Glaucoma

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.