering eye pressure to slow or stop further vision loss, and it requires lifelong monitoring.

Can glaucoma cause blindness? Yes. Left untreated, glaucoma can cause permanent vision loss, including blindness. With early detection and treatment, such as eye drops, laser therapy, or surgery, the disease can often be slowed or halted.

Who is at risk for glaucoma? Risk increases with age, a family history of glaucoma, and African-American, Hispanic, or Asian ancestry. Other risk factors include high eye pressure, thin corneas, nearsightedness, high blood pressure, long-term use of corticosteroids, and eye injury.

Does glaucoma run in families? Yes. Glaucoma is hereditary, and people with a parent, brother, or sister who has it are at higher risk. If glaucoma runs in your family, tell your eye doctor and have regular exams, starting earlier if recommended.

How often should I have my eyes checked for glaucoma? The American Academy of Ophthalmology suggests a baseline eye exam at age 40 for healthy adults, then an exam every 2 to 4 years from 40 to 54, every 1 to 3 years from 55 to 64, and every 1 to 2 years after 65. If you have glaucoma risk factors, you may need exams earlier and more often, so ask your ophthalmologist.

How is glaucoma diagnosed? We use several tests together, including eye pressure measurement (tonometry), an optic nerve exam, visual field testing with virtual reality goggles, gonioscopy to examine the drainage angle, corneal thickness measurement (pachymetry), and nerve fiber layer analysis to detect damage before vision loss.

What is the first treatment for glaucoma? Eye drops that lower eye pressure are the most common first treatment. If drops do not control the pressure, cause side effects, or are hard to use every day, laser treatment such as selective laser trabeculoplasty (SLT) may be recommended, and surgery is considered for resistant cases.

What is selective laser trabeculoplasty (SLT)? SLT is a quick, gentle laser treatment for open-angle glaucoma that targets cells in the eye’s drainage system to improve fluid flow and lower eye pressure. Most patients have little to no recovery time, the effect can last months to years, and the procedure can often be repeated.

What is minimally invasive glaucoma surgery (MIGS)? MIGS refers to several newer procedures, such as stents placed in the eye’s drainage system, that lower eye pressure with less risk and a quicker recovery than traditional glaucoma surgery. They are often performed at the same time as cataract surgery, and some can be done on their own.

Do you treat patients who have both glaucoma and cataracts? Yes. Cataract surgery and glaucoma care are often coordinated, and some glaucoma procedures can be performed at the same time as cataract surgery. Dr. Jones is a fellowship-trained glaucoma specialist who also performs cataract surgery.

What is the difference between a glaucoma specialist and my regular eye doctor? A glaucoma specialist is an ophthalmologist who completed a residency in ophthalmology and then an additional fellowship focused on glaucoma. Dr. Jones completed a clinical glaucoma fellowship at Massachusetts Eye and Ear/Harvard Medical School. Optometrists also play an important role in glaucoma monitoring and often co-manage patients with ophthalmologists.

Can glaucoma be prevented? Glaucoma cannot be prevented, but vision loss from glaucoma often can be. Regular eye exams catch the disease early, and using your treatment as prescribed helps protect your vision.

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Glaucoma information in Spanish

Información sobre el glaucoma en español – Glaucoma Research Foundation

This page is for general education and isn’t a substitute for an eye exam. Only an eye doctor can diagnose glaucoma and recommend treatment.

Watch: glaucoma videos