Glaucoma, often referred to as the “silent thief of sight” is a leading cause of blindness in the United States and the world. Glaucoma is a group of diseases where the optic nerve is damaged and eventually leads to progressive loss of vision which is permanent. Patients are often not aware of any vision changes since glaucoma usually progresses gradually. Currently, we do not have a cure for glaucoma. However, early detection through regular eye exams and treatment is the best option available to slow the disease and preserve as much vision as possible.
Glaucoma is diagnosed by your ophthalmologist as part of a comprehensive eye exam, which includes checking eye pressure, gonioscopy (to evaluate the drainage system) and a dilated exam to examine the optic nerve. Testing for further evaluation includes visual field testing to assess peripheral vision, optical coherence tomography to assess the structure of the optic nerve and retinal nerve fiber layer and corneal pachymetry to assess the thickness of the cornea.
Our goal of slowing glaucoma progression is mostly achieved by lowering eye pressure. This is done by using eye drops, performing laser or surgery. The best treatment option is based on the individual and the stage of their disease.
Some lifestyle activities may have an impact on your eye pressure and modifications should be considered if you have glaucoma. Some activities that may increase your eye pressure include, eye rubbing, sleeping on your side (putting pressure on the eye of that side), playing woodwind or brass instruments, exercises that put your head below your hips (ex. inverted yoga positions like downward dog, head or handstands), neckties and lifting heavy weights. Smoking, obesity, high or low blood pressure, diabetes or excessive caffeine can affect blood circulation and decrease oxygenation thereby making your optic nerves more susceptible to glaucoma damage. Corticosteroids in any form, used in any body part can increase eye pressure. Some medications (antihistamines, decongestants, motion sickness medicines, tricyclic antidepressants) are contraindicated if you have narrow angles and have not had a laser iridotomy.
LPI is a laser treatment used to treat narrow angles. A microscopic hole is created in the colored part of the eye (iris). This hole can change the configuration of the drainage system within the eye, so that aqueous fluid is able to flow more normally and help prevent an acute attack of angle closure glaucoma. Drops to constrict the pupil and an eye pressure lower drop is applied to the eye. The pupil constricting drop may give some people an “ache” over the brow, but this is temporary. The eye is then numbed and a special contact lens is placed in your eye. Usually the laser treatment only lasts a few minutes. Some people may experience a brief pinch of discomfort with the laser. After the laser is completed, your eye pressure is checked and you can go home without any restrictions. If you are taking glaucoma medications, you should continue them. A topical steroid drop is prescribed for a few days to help with the healing process. Risks of laser iridotomy include inflammation (which is expected and treated with steroid drops), increased eye pressure, bleeding, glare or line of light in their vision. The glare or line of light is extremely uncommon and most people notice that this symptom improves with time.
SLT is a glaucoma laser that is used to lower eye pressure. SLT uses short pulses of low energy to target specific cells in the drainage system and improve their function. The eye is numbed and a special contact lens is placed in your eye. The laser treatment only lasts a few minutes. Some people may experience a brief pinch of discomfort with the laser. After the laser is completed, your eye pressure is checked and you can go home without any restrictions. A topical anti-inflammatory drop is prescribed for a few days to help with the healing process. If you are taking glaucoma medications, you should continue using them unless given different instructions. Good candidates for SLT are people with open angle glaucoma and need additional eye pressure reduction. This can be done as a primary treatment or as an adjunctive therapy to patients already on topical medications. SLT does not cure glaucoma and glaucoma patients who have had SLT still require regular follow up visits. Risks of SLT include blurry vision, mild inflammation and an increase in eye pressure. The effect of SLT can last anywhere form 1-5 years and SLT can be repeated.
Trabeculectomy is a glaucoma surgery that creates a new drainage site to allow aqueous fluid to flow outside of the eye, thereby lowering the eye pressure. The fluid flows into a space under the conjunctiva (clear tissue covering the white part of the eye) forming a small blister (called bleb). The bleb is mostly covered by the eyelid after surgery but can be seen if the eyelid is lifted. In order to prevent scarring at the drainage site, anti-scarring medication is used at the time of surgery (5-Fluorouracil or Mitomycin-C). The goal of this survey is not to improve vision or cure glaucoma. This surgery is meant to lower the eye pressure to slow the progression of the disease. Patients will have frequent follow up visits after surgery in order to monitor the progress of the surgery. Since healing varies from person to person, additional procedures may be necessary to achieve optimal results. Some patients may be able to decrease the number of their glaucoma medications after surgery. The most common complications seen with trabeculectomy includes blurry/decreased vision, worsening of pre-existing cataract, corneal swelling, infection, bleeding, suboptimal pressures and possible additional surgery.
Glaucoma drainage device implants involve placing a plastic tube inside the eye that drain the aqueous fluid to an external reservoir. There are many varieties of glaucoma drainage devices, though they are categorized into valved and non-valved implants. The implant is placed underneath the conjunctiva (clear tissue covering the white part of the eye) and then secured to the eye. The tube is then threaded inside the eye and then covered with a reinforcement patch. The tube is mostly covered by the eyelid after surgery but can be seen if the eyelid is lifted. The reinforcement patch may have a white appearance, depending on the type of patch that is used. GDIs are often indicated for those who have a history of a failed trabeculectomy, history of prior eye surgery, susceptible to increased scarring, diabetes or uveitis. The goal of this surgery is not to improve vision or cure glaucoma. This surgery is meant to lower the eye pressure to slow the progression of the disease. Patients will have frequent follow up visits after surgery in order to monitor the progress of the surgery. Since healing varies from person to person, additional procedures may be necessary to achieve optimal results. Some patients may be able to decrease the number of their glaucoma medications after surgery. The most common complications seen with glaucoma drainage devices includes double vision, blurry/decreased vision, worsening of pre-existing cataract, corneal swelling, infection, bleeding, suboptimal pressures and possible additional surgery.
