Glaucoma

Preserve Your Vision

Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve, the nerve that carries visual information from the eye to the brain. In many cases, damage to the optic nerve is due to increased pressure in the eye, also known as intraocular pressure (IOP).The goal of treatment is to reduce eye pressure. Depending on the type of glaucoma, this is done using medications or surgery. Glaucoma can be divided roughly into two main categories, “open angle” and “closed angle” glaucoma. Closed angle glaucoma can appear suddenly and is often painful; visual loss can progress quickly but the discomfort often leads patients to seek medical attention before permanent damage occurs. Open angle, chronic glaucoma tends to progress at a slower rate and the patient may not notice that they have lost vision until the disease has progressed significantly.

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MEDICATIONS

Medical (Eye Drop) Treatment For Glaucoma

For the past 20 years, there have been 4 major families of eye drops that we use to treat glaucoma. Each of these medications aim to lower the pressure in the eye. They achieve this goal by decreasing the amount of fluid (aqueous humor) that the eye makes or by increasing the amount of fluid that drains out of the eye; some medications do both.

The 4 families of medications (with examples of specific medication names) are:

  • Beta Blockers: Timolol, Carteolol, Betaxolol
  • Alpha Agonists: Brimonidine
  • Carbonic Anhydrase Inhibitors: Dorzolamide, Brinzolamide
  • Prostaglandin Analogs: Bimatoprost, Travoprost, Latanoprost, Tafluprost

There are also 2 new glaucoma medications that will soon be available: Latanoprostene Bunod and Netarsudil. These are exciting additions to our treatment options because each of them represents a new family of medication.

LASER

There are two different types of laser treatments that are performed for glaucoma. Not everyone is a candidate for these treatments, but they can be quite effective when used in the right person. These procedures are performed in the office. They take about 15 minutes to perform, and the patient has no restrictions following the procedure.

Selective Laser Trabeculoplasty (SLT)

This is a cold laser that can lower the pressure as much as could be achieved with a single eye drop. The laser energy is applied to the trabecular meshwork, which is a covering over the internal drain of the eye; fluid must pass through this meshwork in order to drain out of the eye. The laser stimulates the cells found naturally in the drain and produces a change that makes it easier for fluid to drain out of the eye, thus lowering the pressure. A one-time treatment can lead to a lower eye pressure that lasts between 1 and 5 years.

Laser Peripheral Iridotomy (LPI)

In certain individuals, access to the internal drain of the eye can become blocked. Acute angle closure is the situation where the entire drainage system is blocked; this causes pain, redness, and blurry vision, and it is an emergency because permanent damage to the vision can occur within a short period of time. If the drain is only partially blocked, the pressure in the eye may rise to a level that can lead to glaucoma.

Your doctor may recommend an LPI if you have an acute angle closure attack, if your doctor thinks you are at risk for acute angle closure, or if the drain is so narrow that the eye pressure is high. During this procedure, a small hole is made through the iris (the colored part of the eye) to allow a second pathway for the fluid to reach the front part of the eye. Doing this will break an acute angle closure attack or will prevent one from happening in the future. It may also help to lower the pressure in the eye to a safer level.

SURGICAL TREATMENT OF GLAUCOMA

The goal of all glaucoma surgery is to lower the pressure inside the eye. The pressure inside the eye is determined by 1) how much fluid (aqueous humor) is made, and 2) how much fluid drains out. If there is too much production or too little drainage, the pressure will increase. With a few exceptions, glaucoma surgery attempts to increase how much fluid drains out of the eye.

Micro-Invasive Glaucoma Surgery (MIGS)

There has been a recent explosion in the number of types of glaucoma surgeries. These are mostly micro-invasive glaucoma surgeries (MIGS), where the surgery is performed through incisions only a few millimeters wide. They attempt to increase drainage through the natural drainage pathways of the eye. MIGS offers a distinct advantage over traditional glaucoma surgery in terms of safety and recovery time, but they do not lower the pressure as much as traditional surgeries. The types of MIGS that we perform at Clarus Vision Clinic are:

  • Trabectome
  • Kahook Dual Blade
  • Gonioscopy-assisted transluminal trabeculectomy (GATT)
  • iStent
  • CyPass
  • Cyclophotocoagulation

TRADITIONAL GLAUCOMA SURGERY

In contrast to MIGS, traditional glaucoma surgery makes a new drainage pathway in order to lower the pressure inside the eye. There are 2 general categories: tube shunt and trabeculectomy (sometimes called a filtering surgery). While the recovery associated with these surgeries is longer than with MIGS, they are often the best surgery in patients who have moderate or advanced glaucoma and in those who need a significantly lower pressure.

XEN Gel Stent

This surgery is somewhat of a hybrid between MIGS and traditional glaucoma surgery. As in other MIGS, the stent is placed in the eye using small incisions; similar to traditional surgery, the stent creates a new drainage pathway. It combines some of the best features of both types of surgery and is often an excellent option for patients with moderate and advanced glaucoma.

Cataract Surgery

This is often overlooked and not included in a discussion of glaucoma management, but studies have repeatedly shown that cataract surgery lowers the pressure inside the eye. Depending on the anatomy of the eye, cataract surgery may be the only glaucoma surgery that a patient needs; on the other hand, it is often combined with one of the other surgeries listed above to augment the amount of pressure-lowering that can be achieved.

What is Glaucoma?

Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve, the nerve that carries visual information from the eye to the brain. Glaucoma is one of the leading causes of blindness in the United States. The vision loss usually occurs very slowly and is often not noticed until the disease is very advanced. Unfortunately, vision lost from glaucoma is permanent. Because there are very few, if any, symptoms of glaucoma, it is important to get regular eye exams where your doctor looks for signs of the condition.

There are several risk factors for developing glaucoma, including family history, age, race, and other systemic conditions. In many (but not all) people with glaucoma, the pressure inside the eye is high. In addition to checking the pressure inside your eyes (tonometry) and looking at your eyes with a special microscope called a slit lamp, your doctor may also measure the thickness of your cornea (pachymetry), formally test your peripheral vision, measure the thickness of the nerve layer of your retina using optical coherence tomography (OCT), and check the retinal function using electroretinography (ERG). Treatment is focused on lowering this pressure and can be accomplished with eye drops, laser procedures, and/or surgery.

Types Of Glaucoma

There are two broad categories of glaucoma:

  1. open angle glaucoma
  2. angle closure glaucoma

These two types of glaucoma have slightly different symptoms and treatments, but they both lead to permanent damage of the optic nerve.
It is possible for infants and children to have glaucoma as well. This is called congenital glaucoma.

Open-Angle Glaucoma Treatment

Open-Angle Glaucoma Treatment

Most people with open-angle glaucoma can be treated successfully with eye drops. Most eye drops used today have fewer side effects than those used in the past. You may need more than one type of drop. Some patients may also be treated with pills to lower pressure in the eye.

Newer drops and pills are being developed that may protect the optic nerve from glaucoma damage.

Some patients will need other forms of treatment, such as a laser treatment, to help open the fluid outflow channels. This procedure is usually painless. Others may need traditional surgery to open a new outflow channel.

Angle-Closure Glaucoma Treatment

Angle-Closure Glaucoma Treatment

Acute angle-closure attack is a medical emergency. Blindness will occur in a few days if it is not treated. Drops, pills, and medicine given through a vein (by IV) are used to lower pressure. Some people also need an emergency operation, called an iridotomy. This procedure uses a laser to open a new channel in the iris. The new channel relieves pressure and prevents another attack.

Congenital Glaucoma Treatment

Congenital Glaucoma Treatment

This form of glaucoma is almost always treated with surgery to open the outflow channels of the angle. This is done while the patient is asleep and feels no pain (with anesthesia).

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6344 South 900 East
Salt Lake City, UT 84121
Right across from Wheeler Farm
(801) 892-8222