This is a partial list of things eye doctors will need to know prior to treating glaucoma. If any of these apply to the patient, doctors and their staff should be informed:
Eye drops that treat and stop the progression of glaucoma are classified by the active ingredient the make the drugs work. Many of the eye drops listed here are available at local pharmacies in Atlanta, Sandy Springs and around Georgia with brand name and generic forms:
These drugs relax the muscles of the eye's interior, allowing for better outflow of fluids, and reduce eye pressure build up. Few side effects are associated with Prostaglandins, but patients report stinging and burning when applied to the eye. iIncreased pigmentation of the iris (darkening) and lengthening and curling of the eyelashes have been noted.
Once the first choice in eye drops, these medicines are now more often used in conjunction with prostaglandins. Beta-blockers work by decreasing aqueous fluid production in the eye. Because Beta-blockers have been known to reduce heart rate and because adverse side effects have been reported in people with heart problems, emphysema, diabetes, depression and other diseases, doctors need to know the medical history of their patients before these drugs are used.
These drugs can be taken orally, but are also used in eye drop form often in combination with other anti-glaucoma eye drops. Side effects like burning and bitter taste have been reported.
These drugs decrease the rate of aqueous fluid production and are often used in combination with other anti-glaucoma drugs. Side effects include red/bloodshot eyes (ocular injection), upper lid elevation, enlarged (dilated) pupils and itching.
This class of anti-glaucoma drugs work by increasing the outflow of aqueous fluid from the eye. Parasympathomimetics are used to control intraocular pressure (IOP) in closed angle glaucoma. Pupil constriction, brow ache, burning, and reduced night vision have been noticed side effects.
These drugs are usually used for people with severely elevated IOP that must be immediately reduced, in emergency or one time situations; they reduce fluid volume in the eye.
If surgery becomes necessary it usually involves laser treatment to reduce intraocular pressure (IOP). This type of surgery will be recommended by doctors depending on the type and severity of the glaucoma and the health of the eye in general. Glaucoma surgery can result in lower pressure when medication is not totally effective, whatever the case vision loss cannot be reversed.
iStent® Trabecular Micro-Bypass Stent
Thomas Eye Group now provides iStent® Trabecular Micro-Bypass Stent as a treatment option to reduce eye pressure for patients with both cataracts and glaucoma. The iStent is FDA-approved for use in conjunction with cataract surgery to reduce eye pressure in adult patients with mild-to-moderate open-angle glaucoma currently being treated with ocular medications. In clinical trials, iStent has been shown to safely reduce eye pressure, which is the primary cause of open-angle glaucoma.
CyPass® Micro-Stent is an option for cataract patients with mild to moderate primary open-angle glaucoma. The CyPass Micro-Stent device is implanted during cataract surgery, just below the surface of the eye, into the supraciliary space. It is designed to lower IOP by enhancing aqueous outflow through one of the natural drainage pathways of the eye, with minimal tissue disruption, which allows the excess fluid in the eye to drain.
Xen Gel Stent
The XEN Gel Stent is an implant for the treatment of glaucoma that connects the anterior chamber to the subconjunctival space and lowers intraocular pressure by allowing fluid to drain to the subconjunctival space in a similar yet distinctly different method as trabeculectomy and tube shunt surgery.
Ab Interno Canaloplasty
Ab-Interno Canaloplasty is a microinvasive glaucoma surgery (MIGS) procedure. Ab-Interno Canaloplasty is a subtle but significant refinement of traditional canaloplasty that may lower IOP in patients with mild to moderate primary open-angle glaucoma.
Gonioscopy-Assisted Transluminal Trabeculotomy
GATT (Gonioscopy-Assisted Transluminal Trabeculotomy) is a minimally invasive surgical treatment for the management of open angle glaucomas and is a modification of a glaucoma surgery (trabeculotomy) that has been around for over 50 years. Trabeculotomy has a proven history of being safe and effective for the treatment of open angle glaucoma.
Laser surgeries have become important in the treatment of different eye problems and diseases. During the laser glaucoma surgery, the eye is numbed so that there is little or no pain. The eye doctor then holds a special lens to the eye. The laser beam is aimed into the eye, and there is a bright light, like a camera flash.
The glaucoma doctors that perform your laser glaucoma surgery have years of experience in providing excellent care. With locations in Atlanta, Sandy Springs and all around Georgia, Thomas Eye provides some of the best glaucoma care.
Laser surgery is still surgery, and can carry some risks. Some people experience a short-term increase in their intraocular pressure (IOP) soon after surgery. In others who require YAG CP (Cyclophoto-Coagulation) surgery, there is a risk of the IOP dropping too low to maintain the eye’s normal metabolism and shape. The use of anti-glaucoma medication before and after surgery can help to reduce this risk.
The following are the most common laser surgeries to treat glaucoma.
For the treatment of narrow-angle glaucoma.
Narrow-angle glaucoma occurs when the angle between the iris and the cornea in the eye is too small. This causes the iris to block fluid drainage, increasing inner eye pressure. LPI makes a small hole in the iris, allowing it to fall back from the fluid channel and helping the fluid drain.
For the treatment of primary open-angle glaucoma (POAG).
The laser beam opens the fluid channels of the eye, helping the drainage system work properly. In many cases, medication will still be needed. Usually, half the fluid channels are treated first. If necessary, the other fluid channels can be treated in a separate session another time. This method prevents over-correction and lowers the risk of increased pressure following surgery. Argon laser trabeculoplasty has successfully lowered eye pressure in up to 75% of patients treated.
For the treatment of primary open-angle glaucoma (POAG).
SLT is the latest development in glaucoma treatment and uses a combination of frequencies that allow the laser to work at very low levels. It treats specific cells"selectively," leaving untreated portions of the trabecular meshwork intact. For this reason, it is believed that SLT, unlike other types of laser surgery, may be safely repeated many times.
This is an alternative to filtering microsurgery that is typically used later in the treatment algorithm. This surgery destroys part of the ciliary body, the part of the eye that produces intraocular fluid. The procedure may need to be repeated in order to permanently control glaucoma.
Filtering microsurgery is recommended usually after laser surgery has been attempted, but in cases where the eye pressure is highly elevated or the optic nerve is badly damaged filtering microsurgery may be the first surgical procedure a patient undergoes.
Doctors often recommend laser surgery before filtering microsurgery, unless the eye pressure is very high or the optic nerve is badly damaged. During laser surgery, a tiny but powerful beam of light is used to make several small scars in the eye’s trabecular meshwork (the eye’s drainage system). The scars help increase the flow of fluid out of the eye.
In contrast, filtering microsurgery involves creating a drainage hole with the use of a small surgical tool. When laser surgery does not successfully lower eye pressure, or the pressure begins to rise again, the doctor may recommend filtering microsurgery.
There is a slight stinging sensation associated with LPI and ALT. In YAG CP laser surgery, a local anesthetic is used to numb the eye. Once the eye has been numbed, there should be little or no pain and discomfort.
Glaucoma laser surgeries help to lower the intraocular pressure (IOP) in the eye. The length of time the IOP remains lower depends on the type of laser surgery, the type of glaucoma, age, race, and many other factors. Some people may need the surgery repeated to better control IOP.
In most cases, medications are still necessary to control and maintain eye pressure. However, surgery may lessen the amount of medication needed.
In general, patients can resume normal daily activities the next day after laser surgery.
The procedure is usually performed in an eye doctor’s office or eye clinic. Before the surgery, your eye will be numbed with medicine. Your eye may be a bit irritated and your vision slightly blurry after the surgery. You should arrange a ride home after your surgery.
There is a small risk of developing cataracts after some types of laser surgery for glaucoma. However, the potential benefits of the surgery usually outweigh any risks. Make sure to speak with your doctor about any concerns you may have.
Thomas Eye Group works to make sure all of our patients have the best experience during their treatment. With locations in Atlanta, Sandy Springs and all around Georgia, we work to bring as much convenience as we can to your treatment.