Glaucoma

Glaucoma comes in many different “versions”, but it is common enough that it is likely you will know someone, or be related to someone, who has glaucoma.

And you may have it yourself.

Glaucoma can be gradual or sudden, related to other eye problems, be inherited or not, and be of big problem or less so. What we will do is sort out the risk, gain some understanding of status and tempo and then Institute any specific intervention for type.

Overall the management of glaucoma is managing the risk of loss of vision, so the important component is to identify what that risk is to start with and then apply the right amount of treatment for that problem.

Fundamental to treatment of glaucoma is the type, the other risk factors, and the rate of progression. We generally use three types of data to manage glaucoma: Eye pressure, Structural Nerve Tests, and Visual Field testing.

One is the intraocular pressure which can be measured in all sorts of different ways and at different times but represents something about the current risk and has a degree of prediction about future risk. Intraocular pressure thus can act as a lead index, giving some view about future rate of change. It is also the most important factor that we vary in treatment, whether using drops, laser, or surgery. All of our tonometers and technicians are calibrated for Clinical Trials and the information stored on our Electronic Medical Record which has been purpose built for managing Glaucoma.

The second piece of data that is used is a structural test. This is a piece of information that well tell us a little bit about how the optic nerve, the structure that gets affected in glaucoma, is faring. This is done with a combination of examination, photo photography and three-dimensional imaging. The latter is performed using an OCT in (ocular coherence tomography) which measures the retinal nerve fibre layer thickness and can be used for serial measurements. We use 2 NIDEK OCT machines that have dedicated retinal nerve fibre layer analysis programs, and can use wide field imaging and ganglion cell mass imaging as well. Both of these machines are networked and all information can be serially reviewed and analysed for change.

The third piece of data is a functional test – this is the Visual Field test. This is a measurement of the mid-peripheral and central visual capacity using a standardised system for measuring visual sensitivity. This process is known as visual field testing or perimetry, and is performed on one of two latest generation Humphrey Visual Field testers (Perimeters) using the SITA Faster program which reduces testing time and fatigue. Both field machines are networked and all data is stored and analysed by a specific program (FORUM).

Making your appointment

In order to provide you with a suitable date and time, where possible we recommend that you phone 6-8 weeks in advance to make your appointment. For all enquiries and appointments at Melbourne Eye Specialists, please call the appropriate number below; Fitzroy – Ph: 9417 1055 Fax: 9417 5952 We appreciate that your time is valuable and we try not to keep you waiting. Each patient consultation is unique and can involve more extensive testing or treatment than others. An initial consultation is a perfect example. We recommend you allow 1-2 hours for your visit. Any emergencies will be attended to immediately which may impact on your waiting time. Also, you are very welcome to telephone before you arrive to check how appointments are progressing. Veteran’s Affairs Gold Card holders are entitled to transport to and from appointments, which our administration staff are happy to organise. Please inform our staff when you book your appointment if you require this service at least 24 hours prior to your appointment.
Do I need a referral?

Yes, you need a current referral from your local doctor or from an optometrist. Generally referrals are valid from 9-12 months from a General Practitioner and Optometrist and 3 months from a Specialist. It is your responsibility to ensure your referral is current for your appointment. Please ask our staff to check this for you if you are unsure.
How long will my first appointment take?

Please allow up to 2 hours for your appointment. It may take a little longer if your doctor organises tests or treatments for you on the day of your visit.
What do I need to bring to my appointment?

* A current letter of referral from a General Practitioner, Optometrist or Specialist * Medicare Card * Pension or Health Care Card * If you wear distance or reading glasses, please bring these with you. * Sunglasses to minimise the sensitivity to glare that may occur from the dilating drops or laser procedures.
Presenting for your appointment

When presenting to our staff for your appointment, new patients will be asked to complete a patient registration form that remains within your history. If you have attended Melbourne Eye Specialists before, we do ask that you inform us of any changes to your personal details such as a change of address, Medicare details, contact phone number or if you have become entitled to any Centrelink benefits since your last visit. If you required a new letter of referral for your consultation, please offer this to our staff when you present for your appointment.
Assessment with Orthoptist

Prior to seeing the doctor, patients will usually see one of our university-trained orthoptists who will perform preliminary testing to assist with history diagnosis, treatment and ongoing management. The orthoptists conduct assessments of your vision and glasses requirements. They may also perform other tests that cover cataract measurement assessment, glaucoma diagnosis (including automated perimetry, and fundus photographs) and retinal assessment (including photos and angiograms). The orthoptist may give you drops to dilate your pupils, which means there may be a degree of blurred vision afterwards. In addition, the orthoptist may provide the ophthalmologist with a range of test results, assist with exercises to recover visual functions, aid the diagnosis and management of eye movement disorders and allow prescriptions of glasses to relieve symptoms and/or restore function.
Assessment with Ophthalmologist

After your orthoptic assessment, you will see your ophthalmologist who will address your problems, provide a diagnosis when appropriate and advise treatment for managing your ocular condition.
At the end of your consultation

If a review appointment is requested by your doctor this will be arranged for you by our staff. Surgery bookings can be arranged with our theatre bookings department on the day of your consultation. Our staff can best answer any questions about fees or payments when you visit. Our administration staff do their best to simplify payment processes for patients. We are registered with Medicare Online Claiming, which allows us to send your account to Medicare, saving you the time and hassle of going to a Medicare office. Payment on the day is appreciated. If you have registered your bank account details with Medicare, and you have paid in full on the day, Medicare will automatically deposit the rebate amount into your account within 2-3 working days. Alternatively, Medicare can send you a cheque in the post. We accept cash, cheque, money order, Eftpos, Visa and Mastercard.
Is the cost of my consultation covered by private health insurance?

No, however Medicare pays 85% of the schedule fee.
What will my consultation cost?

Melbourne Eye Specialists is not a Bulk Billing practice. Fees are dependant on the clinician you see and whether or not you have a procedure, investigation or test performed on the day. Discount rates are offered to pensioners and health care cardholders.
Can I drive to my appointment?

There is a chance you may have drops put in your eyes to dilate your pupils. These drops can blur your near vision for up to 3 hours at most although this can vary with each individual. We would therefore recommend you don’t drive during this period. If you have any concerns or are unable to arrange alternative transport, please let our staff know prior to your appointment so we can inform your doctor.
If I need laser for glaucoma or after cataract, can it be done on the day?"

Yes, this type of laser is available.
Getting here, transportation and parking"

Parking: Metre parking is available along Victoria Parade, Nicholson St and Brunswick Street. There are also paid car parks located next to the Eye and Ear Hospital, or next to St Vincent’s Private Hospital on Fitzroy Street. Train: Parliment station is located approx. 350 m from our practice. Upon leaving the station, take the Lonsdale/Nicholson Street exit and travel up Victoria Parade from Nicholson Street. Tram: The closest tram stop to our practice is St Vincent's plaza. There are four tram routes which stop here, the 11, 12, 30 and 109.