GLAUCOMA
Glaucoma is a disease in which the pressure in the eye leads to optic nerve damage. The optic nerve is what carries light signals from the eye to the brain. Damage to the optic nerve can lead to blindness. 3 million Americans are estimated to have Glaucoma, and half of the patients with it do not realize they have the disease. There are generally no symptoms in the early stages. The loss of vision can be gradual, which makes Glaucoma a silent disease. If left untreated, blindness may occur. Fortunately there are Glaucoma treatments to help prevent vision loss. Dr. Fugate is Premier Eye Care's Glaucoma specialist.
Open-Angle Glaucoma
Primary open-angle Glaucoma (POAG) is the most common form of Glaucoma in the U.S. There is fluid in the eye called aqueous, which drains through the trabecular meshwork and out of the eye. When the fluid drainage is less than the fluid production, intraocular pressure (IOP) increases and leads to Glaucoma damage. Some people may have higher-than-average IOP and not have signs of vision loss or Glaucoma. We call this ocular hypertension. Conversely, other patients may have low-to-normal IOP and yet still develop optic nerve damage called normal-tension Glaucoma (NTG).​Risk factors for Glaucoma include:
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Over 6o years old.
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Family History of Glaucoma.
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African-American.
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Myopia (Nearsightedness).
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High IOP.
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Eye Injury.
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Steroid Use (Particularly Eye Drops).
Angle-Closure Glaucoma
The fluid in the eye drains through the angle, which is the space between the iris and the cornea. If the angle is narrow or closed, the fluid drainage is obstructed, and pressure can build up in the eye. This can happen quickly, as with acute angle-closure Glaucoma, or over time with chronic angle-closure Glaucoma. Patients with increased risk include hyperopes (farsightedness), and Asian ancestry. Over-the-counter decongestants and certain medications can increase the risk of angle-closure Glaucoma. Check with your eye doctor before taking such medications.​
Signs of Acute Angle-Closure Glaucoma:
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Pain.
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Redness.
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Blurred Vision.
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Haloes Around Lights.
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Headaches.
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Nausea and Vomiting.
Secondary Glaucoma
Some patients develop Glaucoma as a result of external pressure on the eye (i.e., from a tumor), inflammation, diabetes, medications, or eye drops. Secondary glaucoma refers to any form of glaucoma in which there is an identifiable cause of increased eye pressure, resulting in optic nerve damage and vision loss. As with primary glaucoma, secondary glaucoma can be of the open-angle or angle-closure type and it can occur in one or both eyes.
Glaucoma Treatments
The most common treatment for glaucoma is medication eye drops. These mediations help lower the IOP by decreasing aqueous production or increasing aqueous drainage. Eye drops will not affect or improve the vision, but they are used to reduce progression of glaucoma and vision loss. Compliance and daily use of Glaucoma drops are crucial. Fortunately, at Premier Eye Care Group, we offer minimally invasive laser and surgery options for those that have exhausted or failed glaucoma medication therapy. If eye pressure is uncontrolled despite maximal medical therapy, laser or surgery is the next line of treatment. Laser is also a first-line option for patients with early or mild Glaucoma who elect this therapy over using drops. Find out more about our Ophthalmology Surgery Center here!
Laser Peripheral Iridotomy
Fortunately, angle-closure Glaucoma is preventable for those with narrow angles when detected early. A laser peripheral iridotomy (LPI) is most commonly performed to create a new drainage pathway by creating a small opening in the iris. If cataracts and visual symptoms are present, cataract surgery can also be a method for resolving the narrow angle. Both LPI and cataract surgery are outpatient procedures covered by Medicare and insurances.
Stents
The iStent is similar to stents used to prevent heart attacks and strokes. If you have glaucoma, over time your eye's natural drainage system becomes clogged. The iStent creates a permanent opening through the eyes natural fluid outflow. This procedure alleviates the potential pressure build up within your eye. In a clinical study, 68% of patients who received an iStent remained medication-free for at least 12 months. It can also be inserted during cataract surgery and begins to work immediately to relieve your eye pressure.
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The XEN Gel Stent is a surgical implant designed to lower high eye pressure in open-angle glaucoma patients. The stent creates a small channel in the eye to drain fluid and help lower eye pressure and is about the size of an eyelash!
Selective Laser Trabeculoplasty
Selective laser trabeculoplasty, or SLT, is a laser procedure performed to lower the eye pressure. It works by targeting specific cells in the trabecular meshwork, which is the main drainage pathway for the aqueous. This outpatient procedure has been shown as effective for lowering eye pressure without systemic side effects or ocular irritation that may be seen with Glaucoma drops. SLT is covered by Medicare and other insurances.
Endoscopic Cyclo Photocoagulation
ECP is a surgical technique that inhibits the production of aqueous in the eye. The reduced production decreases the interocular pressure along with the dependence on glaucoma medications. This procedure can be done simultaneously with cataract surgery. The laser procedure utilizes an integrated imaging and laser fiber-optic bundle to allow simultaneous viewing and targeted treatment of the surface cells of the ciliary processes. Ciliary processes are a series of organs located below the base of the underside of the iris which exude aqueous fluid into the eye.
Durysta
DURYSTA® is a dissolvable, sustained-release implant that the doctor places in your eye. The tiny, preservative-free implant works for several months. As DURYSTA® dissolves, it automatically releases medicine to help reduce high pressure inside your eye. The most common side effect involving the eyes reported in patients using DURYSTA® was eye redness. ​
Goniotomy
Goniotomy is a surgical procedure in which the doctor uses a lens called goniolens to see the structures of the front part of the eye also known as the anterior chamber. An incision is made in the trabecular meshwork, a network of tiny canals located in the drainage angle, where fluid leaves the eye. The incision helps the fluid bypass the diseased/clogged tissue allowing the fluid to drain easier and control the eye pressure.