Glaucoma refers to a series of diseases which result in damage to the optic nerve, the main nerve that carries the vision from the eye to the brain. The condition occurs in about 4% of whites and 10% of African Americans over 40 years old. It is more common in persons with a family history, as we get older and can also be the result of certain medications and other eye diseases.
Glaucoma may lead to blind areas in your field of vision, usually affecting peripheral (side) vision first, and if not treated promptly and properly, may lead to loss of central vision and even total blindness. Generally, there are no symptoms so regular eye exams are the only way to detect this “silent thief of sight.”
Glaucoma is usually related to an increase in the fluid pressure in the eye but can sometimes occur even with normal intra-ocular pressures. There are different types of glaucoma, some of which can be quite painful. During an evaluation, which includes measuring the intraocular pressure, evaluating the drain where fluid leaves the eye, measuring and charting the visual field and photographing and scanning the optic nerve and retinal nerve fiber layer using ocular coherence tomography, we can determine the type and extent of the disease and plan with you the best course of therapy.
Once diagnosed, glaucoma can usually be controlled and vision preserved by lowering the intraocular pressure, but once there is visual loss, it cannot be reversed.
Currently, there are four classes of eye drops used to control glaucoma. As their effect only lasts so long, they must be used daily or even more frequently to control the pressure. Sometimes more than one class of eye drop must be used together. Eye drops are the simplest treatment though they can sting, result in red eyes or rarely have systemic side effects.
Now there is Vyzulta™ (latanoprostene bunod ophthalmic solution 0.024%), the newest drop medication available to treat glaucoma using the new Nitrous Oxide pathway in the eye. Cleared by the FDA in late 2017, this new generation of glaucoma treatment increased outflow of fluid from within the eye through two, rather than one, pathway. There is also some hope that this type of new compound will be found through future study to finally protect the optic nerve and reduce the blindness that occurs with glaucoma.
These are used rarely as they have systemic side effects and generally are no more effective than eye drops.
These may be used as a first line treatment for patients who do not want to use eye drops or as an adjunct treatment when eye drops do not control the pressure. The effects may or may not be permanent however. Laser treatments may or may not be able to be repeated.
Micro invasive glaucoma surgery (MIGS) is a revolutionary new procedure in which an iStent® Trabecular Micro-Bypass is placed in the eye’s drainage system during cataract surgery to lower the pressure. Virtually without complications, it is effective in about 70% of patients.
Trabeculectomy and Tube shunts are generally used when less conservative procedures fail to control the pressure. Performed in the CarlinVision Ambulatory Surgery Center, these procedures are effective about 85% of time and may even eliminate the use of eye drops altogether.