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Glaucoma

What is Glaucoma?

Glaucoma is an eye disease in which damage to the optic nerve leads to progressive, irreversible vision loss. Glaucoma is the second leading cause of blindness.

What risk factors are associated with glaucoma?

  • Family history of glaucoma (parent or sibling)
  • People over the age of 60
  • African Americans over the age of 40
  • High Myopia or "nearsightedness"

Most people with glaucoma suffer from “open-angle” or “closed-angle” glaucoma.

What is open-angle glaucoma?

  • The most common form of glaucoma (90% of all cases)
  • Inner eye pressure rises
  • Occurs when blockage develops inside the eye’s drainage canals
  • Responds well to medication if detected early

What is closed-angle glaucoma?

  • More rare form of glaucoma
  • Occurs when the edges of the iris block the eye’s drainage canals
  • Often painful and sudden, characterized by quickly progressing vision loss
  • Symptoms may include eye pain and redness, blurred vision, headaches, vomiting, and the appearance of halos
  • In addition to these symptoms, doctors look for dilated pupils, lack of response to light, cloudy corneas, and reduced vision to diagnose closed-angle glaucoma

Rare/Less Treatable Forms of Glaucoma

  • Most forms of developmental and secondary glaucoma respond to treatment but resulting outcomes vary
  • Developmental glaucoma: congenital (present at birth), infantile (occurring between ages 1-2 years) and hereditary/familial disease
  • Secondary glaucoma: inflammatory, photogenic, intraocular hemorrhage, traumatic glaucoma, neovascular* glaucoma, drug-induced glaucoma, and glaucoma of miscellaneous origin

*Individuals with poor circulation are at high risk for neovascular glaucoma, which is rare, untreatable, and characterized by the development of abnormal vessels that block fluid drainage in the eye. Toxic glaucoma, which is also untreatable, results from an unexplainable rise in intraocular pressure. These forms of glaucoma are rare but dangerous.

How is glaucoma treated?

Glaucoma eye drops

Eye drops that treat and stop the progression of glaucoma are classified by the active ingredient. Most are available at local pharmacies as brand names and generic forms.

Prostaglandins

  • Reduce eye pressure build-up
  • Improve tear duct drainage
  • Reduce eye pressure build-up
  • Mild side effects may include: stinging/burning, darkening of the iris, and lengthening

Beta-blockers

  • Decrease aqueous fluid production in the eye
  • Adverse side effects reported in people with heart problems, emphysema, diabetes, depression, and other diseases

Carbonic Anhydrase Inhibitors

  • Available in oral and eye drop form in combination with other anti-glaucoma eye drops
  • Mild side effects may include burning and (for oral medication) bitter taste

Alpha-Adrenergic Argonists

  • Decrease the rate of aqueous fluid production
  • Often used in combination with other anti-glaucoma drugs
  • Side effects may include red/bloodshot eyes (ocular injection), upper lid elevation, enlarged (dilated) pupils, and itching.

Parasympathomimetics

  • Increase the outflow of aqueous fluid from the eye
  • Control intraocular pressure (IOP) in closed-angle glaucoma
  • Side effects may include pupil constriction, brow ache, burning, and reduced night vision

Hyperosomics

  • Reduce the fluid volume in the eye
  • Immediately reduce severely elevated IOP (in an emergency or one-time situation)

Glaucoma Surgery

If your doctor recommends surgery, this usually involves laser treatment to reduce intraocular pressure (IOP). Glaucoma surgery can result in lower eye pressure, but vision loss cannot be reversed.

Additional Glaucoma Treatments

iStent® Trabecular
Micro-Bypass Stent

  • FDA-approved for use in conjunction with cataract surgery
  • Reduces eye pressure in adult patients with mild-to-moderate open-angle glaucoma
  • Currently being treated with ocular medications

CyPass® Micro-Stent

  • Treatment option for cataract patients with mild to moderate primary open-angle glaucoma
  • Device is implanted during cataract surgery, just below the surface of the eye
  • Lowers IOP and allows excess fluid in the eye to drain

Xen Gel Stent

  • Small tube that creates a small channel in the eye to improve drainage and lower eye pressure in patients with open-angle glaucoma
  • Recommended for patients when previous treatments have not been effective

Ab Interno Canaloplasty

  • Microinvasive glaucoma surgery (MIGS) procedure to lower the IOP in patients with mild to moderate primary open angle glaucoma

Gonioscopy-Assisted Transluminal Trabeculotomy (GATT)

  • Minimally invasive surgical treatment for managing open-angle glaucoma

Laser Glaucoma Surgery

  • Nearly painless procedure in which your doctor aims a laser beam into the eye, activating a bright light, like a camera flash
  • Laser glaucoma surgeries help to lower the intraocular pressure (IOP) in the eye
  • Some patients may require multiple treatments to better control IOP
  • Following surgery, medications are still necessary to control and maintain eye pressure; however, surgery may lessen the amount of medication needed

Risks of laser surgery

  • Short-term increase in intraocular pressure (IOP) soon after surgery
  • Small risk of developing cataracts after some types of laser surgery for glaucoma
  • For patients who require YAG CP (Cyclophoto-Coagulation) surgery, IOP may drop too low to maintain the eye’s normal metabolism and shape; anti-glaucoma medication before and after surgery can help reduce this risk

What are the most common laser surgeries
to treat glaucoma?

Laser peripheral iridotomy (LPI) for narrow-angle glaucoma

  • LPI procedure makes a small hole in the iris, helping the fluid drain and reducing inner eye pressure

Selective laser trabeculoplasty (SLT) for primary open-angle glaucoma (POAG)

  • Uses a combination of frequencies that allow the laser to work at very low levels
  • Treats specific cells "selectively" leaving untreated portions of the trabecular meshwork intact, making multiple treatments safe

Argon laser trabeculoplasty (ALT) for primary open-angle glaucoma (POAG)

  • Laser beam opens the fluid channels of the eye, improving drainage
  • Requires multiple sessions to prevent over-correction and lower the risk of increased pressure following surgery
  • ALT has successfully lowered eye pressure in up to 75% of patients treated

Neodymium: YAG laser cyclophotocoagulation (YAG CP)

  • Clears the frosting from the back surface of the intraocular lens
  • May require multiple treatments to permanently control glaucoma

Filtering microsurgery

  • Recommended when laser surgery does not successfully lower eye pressure, and/or the optic nerve is badly damaged
  • Improves drainage, lowers pressure, and prevents/reduces optic nerve damage

Recovery time

Most patients resume normal daily activities the day after laser surgery.

The procedure is performed in your eye doctor’s office or eye clinic. Before surgery, your eye will be numbed with medicine. Your eye may be irritated and your vision slightly blurry after the surgery, so for your safety, please arrange a ride home after surgery.

Schedule an appointment with one of our Glaucoma Specialists today.

Glaucoma Specialists
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The material contained on this site is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider. Section 1557 – Affordable Care Act (ACA)

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