What is Glaucoma?
Glaucoma is an eye disease which causes damage to your eye’s optic nerve. Your optic nerve is an essential part of good vision, and the damage caused by Glaucoma can lead to irreversible vision loss and blindness. The damage caused by Glaucoma is typically caused by the build-up of high pressure in your eye.
Different Types of Glaucoma:
Glaucoma is actually a group of conditions and there are different types of Glaucoma.
Chronic Open-angle Glaucoma
Chronic Glaucoma is caused when your eye’s anterior chamber fills up with too much fluid (called aqueous). Typically, the build-up is caused because drainage channels (called trabecular meshwork) have become blocked. This imbalance in the production and drainage of fluid causes a high build-up of pressure, which damages your optic nerve.
Open-Angle Glaucoma is the most common form of Glaucoma. The symptoms and vision loss are gradual and generally unnoticeable until very late.
Angle Closure Glaucoma
Angle-Closure Glaucoma is a less common form of Glaucoma. It is caused when your eye’s drainage become blocked mechanically and the build-up of fluid can cause a very rapid build-up of pressure.
Angle-Closure Glaucoma can develop much more quickly and because of this, the signs are generally more noticeable than open-angle. Noticeable symptoms include severe pain, loss of vision, blurred vision, and nausea. If you experience any of these symptoms, it is crucial that patients seek help as soon as possible. Angle-closure glaucoma is more common in women, farsighted individuals, and those of Asian, Native American, and Hispanic ethnicity. If diagnosed early enough, it can be preventively treated with a special laser called Laser Peripheral Iridotomy which can help prevent the more severe symptoms.
listed above from ever happening. This is one of the reasons annual eye exams by a competent eye doctor is recommended. The test of choice for diagnosis is Gonioscopy.
Glaucoma Prevention and Treatment
During your routine eye exams, your doctor will assess your intraocular pressure and optic nerve for signs of elevated eye pressure or damage. Although it is not always possible to prevent glaucoma, regular eye exams allow for early detection and treatments that avoid vision loss. In addition to eye drop medications that are available for glaucoma, there are multiple surgical options for lowering eye pressure.
Selective Laser Trabeculoplasty (SLT)
SLT is one of the safest and a very effective treatment for open-angle glaucoma. This is a pain-free 10-minute procedure that can lower eye pressure up to 30%. It can be used as a standalone treatment for glaucoma, to reduce a patient’s dependence on drops, or as an addition to drop therapy. In many cases, SLT can be performed instead of or as a replacement for drops. This in turn helps reduce the medication regimen burden for the patient. Good candidates for SLT may include:
- Highly active individuals who don’t want to be burdened by drops
- Patients who are allergic or intolerant to drops or want to avoid their side effects
- Patients with arthritis who have trouble administering eye drops
- Patients for whom eye drops have not been effective or are inadequate to control eye pressure
- Patients highly dependent on contact lenses for whom taking the contacts out to use drops creates an undue burden
Traditional Trabeculectomy is a very detailed surgical procedure where an intricate opening is created through the sclera (white part of the eye) to allow fluid to drain between the surface layers of the eye and bypass the natural drain of the eye. This procedure carries more risk and is reserved for cases of glaucoma that are not responsive to less invasive treatments. Due to the advent of less invasive procedures now available, very few patients have to undergo this procedure currently.
Glaucoma Tube Shunt Surgery
These procedures allow for a surgical device attached to a tube to be inserted in the eye under the surface layer (conjunctiva) of the eye in order to drain fluid from the eye. They carry less risk than
Trabeculectomy but also do not lower eye pressure as much. Our glaucoma specialist can determine what is the best treatment plan for your glaucoma needs based on your unique situation.
Minimally Invasive Glaucoma Surgery (MIGS)
These surgeries include Trabeculotomy, the Xen procedure, OMNI procedure and iStent implants for the treatment of glaucoma. These procedures represent the latest technological advances in the field of glaucoma. They function by bypassing the natural drainage system of the eye in one way or another. The benefit of these surgeries is they are less invasive than traditional glaucoma surgeries (such as Trabeculectomy or Tube Shunt Surgery) and have a much better safety profile. Most glaucoma patients qualify for one of these procedures if drops and Laser are inadequate to control eye pressure.
Xen Gel Implant
The Xen Gel implant is placed in the eye to make a new permanent pathway for the excess fluid to drain from the inside the eye into a small bleb under the conjunctiva. The procedure is performed through a microscope incision in the cornea. The procedure can be performed by itself or in conjunction with cataract surgery.
This new technique targets all three points of resistance and provides the option of being performed in conjunction with cataract surgery!
Micro-Invasive Approach: The surgeon will use a pre-existing incision if the procedure is being done at the time of cataract surgery or will make a small (2- 4mm) incision in the clear cornea to access the “natural drain”.
Viscoelastic Delivery: The surgeon will use the cannula to insert a thin tube (microcatheter) into the main pipe of the drain (Schlemm’s Canal) to deliver a small amount of elastic fluid (viscoelastic).
Trabeculotomy: The surgeon can also thread the tube (microcatheter) into the main pipe (Schlemm’s Canal) and remove the first layer of potential resistance, Trabecular meshwork which is the top of the drain.
iStent inject W is FDA-approved and is one of the smallest medical devices known to be implanted in the human body. Approved for glaucoma patients with cataracts, iStent inject W is implanted at the time of cataract surgery. You will not see or feel the stents after they are inserted, but they are designed to effectively manage your intraocular pressure (IOP).
Which Glaucoma Procedure is Right for You?
Only your glaucoma specialist can determine if you are a good candidate for any of these procedures. At Insight Vision Group, we are proud to offer the most extensive options and technological advances available in the field of glaucoma. In line with our mission statement, our glaucoma team incorporates the most advanced surgical options for your ophthalmologic care. Please call or schedule a consultation to learn more about Glaucoma treatment at Insight Vision Group.