Glaucoma is a condition that results in damage to the optic nerve. This can lead to vision loss and even blindness. It is caused by an increase in pressure inside the eye, which puts stress on the optic nerve. Although glaucoma can occur at any age, it is more common in older adults. There are several different types of glaucoma, each with its own set of symptoms. Glaucoma can be treated with medication or surgery, but it is important to catch it early to prevent vision loss. If you think you might have glaucoma, see your eye doctor for a diagnosis.
Who is at Risk for Glaucoma?
Everyone has some risk of glaucoma. It is important for everyone to have routine eye exams to look for the early signs of glaucoma. The risk for glaucoma is increased with these factors:
Other medical conditions – diabetes, migraines, poor circulation
Use of steroid medications
What Causes Glaucoma?
Glaucoma is a disease that damages the optic nerve and causes vision loss – often without warning or symptoms. Like a cable wire, the optic nerve is responsible for carrying the images we see to the brain. Damage to the optic nerve can occur when the pressure within the eye increases, usually due to a build-up of aqueous fluid inside the eye. This leads to the development of blind spots in our field of vision. However, damage may occur without elevation of the intra-ocular pressure. Conversely, the pressure may at times be elevated without damaging the optic nerve. This is a condition known as Ocular Hypertension. Blind spots in the field of vision usually go undetected by the individual until the optic nerve is significantly damaged and a great loss of peripheral or central vision has occurred. A Visual Field evaluation can detect glaucoma damage in its very early stages. If the disease is untreated the optic nerve may be damaged to a point that irreversible blindness will result.
Most people with glaucoma suffer from one of two major types of the disease, “open angle” and “closed angle” glaucoma.
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Glaucoma Treatment Options
If you are diagnosed with glaucoma, treatment is available to save your vision. The primary goal of glaucoma treatment is to lower the intraocular pressure (IOP) and stop the optic nerve damage. Several kinds of treatment are available to lower IOP. These include eye drops, laser therapy, and surgery.
Eye drop medications lower IOP by either reducing the amount of fluid entering the eye or increasing the amount of fluid exiting the eye. There are several different kinds of glaucoma medications, and each differs in terms of both its ability to lower IOP and its potential side effects. Laser therapy often is used when medications fail to lower IOP; it is also used for patients who cannot tolerate medications due to side effects. If eye drop medications or laser therapy fail to bring the intraocular pressure down to a safe range, surgery is available to lower this level.
Trabeculectomy is the most common surgical method used to reduce the pressure associated with glaucoma. During the procedure, the surgeon removes a tiny section of the wall of the eye, creating a drain which allows for the outflow of aqueous fluid. Using instruments under an operating microscope, your surgeon creates an opening in the white of your eye (sclera) and removes a small piece of the trabecular meshwork. The aqueous humor can now freely leave the eye through this hole. As a result, your eye pressure will be lowered. The hole is covered by the conjunctiva, so trabeculectomy leaves no open hole in your eye. You will need several follow-up visits and to use antibiotic and anti-inflammatory eye drops to fight infection and scarring of the newly created drainage opening (bleb).
Today, adding another step to your cataract surgery that may allow you to treat your mild to moderate open-angle glaucoma in an entirely new way. The iStent Trabecular Micro-Bypass Stent is designed to reduce your eye pressure and you have it done at the same time you have cataract surgery. During cataract surgery, iStent is implanted and creates a lasting opening in the drainage system in the eye. This restores the aqueous outflow mechanism lowers and controls pressure within the eye.
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Another type of surgical procedure, called drainage implant surgery, may be an option for people with secondary glaucoma or for children with glaucoma. Also known as “aqueous shunts” or “glaucoma drainage devices, ”we’ll refer to them simply as “implants.”
The idea behind implants is to enhance standard glaucoma surgery by positioning a device that will help keep the surgically-created drainage opening from healing and closing down. Many current implants include a tube through which the aqueous fluid passes. Others are solid and promote the flow of fluid along the surface of the implant. Regardless of type, implants have a common goal – to lower IOP by increasing outflow. Some implants commonly used are “valved” (Ahmed ) and “non-valved” (Molteno, Baerveldt) designs.
A hole or bleb is created similarly to conventionally trabeculectomy surgery. With implant surgery, most of the device is positioned on the outside of the eye under the conjunctiva. A small tube or filament is carefully inserted into the anterior chamber of the eye, just in front of the iris (colored part of the eye). The fluid drains through the tube, or along the filament, into the area around the back of the implant where fluid collects. The tube provides a passageway for the movement of this fluid out of the eye and into a place where the capillaries and lymphatic system reabsorb it back into the body.
There is often an inflammatory reaction immediately after surgery. This is commonly associated with variable IOP (often IOP elevation), and usually stabilizes within four to six weeks There is the possibility of IOP being too low. This is known as “hypotony.” Additionally, the implant may interfere with other ocular tissues such as extraocular muscles (muscles that move the eye from side to side) and the cornea. Like most surgeries, those with a smooth uncomplicated surgical course do the best over time.
