Glaucoma

 
Overview

Glaucoma is a disease of the optic nerve, which is the part of the eye that carries the images we see from the eye to the brain. The optic nerve is made up of many nerve fibers (like an electric cable containing numerous wires).  Glaucoma damages nerve fibers, which can cause blind spots in our vision and vision loss.

 

Glaucoma has to do with the pressure inside the eye, or intraocular pressure (IOP).  When the clear liquid called the aqueous humor, which normally flows in and out of the eye, cannot drain properly through the drainage angle, pressure builds up in the eye. The resulting increase in IOP can damage the opticnerve.

Understanding glaucoma:

 
Types of Glaucoma
Here are the different types of glaucoma:
  • Primary Open-Angle Glaucoma: The most common form of glaucoma is primary open-angle glaucoma (POAG), where the aqueous fluid that normally circulates in the front portion of the eye is blocked from flowing back out of the eye through a tiny drainage system.  This causes the pressure inside your eye to increase, which can damage the optic nerve and lead to vision loss.  Most people who develop primary open-angle glaucoma notice no symptoms until their vision is impaired.

  • Angle-Closure Glaucoma: In angle-closure glaucoma, the iris (the colored part of the eye) may drape over and completely close off the drainage angle, abruptly blocking the flow of aqueous fluid and leading to increased IOP and optic nerve damage.   In acute angle-closure glaucoma, there is a sudden increase in IOP due to the buildup of aqueous fluid.  This condition is considered an emergency because optic nerve damage and vision loss can occur within hours of the problem. Symptoms can include sudden onset of blurry vision, seeing halos around lights, severe eye pain,  headache, nausea, and vomiting.

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Closed Angle

Open Angle

  • Normal Tension Glaucoma: Even people with "normal" IOP can experience vision loss from glaucoma.  This condition is called normal-tension glaucoma.  In this type of glaucoma, the optic nerve is progressively damaged even though the IOP is considered normal.  Normal tension glaucoma is not well understood, but we do know that lowering IOP has been shown to slow the progression of this form of glaucoma.

  • Childhood Glaucoma: Childhood glaucoma is rare and starts in infancy, childhood, or adolescence.  Like primary open-angle glaucoma, there are few, if any, symptoms in the early stage.  Blindness can result if it is left untreated.  Like most types of glaucoma, this type of glaucoma may run in families.

 
Risk Factors

The older a person is, the more likely glaucoma is to occur. Race is also a documented factor;  African Americans and Hispanics are at an increased risk. Family history matters. Those with a parent or sibling with glaucoma are at higher risk. Other risk factors include diabetes, use of long-term steroid medications, and previous significant injuries to an eye.

Current guidelines recommend that you should be screened by an ophthalmologist routinely if any of the following apply to you:

  • Age over 60

  • Have a parent or sibling who was diagnosed with glaucoma

  • African American or Latin American over age 50

  • Have diabetes

 

Your ophthalmologist will weigh all of these factors before deciding whether you need treatment for glaucoma, or whether you should be monitored closely as a suspect. This means that your risk of developing the disease is higher than normal, and you need to have regular examinations to detect any early signs of damage to the optic nerve.

Detection and Diagnosis

The only sure way to diagnose glaucoma is with a complete eye exam by an ophthalmologist. A glaucoma screening that only checks eye pressure is not enough to diagnose glaucoma.

During a glaucoma exam, Dr. Kim will:

  • Measure your eye pressure

  • Inspect your eye's drainage angle

  • Examine your optic nerve for damage

  • Test your peripheral (side) vision

  • Take a picture of your optic nerve

  • Take a non-invasive computer measurement of your optic nerve called Optical Coherence Tomography (OCT)

  • Measure the thickness of your cornea

 

Glaucoma has no symptoms in its early stages. In fact, half the people with glaucoma do not know they have it. Having regular eye exams can help your ophthalmologist find this disease before you lose vision. Your ophthalmologist can tell you how often you should be examined. 

Treatment

Early diagnosis and treatment is the key to having the best outcome. Glaucoma treatments are focused on lowering and stabilizing eye pressure. There have recently been several new advances in treatment. These include:

  • LASER

  • Eyedrop medication

  • Minimally invasive procedures (or MIGS procedures)

  • Traditional glaucoma surgeries

 

Sometimes a combination of these treatments is required. 

Laser Treatment

 

There are two main types of laser surgery to treat glaucoma. They both help aqueous fluid drain from the eye.

  • Selective Laser Trabeculoplasty (SLT): This is a form of laser surgery that is used to lower intraocular pressure in patients who have primary open-angle glaucoma. It is used when eye drop medications are not lowering the eye pressure enough or are causing significant side effects. It can also be used as an initial treatment in glaucoma. Recent advances in laser technology have resulted in greater use of SLT laser treatment, often avoiding the need for more invasive surgery or extra glaucoma drops.

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  • Iridotomy: This is for people who have angle-closure glaucoma. Your eye surgeon uses a laser to create a tiny hole in the iris.  These openings help fluid flow to the drainage angle. 

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At Polaris Eye & Laser, we are pleased to offer both SLT and Iridotomy laser treatment right here in the clinic rather than at a hospital or a surgery center for your convenience and affordability. 

Eyedrop Medication

Glaucoma is usually controlled with eyedrop medicine. Used every day, these eye drops lower eye pressure. Some do this by reducing the amount of aqueous fluid the eye makes. Others reduce pressure by helping fluid flow better through the drainage angle. While Glaucoma medications can help you keep your vision, they may also produce side effects. Some eye drops may cause:

  • Dry mouth

  • Blurred vision

  • Eyelash growth

  • Changes in your eye color, the skin around your eyes, or eyelid appearance

  • stinging or itching sensation

  • Red eyes or red skin around the eyes

  • Changes in your pulse and heartbeat

  • Changes in your energy level

  • Changes in breathing (especially if you have asthma or breathing problems)

 

All medications can have side effects. Some drugs can cause problems when taken with other medications. It is important to give your doctor a list of every medicine you take regularly. Be sure to talk with your ophthalmologist if you notice side effects from glaucoma medicine. Never change or stop taking your glaucoma medications without talking to your ophthalmologist. If you are about to run out of your medication, ask your ophthalmologist if you should have your prescription refilled.

 

Minimally Invasive Glaucoma Surgery (MIGS) 

MIGS is a state-of-the-art minimally invasive glaucoma surgery that uses microscopic instruments to facilitate small incision surgery. It provides a safer option to reduce eye pressure than conventional surgery, with the added benefits of a higher success rate and faster recovery time. The goal of MIGS procedures is to improve fluid drainage out of the eye in patients with mild to moderate glaucoma, reducing elevated eye pressure that damages the optic nerve. Clinical trials have shown that MIGS procedures achieve a significant decrease in eye pressure over periods up to 24 months, also decreasing the need for eyedrop medication. MIGS procedures are often performed in combination with cataract surgery for the appropriate patients. MIGS performed at the Polaris Eye & Laser include iStent® and Hydrus™ Microstent. 

 

Traditional Glaucoma Surgeries

Some glaucoma surgery is done in an operating room. It creates a new drainage channel for the aqueous humor to leave the eye.

  • Trabeculectomy: This is where your eye surgeon creates a tiny flap in the sclera. He or she will also create a bubble (like a pocket) in the conjunctiva called a filtration bleb. It is usually hidden under the upper eyelid and cannot be seen. Aqueous humor will be able to drain out of the eye through the flap and into the bleb. In the bleb, the fluid is absorbed by tissue around your eye, lowering eye pressure.

  • Glaucoma drainage devices: Your ophthalmologist may implant a tiny drainage tube in your eye. The glaucoma drainage implant sends the fluid to a collection area (called a reservoir). Your eye surgeon creates this reservoir beneath the conjunctiva. The fluid is then absorbed into nearby blood vessels.

  • Cataract surgery: For some people with narrow angles, removing the eye's natural lens can lower eye pressure. With narrow angles, the iris and the cornea are too close together. This can cover and block the eye’s drainage channel. Removing the eye's lens with cataract surgery creates more space for fluid to leave the eye. This can lower eye pressure.

 

Treating glaucoma successfully is a team effort between you and your doctor. Your ophthalmologist will prescribe your glaucoma treatment, monitor progress and make adjustments. It is up to you to follow your doctor’s instructions and use your eye drops.  With proper treatment, many patients can maintain a lifetime of healthy vision.

 
 
 
 
 
 
 
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