Glaucoma is a disease of the optic nerve that can diminish vision if left untreated. The condition is common, especially in patients with a family history of glaucoma.
How is glaucoma diagnosed?
During a routine eye exam your doctors at Physicians Eye Care will screen for glaucoma by assessing your ocular and family history, checking your eye pressure as well as examining your optic nerve after pupil dilation. The image below shows optic nerve cupping over time which is a sign of optic nerve damage.
Additional tests to assess one’s risk for glaucoma may be performed if your physician feels you are at risk. These tests may include the following:
-Corneal Thickness Testing
-Gonioscopy (a lens to assess the fluid drainage portion of the eye)
-Optic Nerve Scanning (This is a scan called OCT – Optical Coherence Tomography that measures your nerve fiber thickness and health.)
-Visual Field Testing (This is a test that will assess your peripheral vision to determine if you have damage from glaucoma.)
How is glaucoma treated?
Doctors at Physicians Eye Care Center utilize the most advanced techniques to treat glaucoma. Treatment involves lowering one’s eye pressure and is tailored to each individual patient. In most cases of glaucoma, surgery can be avoided if detected and treated early enough. Routine glaucoma screening and early detection is key.
The following are some of the modalities utilized to treat glaucoma:
Eye Drops – Your physician may prescribe you eye drops to lower your eye pressure. There are several eye drops available and each has its dosing schedule and profile.
Laser – Depending on what type of glaucoma you have, it may be amenable to laser treatment. Selective laser trabeculopasty (SLT) is a quick and painless laser that facilitates more efficient fluid drainage from the eye, which lowers eye pressure. SLT can often decrease or eliminate the need for eye drops. Alternatively, it can be used as a therapy to help lower eye pressure in more advanced cases of glaucoma and put off the need for glaucoma surgery. Laser peripheral iridotomy (LPI) is a laser used in narrow angle glaucoma to help prevent damage from angle closure which can cause pain and vision loss. Both SLT and LPI are performed in the office and do not require any post-procedure restrictions.
Glaucoma Treatment with Cataracts
With the newest advancements in glaucoma technology, our eye surgeons can help slow the progression of glaucoma for cataract surgery patients. There are several additional procedures that our eye surgeons can perform along with your cataract surgery to lower your eye pressure and help treat mild to moderate glaucoma. These procedures are collectively referred to as Micro-Incisional Glaucoma Surgery (MIGS). There can be several advantages of MIGS procedures, including the following:
- Lower intraocular pressure (IOP)
- Less risk compared to other traditional surgical glaucoma procedures
- Reduction in, if not complete elimination of, the use of expensive medication
Below is a list and brief description of MIGS procedures commonly performed by surgeons at Physicians Eye Care Center. Your eye surgeon will discuss the risks and benefits of these procedures as well as which MIGS procedure would be best for you.
Endoscopic Cyclophotocoagulation (ECP)
Endocscopic Cyclophotocoagulation (ECP) is a technology that involves using a laser to treat the fluid producing organ of the eye (the ciliary body) so that the fluid production is more appropriate for your eye and your eye pressure is lower.
Kahook Dual Blade
The Kahook Dual Blade is a device used to create a goniotomy – which is an opening in the trabecular meshwork, creating a path through which excess fluid can drain from the eye, which results in an overall decrease in eye pressure.
iStent Trabecular Micro-Bypass Stent
The iStent is the smallest implantable device approved for use in the human body. It is a titanium device that is implanted at two to three different sites in the front of your eye to create bypasses that increase ocular fluid outflow through your eye's natural drainage system.
The iStent is typically implanted at the time of cataract surgery. In clinical trials of the iStent, most patients were completely off glaucoma medications at 23 months. The stent is made of titanium, so you can safely undergo magnetic resonance imaging (MRI) studies without the risk associated with metal implants.
The field of MIGS has expanded rapidly in the last decade adding to the glaucoma surgeons’ armamentarium and their ability to tailor surgical approaches to each specific patient. Future devices and surgical approaches will continue to be developed in the coming years. Your doctor may decide to perform a newer MIGS not mentioned here. Talk to your doctor if you have any questions about MIGS.
Advanced glaucoma technology for redirecting excess ocular fluid
For patients who don’t benefit from or can’t have a drainage procedure, fluid redirection can help reduce eye pressure. One option for redirecting excess ocular fluid is the XEN Gel Stent. Other more traditional options include Trabeculectomy and Glaucoma drainage implants. Dr. Dhannawat is a fellowship trained Glaucoma specialist and can help you navigate the advanced surgical options for your eye condition.
XEN Gel Stent
This is a stent device made of a soft gel material the size of an eyelash. The goal of the stent is to redirect excess ocular fluid out of your eye.
It is placed through the eyewall without requiring an incision in the conjunctiva (the clear membrane covering the white of your eye). It is designed to stay in your eye permanently. The XEN stent is placed in the front of your eye to shunt excess ocular fluid from within your eye to a subconjunctival space.
Trabeculectomy
One way to reduce pressure in an eye with glaucoma is to make a new drain in the eye. This type of surgery is called a trabeculectomy. During this operation, a flap is made in the sclera (wall of the eye) and a small hole is created to drain fluid into a reservoir (bleb) formed under the conjunctiva.
Recovery takes several weeks and close monitoring is crucial.
Glaucoma Drainage Implant Surgery
Glaucoma drainage implants are small prosthetic devices that are placed to help lower the intraocular pressure and prevent further optic nerve damage.
Glaucoma drainage implants come in different shapes and sizes. All these implants have a tube and plate design. Regardless of which type of implant is used, a silicone tube is inserted into the front of the eye, and connected to a plate sewn onto the sclera underneath the upper eyelid. With the upper lid retracted, a clear or white patch may be noted. This is a patch that covers the tube and prevents irritation. With all drainage implants, it can take 3 months or longer after surgery for the intraocular pressure to stabilize, as the capsule surrounding the plate of the implant needs time to mature in the eye.
Diode Laser Cyclophotocoagulation: Cyclodestructive procedure which reduces aqueous humor production by partially destroying the ciliary body. Used to treat advanced and refractory glaucoma.
For more information about our glaucoma services or for an appointment at Physicians Eye Care Center please contact us today!
