What Is Glaucoma Monitoring?
Glaucoma monitoring is a programme of regular, structured eye assessments designed to detect whether glaucoma is present, stable, or progressing over time. It is a diagnostic and preventative service rather than a surgical procedure, and it usually continues for many years because glaucoma is a long-term condition.
At each visit, several measurements are repeated and compared with previous results. Small changes in intraocular pressure, the appearance of the optic nerve, or the visual field can indicate that a treatment plan needs adjusting. The aim is to identify progression early, while there is still an opportunity to protect remaining sight.
Monitoring typically includes:
- Measurement of eye pressure (intraocular pressure), often using applanation tonometry
- Visual field testing to map any areas of reduced sensitivity
- Optical coherence tomography (OCT) scanning of the optic nerve and retinal nerve fibre layer
- Examination of the optic disc, sometimes with photographs for comparison over time
- Gonioscopy to assess the drainage angle of the eye
- Corneal thickness measurement (pachymetry), which helps interpret pressure readings
- Review of your symptoms, general health, medication use, and family history
The NICE guideline on glaucoma diagnosis and management recommends that the frequency of review is based on individual risk, including how well pressure is controlled and how much damage is already present. Some patients are seen every few months, others annually.
Who May Benefit From Glaucoma Monitoring?
Specialist monitoring may be recommended for people who:
- Have been diagnosed with any form of glaucoma, including primary open angle glaucoma
- Have ocular hypertension, meaning raised eye pressure without detectable nerve damage
- Have been referred as a glaucoma suspect following a routine sight test
- Have a close family member with glaucoma, as risk is higher in first degree relatives
- Have narrow drainage angles or a history of acute angle closure
- Are using long-term steroid medication, which can raise eye pressure
- Have had previous eye surgery, trauma, or inflammation affecting pressure control
- Are of African, Caribbean, or Asian heritage, groups with a recognised increased risk of certain glaucoma types
Most people with early glaucoma notice nothing at all. Where symptoms do occur, they may include loss of peripheral awareness, difficulty adjusting to changes in light, or bumping into objects. Sudden eye pain, redness, blurred vision, haloes around lights, nausea, or vomiting can suggest acute angle closure, which requires urgent assessment on the same day.
Conditions Assessed and Monitored
- Primary open angle glaucoma
- Normal tension glaucoma
- Ocular hypertension
- Angle closure glaucoma and narrow angles
- Secondary glaucoma, including pigmentary, uveitic, and steroid related forms
- Glaucoma occurring alongside cataract
- Progression following previous laser or glaucoma surgery
Potential Benefits
Regular monitoring cannot reverse damage that has already occurred, but it can play an important role in protecting vision. Depending on your diagnosis, it may:
- Help detect progression at an earlier stage, when treatment changes may be most useful
- Support decisions about whether drops, laser, or surgery are appropriate
- Confirm that a current treatment plan is working, avoiding unnecessary changes
- Reduce the risk of avoidable sight loss over the longer term
- Provide reassurance for people who are glaucoma suspects rather than confirmed cases
- Identify other eye conditions, such as cataract, that may be affecting vision
Consultation and Assessment Process
Your first appointment with Ms Diana Urbaneja is usually longer than later reviews, because it establishes a baseline. It generally includes a discussion of your symptoms, past eye problems, general medical history, current medicines, allergies, and any family history of glaucoma. Vision is checked, and the front and back of the eye are examined with a slit lamp after drops are used to widen the pupil and, in some cases, to numb the eye surface.
Findings are then explained clearly, along with the reasons behind any recommendation. Where clinically appropriate, options such as eye drops, laser treatment, minimally invasive glaucoma surgery, or combined cataract and glaucoma procedures may be discussed, together with their risks, benefits, and alternatives, including the option of observation alone.
How Monitoring Appointments Are Carried Out
Monitoring takes place in an outpatient clinic setting, with no anaesthetic beyond dilating or anaesthetic eye drops. A typical review lasts around thirty to sixty minutes, including time for scans and visual field testing. Nothing about the process is painful, although the bright lights used during examination can feel uncomfortable for a short time.
Dilating drops blur near vision and increase glare for a few hours, so it is sensible to arrange a lift or use public transport rather than drive immediately afterwards, and to bring sunglasses.
Afterwards and Ongoing Care
Most people return to normal activities the same day once the drops have worn off. You will be given a review interval based on your risk, and asked to continue any prescribed drops exactly as directed, since irregular use is a common reason for pressure control being lost. Your optometrist and GP are usually kept informed so that care is joined up.
Seek prompt advice if you develop sudden eye pain, marked redness, a rapid change in vision, or persistent haloes around lights.
Risks and Considerations
Monitoring itself carries very little risk. Dilating drops can temporarily blur vision and, rarely, trigger a pressure rise in eyes with very narrow angles, which is one reason gonioscopy is performed. Visual field testing depends on concentration, so results occasionally need repeating. No test is perfect, and early changes can take several visits to confirm. Outcomes vary between individuals, and treatment aims to slow progression rather than restore lost vision.
Why Choose Ms Diana Urbaneja?
Ms Diana Urbaneja is a Consultant Ophthalmologist with over sixteen years of experience in ophthalmology, sub-specialising in glaucoma and cataract surgery. She has completed three glaucoma fellowships, including a fellowship at Moorfields Eye Hospital, and serves as Glaucoma Lead for Cwm Taf Morgannwg Health Board. Her research has examined acute angle closure glaucoma using anterior segment OCT, and she is a member of the Paul Glaucoma Implant European investigation group. She has performed over 5,000 cataract operations and offers premium intraocular lens cataract surgery, minimally invasive glaucoma surgery (MIGS), and selective laser trabeculoplasty, supported by modern diagnostic imaging and an evidence-based, patient-centred approach.
Areas Served
Glaucoma monitoring is available to patients across South Wales, including those travelling from Bridgend and Cardiff, with both private and NHS care provided.
01
Testing
Pressure, imaging & visual field
02
Review
Results compared over time
03
Plan
Treatment adjusted if needed
At a glance
Duration
~30-45 min
Includes
Eye pressure, OCT & visual field testing
Frequency
Agreed based on your risk
Next steps
Treatment reviewed if needed