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Glaucoma is a leading cause of blindness in the U.S. It usually occurs when the pressure inside the eye rises, damaging the optic nerve and causing gradual but steady vision loss. In some patients, optic nerve damage indicative of glaucoma can occur even at normal eye pressures.

There are two main types of glaucoma, open-angle and angle-closure. Open-angle glaucoma is the most common type of glaucoma and is characterized by a reduced capacity of the eye to properly drain the intraocular fluid (aqueous humor). Angle-closure glaucoma involves a sudden buildup of pressure in the eye and poor drainage because the angle between the iris and the cornea is blocked or is too narrow.

The condition often develops over many years without causing pain or other noticeable symptoms – so you may not experience noticeable vision loss until the disease has progressed significantly. Unfortunately, vision loss from glaucoma is irreversible.

Sometimes symptoms do occur, particularly in acute narrow angle glaucoma. They may include:

  • Blurred vision
  • Loss of peripheral vision
  • Halo effects around lights
  • Painful or reddened eyes

People at high risk include those who are over the age of 40, diabetic, near-sighted, African-American, or who have a family history of glaucoma.

To detect glaucoma, your physician will perform a series of tests including visual acuity testing, visual field testing, intraocular pressure measurements, examination of the anatomy of the eyes as well is imaging and ocular photography. Regular eye exams will be scheduled to monitor the changes in your eyesight and to determine whether you may develop glaucoma.

Once diagnosed, glaucoma can be controlled and further vision loss can be prevented. The mainstays of treatment are medications (usually eye drops) and in office laser procedures. These treatments are safe and effective and side effects of medications taken for glaucoma are generally mild and cease upon discontinuation of the drops. 85-90% of glaucoma patients respond to drops and/or laser. For the patients that don’t respond surgery is the next option.

Laser Surgery

  • Laser Peripheral Iridotomy (LPI) – This is an in office performed for patients with narrow-angle glaucoma. A small hole is made in the iris to increase the angle between the iris and cornea and encourage fluid drainage.
  • Laser (Trabeculoplasty) – For patients with primary open angle glaucoma (POAG). The trabecular passages are treated to increase fluid drainage. Laser trabeculoplasty is effective in about 90% of patients, and, depending on the type of trabeculoplasty, may be repeated one or more times.
  • Diode Laser Cyclophotocoagulation (Diode CPC) – For patients with severe glaucoma damage who have not been helped with other surgeries. The ciliary body that produces intraocular fluid is treated with the laser in an outpatient procedure to decrease the amount of fluid produced.

Glaucoma Surgery

In a healthy eye, fluid is produced in the ciliary body, enters the eye, and then drains through tiny passages called the trabecular meshwork. In people with glaucoma, these passages become blocked and intraocular pressure rises. The purpose of the surgery is to reroute the fluid so that it escapes from the eye more readily, normalizing the pressure.

  • Filtering Microsurgery (Trabeculectomy) – This is the most commonly performed surgery for patients who have not been helped with laser surgery or medications. A new drainage passage is created by cutting a small hole in the sclera (the white part of the eye) and creating a collection pouch between the sclera and conjunctiva (the outer covering of the eye). It is an outpatient surgery that is done under conscious sedation, takes about an hour and has an 85-90% ten- year success rate.
  • Tube Shunt Surgery – Another type of glaucoma surgery that is often done if a trabeculectomy fails or as an initial glaucoma surgery instead of trabecuelctomy. It is an outpatient procedure in which a silicone tube attached to a plastic plate is placed into the eye to facilitate fluid drainage.

Dry Eye

Dry eye occurs when the eyes aren't sufficiently moisturized, leading to itching, redness, foreign body sensation, and pain from dry spots on the surface of the eye. The eyes may become dry and irritated because the tear ducts don't produce enough tears, or because the tears themselves have a chemical imbalance, causing them to evaporate quicker than normal. People usually begin experiencing dry eye symptoms as they age, but the condition can also result from certain medications, conditions or injuries.

Dry eye is not only painful; it can also damage the eye's tissues and impair vision. Fortunately, many treatment options are available.

Non-surgical treatments for dry eye include increasing the humidity at home or work and the use of artificial tears, moisturizing ointment, and/or prescription eye drops. In combination with this, small punctal plugs may be inserted in the corners of the eyes to limit tear drainage, or the drainage tubes in the eyes may be surgically closed. Eyelid surgery is also a solution if an eyelid condition is causing your dry eyes.

Macular Degeneration

The macula is a part of the retina in the back of the eye that ensures that our central vision is clear and sharp. Age-related macular degeneration (AMD) occurs when the arteries that nourish the retina harden. Deprived of nutrients, the retinal tissues begin to weaken and die, causing vision loss. Patients may experience anything from a blurry, gray or distorted area to a blind spot in the center of vision.

AMD is the number-one cause of vision loss in the U.S. Macular degeneration doesn't cause total blindness because it doesn't affect the peripheral vision. Possible risk factors include genetics, age, diet, smoking and sunlight exposure. Regular eye exams are highly recommended to detect macular degeneration early and prevent permanent vision loss.

Symptoms of macular degeneration include:

  • A gradual loss of ability to see objects clearly
  • A gradual loss of color vision
  • Distorted or blurry vision
  • A dark or empty area appearing in the center of vision

There are two kinds of AMD: wet (neovascular/exudative) and dry (non-neovascular). About 10-15% of people with AMD have the wet form. "Neovascular" means "new vessels." Accordingly, wet AMD occurs when new blood vessels grow into the retina as the eye attempts to compensate for the blocked arteries. These new vessels are very fragile, and often leak blood and fluid between the layers of the retina. Not only does this leakage distort vision, but when the blood dries, scar tissue forms on the retina as well. This creates a dark spot in the patient's vision.

Dry AMD is much more common than wet AMD. Patients with this type of macular degeneration do not experience new vessel growth. Instead, symptoms include thinning of the retina, loss of retinal pigment and the formation of small, round particles inside the retina called drusen. Vision loss with dry AMD is slower and often less severe than with wet AMD.

Recent developments in ophthalmology allow doctors to treat many patients with early-stage AMD with the help of lasers and medication.

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