Glaucoma Treatments

What is Glaucoma?

Glaucoma is a degenerative disease that if left untreated can cause permanent damage to the optic nerve resulting in gradual vision loss and eventual blindness. Damage to the optic nerve, due to glaucoma, is usually caused by an elevated intraocular pressure.

The “Silent Thief” of  Sight 

Glaucoma, the leading cause of blindness and visual impairment in the United States, is an eye disease that can lead to a permanent loss of vision. This disease has been labeled the “Sneak Thief of Sight” because in its most typical form, there are no symptoms. No pain, no swelling, no redness. Patients with glaucoma may not notice symptoms until vision has been permanently lost.

Simply, glaucoma is elevated intraocular pressure of the eye. Every eye has fluid, called aqueous humor, that is constantly being produced as well as constantly being drained. In a glaucomatous eye, this fluid does not drain properly resulting in an increase in the pressure inside the eye. This increased pressure destroys vision gradually, usually starting with the peripheral ( side ) vision, and if left untreated, will lead to eventual blindness by destroying the optic nerve. With early diagnosis and treatment, useful vision may be preserved.

There are four types of glaucoma :

• Chronic. This is the most common type of glaucoma, and occurs slowly over time. There is no pain, redness or swelling or other symptoms.
• Acute. This happens suddenly and is very painful. Victims of an acute glaucoma attack may complain of serious headache and vomiting. Surgical intervention is needed immediately to bring the pressure under control to prevent further vision loss.
• Congenital. Present at birth, congenital glaucoma is a rather rare condition.
• Secondary. Occurring as a result of systemic disease such as diabetes, from medications such as steroid, or from an eye injury.

The following factors increase your risk of developing glaucoma :

• Age ( at least 45 years old without regular eye examinations )
• Family history of glaucoma
• African American or Asian descent
• Diabetes
• Nearsightedness
• Steroid use
• Past eye injury

Your doctor will check for the presence of glaucoma during a routine eye examination. The test is essentially pain-free, and takes only seconds. If glaucoma is detected, the initial treatment, in most cases, is prescription eye drops. There are many different types of glaucoma medications (eye drops ) that can control pressure. Your eye doctor will consider your general health as well as your eye condition to determine which drop is best suited for your case. If eye drops are not effective, oral medication and/or laser of filtration surgery may be recommended.

The best defense against glaucoma is simple: If you have risk factors and are over 30, have your vision checked annually. If you are over 40 and without risk factors, undergo routine eye examinations every two years. If glaucoma medication is prescribed, be faithful about taking it. Remember, glaucoma medication may preserve your vision, and sight destroyed by glaucoma is a permanent loss !

Open Angle Glaucoma (OAG) , occurs when there is an increase in fluid production or a decrease in fluid drainage. Over time, as the optic nerve fibers are destroyed, peripheral (side) vision is lost.

What causes Glaucoma?

Clear fluid, called Aqueous Humor is produced by tissue called Ciliary Body. This fluid circulates through the eye providing nourishment to the tissues to help maintain the shape of the eye. It flows out of the eye and back to the blood stream through the Trabecular Meshwork, the eye's natural drainage canal located near the iris. If this canal is blocked, it restricts drainage and the pressure inside the eye increases. This elevated pressure results in damage to the optic nerve and vision loss occurs.

How is Glaucoma treated?

Medications

Eye drops can be used to treat Glaucoma. Some allow for faster drainage, while others reduce the production of fluid.

SLT Therapy

Selective Laser Trabeculoplasty (SLT) is a non-surgical laser treatment for Glaucoma which treats the canal called Trabecular Meshwork. The goal of SLT is to improve the flow of fluid out of the eye, which in turn lowers the eye pressure.

SLT uses an advanced laser system to target cells of the canal containing melanin, a natural pigment, which causes blockage. SLT works by using laser to stimulate the body's own healing response to lower eye pressure. The laser applications are made through a special microscope, similar to the one used for eye examinations. A lens is place over the eye to direct the laser to the canal for treatment. SLT Therapy is performed in The Eye Center clinic.

ECP

Endoscopic CycloPhotocoagulation (ECP) is a surgical laser treatment for Glaucoma. ECP can be performed during cataract surgery or for someone who has already had cataracts removed. The goal of ECP is to reduce the fluid production, which in turn reduces the pressure in the eye.

During the ECP procedure, a small, self-sealing micro-incision is made to allow the insertion of the laser probe. The ECP probe allows the doctor to see the tissue and treat it with the laser. Laser energy is applied directly to the tissue, reducing the fluid production. ECP has been very effective for reducing or eliminating the need for eye drops after this treatment. ECP is performed in The Wilson County Eye Surgery Center.