Glaucoma Surgery

What is glaucoma?

Glaucoma is a condition in which irreversible vision loss occurs due to damaged optic nerve fibers. These fibers are thought to be damaged by increased pressure within the eye. Everyone has a normal eye pressure level determined by the flow of fluid throughout the eye. This pressure maintains the shape and function of the eyeball. If there is overproduction and/or insufficient drainage of fluid, glaucoma can occur.

Glaucoma can be a gradual, progressive disease, or it can be a quick and sudden process. Some people may experience blurred vision, distorted vision, compromised peripheral vision, or vision loss. However, glaucoma typically has no symptoms in its early stages. More than 3 million Americans have glaucoma, but only half are aware they do. Scheduling regular comprehensive eye exams that check for glaucoma is essential to long-term vision health. Eating foods high in certain antioxidants and taking supplements helps, too.

Glaucoma – Pathology, Diagnosis, Treatment by Osmosis

Am I at Risk?

Every patient is monitored for glaucoma. Patients with specific risk factors may have additional tests run to fully assess.

Risk factors include:

  • Family history of glaucoma
  • Elevated intraocular pressure
  • African American
  • > 40 years old
  • Diabetic
  • Thin cornea

Ninety percent of those with glaucoma are 40+ years old and are affected by the most common form, open-angle glaucoma. The 3 main glaucoma categories are:

  • Open angle – Most common type consisting of problems in the eye’s drainage canal which causes eye pressure to build, often painless and causes no initial vision changes
  • Closed or narrow angle Occurs when the iris is very close to the drainage angle in the eye thus blocking drainage, no initial symptoms are detected but this type can result in rapidly rising eye pressure and an acute attack characterized by sudden blurriness, light halos, severe eye pain, headache, or nausea and can lead to blindness
  • Congenital, pediatric, or infantile – occurs in babies and young children, usually diagnosed within the first year, caused by incorrect development of the eye’s drainage system before birth

How do we test for glaucoma?

If one of our doctors suspects glaucoma, he or she may perform one or more of the following:

  • Tonometry to measure your eye pressure
  • Gonioscopy to inspect your eye’s drainage angle
  • Ophthalmoscopy to examine your optic nerve for damage
  • Perimetry to test your peripheral (side) vision
  • Photography or Nerve Fiber Layer Analyzer to take a picture or computer measurement of your optic nerve
  • Pachymetry to measure the thickness of your cornea
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The damage caused by glaucoma cannot be reversed. But proper diagnosis, treatment, and monitoring, can help slow or prevent vision loss, especially if the disease is caught in its early stages.

How is glaucoma treated?

The goal of glaucoma treatment is to lower pressure in your eye (intraocular pressure). Depending on your situation, options may include medication (eye drops, oral) or supplements, laser surgery, or conventional surgery. Additionally, some glaucoma procedures can be combined with cataract surgery if both are requiring treatment. Significant advances have been made in all of these modalities over the years, and our success rate in controlling the disease continues to increase.

 

Medications


Eye Drops
Glaucoma treatment frequently begins with prescription eye drops to lower eye pressure by either increasing aqueous fluid drainage or decreasing the amount of aqueous fluid in your eyes. Types of eye drop medications include:

  • Prostaglandins (Lumigan, Travatan, Xalatan)
  • Beta blockers (Timolol, Levobunolol)
  • Alpha-adrenergic (Alphagan P)
  • Carbonic Anhydrase Inhibitor (Dorzolamide)
  • Miotic or cholinergic agents (Pilocarpine)

Oral Prescription Medications
If eye drops are not sufficiently effective, our doctors may rarely need to prescribe an oral medication, typically a carbonic anhydrase inhibitor.

Once you are taking medications for glaucoma, we will want to monitor you regularly. Carefully follow your medication regimen to preserve a healthy eye pressure and prevent vision loss.

Laser Surgery

Trabeculoplasty – Option for open-angle glaucoma patients. Your eyes are numbed with drops, and a laser beam is used to open clogged channels in the trabecular (drainage) meshwork to improve fluid drainage. May reduce or eliminate the need to take medication.

Iridotomy/Iridectomy – Option for closed or narrow-angle glaucoma patients. A laser creates a tiny hole in the iris which helps fluid flow to the drainage angle. May reduce or eliminate the need to take medication.

Cycloablation Option for open-angle glaucoma patients who did not experience resolution from more traditional treatments. The laser treats the ciliary body (the part of the eye that connects the iris to the choroid or layer of the eyeball) to reduce the amount of fluid production. May reduce or eliminate the need to take medications.

Conventional Surgery

Trabeculectomy – Option for both open-angle and closed-angle glaucoma. By creating an opening in the sclera (white of the eye) and removing part of the trabecular meshwork, fluid is allowed to drain through this newly created channel. May reduce or eliminate the need to take medication.

Drainage implant – Several different devices have been developed to aid fluid drainage. Our surgeons insert a small drainage tube in your eye. It sends the fluid to a reservoir so it can be absorbed into nearby blood vessels. This surgery lowers pressure less than trabeculectomy. But it is preferred for patients whose pressure cannot be controlled via conventional surgery or who have previous scarring.

Micro-invasive Glaucoma Surgery – iStent®

The iStent® Trabecular Microbypass Stent implant by Glaukos, first to be FDA-approved for micro-invasive glaucoma surgery, is utilized at Heart of America Eye Care. It is an excellent option for people with mild to moderate open-angle glaucoma who are on

eye drops and who are ready for cataract surgery. This safe implant helps control your eye’s internal pressure. The doctor performs this procedure in conjunction with cataract extraction. Most patients are able to maintain normal eye pressure afterwards.

iStent is typically covered by most private insurance companies as well as Medicare. If you have glaucoma and are preparing for cataract surgery, ask us if the iStent® could be right for you.

Heart of America Eye Care doctors can determine if you have glaucoma.

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