- Glaucoma is a common disease caused by damage to the optic nerve due to a gradual increase in fluid pressure in the eye.
- Glaucoma is one of the leading causes of blindness and is estimated to affect 1 of every 50 American adults. Those with a family history, African Americans over age 40 and anyone over the age of 60 are at higher risk.
- Treatment plans include eye drops, Selective Laser Trabeculoplasty, Laser Peripheral Iridotomy, and a variety of incisional glaucoma surgeries, including combinations with cataract surgery.
What is Glaucoma?
The front portion of the eye contains fluid that constantly circulates through the eye, nourishing the lens and the cornea, removing unwanted debris, and helping to maintain intraocular pressure. A healthy eye produces fluid at the same rate that it drains, thus maintaining a normal pressure. Glaucoma occurs when the eye’s drainage system fails to drain this fluid properly, allowing pressure to build in the eye. If not treated, the high pressure damages the optic nerve, resulting in permanent vision loss.
There are different types of glaucoma; when you come in for your evaluation your doctor will conduct a thorough examination to determine what form of the disease you have and the best treatment option.
- Open Angle Glaucoma: The most common form of the disease and effects peripheral (side) vision first, leading to “tunnel vision” over time. As the disease advances, central vision can be affected and if left untreated can result in total blindness.
- Closed Angle Glaucoma: A less common form of the disease and can cause a sudden onset of blurred vision, severe headaches, nausea and halos around lights.
- Congenital Glaucoma: Though rare, can cause symptoms in infants such as an enlarged eye, cloudy cornea, light sensitivity and excessive tearing.
Glaucoma is one of the leading causes of blindness and is estimated to affect 1 of every 50 American adults. While glaucoma can affect anyone – those with a family history, African Americans over age 40 and anyone over the age of 60 are at higher risk.
Most symptoms of glaucoma go unnoticed because the build up of pressure is gradual and painless. People often do not detect a change in vision until substantial loss of sight has occurred. For this reason, regular eye exams are recommended.
How We Treat It
In most cases, glaucoma is detected during a routine eye examination before the patient experiences any vision problems. The evaluation for glaucoma is painless and includes measuring the pressure in the eye with a tonometer. The optic nerve is checked for damage and a special mirrored magnifying lens called a gonioscope is used to examine the drainage channels for proper fluid outflow. If glaucoma is suspected or detected, the patient’s field of vision is tested for damage.
With early detection and treatment, glaucoma can be controlled and vision preserved. However, glaucoma cannot be cured and once vision has been damaged, it cannot be restored. The most common treatment for glaucoma is the use of eye drops. Some medications are also used to allow for faster drainage of fluid from the eye, while others reduce the production of fluid.
Selective Laser Trabeculoplasty
For patients who may be intolerant to drops, we offer Selective Laser Trabeculoplasty (SLT). This treatment uses an advanced laser system to target only specific cells of the eye – those containing melanin, a natural pigment. This allows for only these cells to be affected, leaving surrounding tissue intact. As a result, your body’s own healing response helps lower the pressure in your eye. This outpatient procedure only takes a few minutes and most patients see results within the next day.
Laser Peripheral Iridotomy
To help lower eye pressure, your surgeon may suggest a Laser Peripheral Iridotomy. During the procedure, laser energy is used to make an opening in the iris. This opening allows fluid to flow between the front of the eye and the area behind the iris.
For patients with both glaucoma and cataracts, iStent is a Micro Invasive Glaucoma Surgery (MIGS) device that safely lowers eye pressure by creating a permanent opening to improve your eye’s natural fluid outflow. iStent is the smallest medical device ever approved by the FDA. It is placed in your eye during cataract surgery and is so small that you won’t be able to see or feel it after the procedure is over.
Endoscopic Cyclophotocoagualtion (ECP), also performed during cataract surgery, is a procedure that lowers the eye pressure by decreasing production of the fluid itself. An ECP probe is inserted into the incision that was made when removing the cataracts and applies laser energy to the ciliary bodies that produce fluid, reducing production and lowering pressure.
Other Micro-Invasive Glaucoma Surgeries (MIGS)
There are various other procedures that can be done to help reduce the pressure in the eye. These procedures are often combined with cataract surgery and usually involve improving the drainage of fluid from inside the eye. The exact procedure chosen depends on the type and severity of glaucoma.
Incisional Glaucoma Surgery
When other options do not control glaucoma, other more invasive procedures can be done for severe glaucoma. These procedures include trabeculectomy, in which fluid from inside the eye is drained to the area around the eye (subconjunctival space). Another option is to use a glaucoma drainage device, which is implanted around the eye to help drain fluid from inside the eye.
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