WHAT IS GLAUCOMA?
Glaucoma is an eye disease, usually but not always associated with abnormally high eye pressure, that gradually and irreversibly damages the optic nerve. Glaucomatous nerve damage is experienced as a slowly progressive blindness that starts peripherally and which, if untreated, eventually leads to complete blindness. There are many different kinds of glaucoma, including primary open-angle glaucoma (the most common form), angle-closure glaucoma, narrow-angle glaucoma and congenital glaucoma.
What causes glaucoma?
In a healthy eye, clear fluid constantly circulates around the iris and inside of the cornea, then drains back into the bloodstream through a sieve-like drain (called the “angle”) surrounding the iris. A frequent cause of glaucoma is impaired flow of fluid through this drain, which results in high pressure inside of the eye. This increased pressure in the eye contributes to irreversible damage of the delicate fibers in the optic nerve.
Who gets glaucoma?
People over the age of 40
While glaucoma can develop in younger patients, it occurs more frequently as we get older.
People who have a family history of glaucoma
Glaucoma tends to run in families. For many patients, the tendency for developing glaucoma is inherited. However, just because someone in your family has glaucoma does not mean that you will necessarily develop the disease.
People with abnormally high intraocular pressure (IOP)
High IOP is the most important risk factor for glaucomatous damage.
People of African American, Hispanic, or Asian American descent
African Americans and Hispanics have a greater tendency for developing primary open-angle glaucoma than do people of other races. Asian Americans are more prone to develop angle-closure glaucoma and normal-tension glaucoma.
People who have:
- Myopia (nearsightedness)
- Regular, long-term steroid/cortisone use
- A previous eye injury
- A family history of glaucoma
- Extremely high or low blood pressure
Is treatment necessary?
Yes. Early diagnosis and treatment are absolutely essential because the progressive blindness caused by glaucoma is irreversible. Treatment is necessary to lower eye pressure and prevent further damage to the optic nerve.
What are the treatment options?
Medications in the form of eye drops are the most common treatment for glaucoma. However, if available medications cause uncomfortable side effects or become ineffective at controlling eye pressure. Our physicians may recommend one of several different laser treatments or surgery, depending on the kind of glaucoma that has been diagnosed. These advanced treatments are used to either open the natural drain in the eye or make a new drain.
What's involved in laser treatment?
During a laser procedure, you will be sitting down while your chin rests on a special stand in front of the laser. Laser procedures are usually painless.
Selective Laser Trabeculoplasty – Patients with open-angle glaucoma are often good candidates for a laser procedure known as trabeculoplasty. During this procedure, your ophthalmologist will focus a laser beam on the blocked drain in your eye. The laser stimulates a process that encourages fluid to drain from your eye more easily. An improved, more efficient drain may lower your eye pressure.
Laser iridotomy – This procedure is a nonsurgical alternative for treating narrow-angle glaucoma and the definitive treatment for angle-closure glaucoma. During the procedure, we use a laser to create an opening in the iris; this opening allows the drain in your eye to assume a more open position.
What's involved in surgical treatment?
The most common surgical treatments for glaucoma are trabeculectomy and aqueous shunt (tube) surgery. These are typically used to treat open-angle glaucoma when laser surgery is not successful. During these procedures, a high-powered microscope and precision instruments are used to create an alternate pathway for fluid to drain from the inside to the outside of the eye. Patients are awake for this type of surgery, but receive numbing medications to make the procedure painless.
Our physician receives a significant volume of complicated patients from other eye doctors who perform glaucoma surgery. He is typically asked to assess and surgically treat patients who have had previously failed trabeculectomies, or who have had vision-threatening complications with various other procedures such as tube-shunts, express-shunts, trabeculoplasties, and cataract surgeries. Because of this, he is highly experienced with management and repair of failed or failing glaucoma surgeries, and he commonly performs specialized techniques such as iris repair, lens suturing, tube repositioning, bleb revision, correction of hypotony, and surgical repair of a closed angle.
How safe is treatment?
There are risks with any type of surgical procedure. However, glaucoma surgery is relatively safe. With the increasing use of anti-scarring agents and various postoperative techniques, complications from the surgical treatment of glaucoma are becoming much more rare. Laser procedures used to treat glaucoma are also considered relatively safe. In fact, they typically result in fewer side effects than the medications used to treat glaucoma. And unlike invasive surgery, laser treatment poses no threat of infection. The most common complication of laser treatment is a temporary rise in the eye's intraocular pressure.
What is the expected duration of the laser treatment or surgery?
Laser treatments for glaucoma usually take between 5 and 15 minutes. Surgery generally takes from 30 to 60 minutes.
Will treatment fully restore vision?
Unfortunately, it will not. With glaucoma, the objective of treatment is to prevent further vision loss. Damage caused by glaucoma is irreversible.
How much discomfort should I expect right after treatment and in the days to follow?
If you undergo a laser procedure, you should not experience any postoperative discomfort. If your glaucoma is treated surgically, you may experience some minor discomfort in the days following your procedure.
What happens after treatment?
You'll most likely go home after a short stay in the recovery area of the surgery center. If you had a laser procedure, your vision may be slightly blurry for a couple of hours. Once home, wait for any blurred vision to subside before resuming your normal routine. If you had surgery to treat your glaucoma, you should plan on resting for the remainder of the day. Your ophthalmologist may advise you to avoid lifting and other strenuous activities for a few days. For the most part, however, you'll be able to resume normal daily activities almost immediately.
Will I need any follow-up visits?
For laser procedures, you will typically see the doctor again in about a week. For surgery, you will have to be seen the day following your surgery to check your eye pressure and monitor your healing.