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)
Micro invasive glaucoma surgery (MIGS) refers to a group of modern revolutionary procedures that are used to lower the eye’s pressure and reduce or even eliminate the use of eye drops. These procedures are effective about 70% of the time, with minimal to no complications, performed through extremely small incisions (generally 1mm or less), and taking just a few minutes. Procedures may be performed with or without cataract surgery.
As a comprehensive glaucoma practice, we use a variety of procedures, including the new iStent inject®, trabecular bypass goniotomy, Trab 360/OMNI® and XEN® Gel Stent, so we can pick the best procedure for your particular situation. These can even be used for patients who desire to reduce the hassle and expense of eye drops.
Placed in the drain where fluid exits the eye two small shunts bypass the trabecular meshwork to allow fluid to exit the eye. FDA-approved for use ONLY in conjunction with cataract surgery.
Trabecular bypass goniotomy
A special dual blade is used to excise a portion of the roof of the trabecular meshwork where fluid exits the eye. It lowers pressure by allowing more fluid to exit through the canal. May be performed with or without cataract surgery.
A catheter is placed in the drain through which a viscoelastic is injected to dilate the trabecular meshwork and collector channels, and then the roof of the meshwork is removed using the catheter to shear off the roof. Performed with or without cataract surgery.
XEN Gel Stent
A 6mm mico tube is placed from under the conjunctiva into the eye to allow fluid to drain completely bypassing the normal outflow pathways. It produces a small bubble (bleb) underneath the conjunctiva. Performed with or without cataract surgery.
Conventional glaucoma surgery is generally used when medications, laser surgery, and micro-invasive procedures fail to control the pressure. While effective about 85% of the time, they are more invasive and require more healing and post-operative care. They are performed at the CarlinVision Surgery Center and can even eliminate the use of eye drops altogether. The most common procedures are:
Under the conjunctiva a portion of the trabecular meshwork is removed to allow fluid to drain from the inside of the eye out underneath the conjunctiva, which then back into the circulation. A small bubble or bleb results from the fluid flowing out of the eye.
A reservoir is placed outside the eye under the conjunctiva with a tube that is inserted into the eye. This allows fluid to drain from inside the eye through the tube into the reservoir and then back into the circulation.