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Glaucoma is the leading cause of blindness and visual impairment in the US, and can affect patients of all ages, many of who do not experience any symptoms and may not be aware that they have the disease. Glaucoma actually refers to a group of diseases that cause damage to the optic nerve as a result of increased pressure within the eye, but can also be caused by a severe eye infection, injury, blocked blood vessels or inflammatory conditions of the eye.
There are two main types of glaucoma, open-angle and angle-closure. Open-angle glaucoma is the most common type of glaucoma and involves fluid in the eye not draining properly through the trabecular meshwork. Angle-closure glaucoma involves a sudden buildup of pressure in the eye and poor drainage because the angle between the iris and the cornea is too narrow.
Many patients do not experience any symptoms during the early stages of glaucoma, including no pain and no vision loss. This makes it difficult for many patients to know if they have the disease. But as glaucoma progresses, patients may experience a loss of peripheral or side vision, along with sudden eye pain, headache, blurred vision or the appearance of halos around lights.
While some patients may experience symptoms from glaucoma as the disease progresses, others do not learn they have the condition until they undergo a routine eye exam. There are several different exams performed to diagnose glaucoma, including a visual field and visual acuity test. These tests measure peripheral vision and how well patients can see at various distances. Other tests may also be performed, such as tonometry to measure the pressure inside the eye and pachymetry to measure the thickness of the cornea.
At The Ophthalmic Center, glaucoma is further evaluated using the most modern and advanced diagnostic equipment available today:
Visual Field Test (Perimetry) is used to measure the lost of peripheral and central vision associated with glaucoma. The patient is tested periodically to follow the progression of disease and determine if further intervention is needed. The patient looks into the device which projects points of light in different areas and at different strengths to determine the sensitivity of the optic nerve.
The Heidelberg Retinal Tomography (HRT) scans the retinal surface and optic nerve with a laser. It then constructs a topographic (3-D) image of the optic nerve including a contour outline of the optic cup. The nerve fiber layer thickness is also measured.
Optical Coherence Tomography (OCT) creates images by use of special beams of light. The OCT machine can create a contour map of the optic nerve, optic cup and measure the retinal nerve fiber thickness.
Over time all three of these devices can detect loss of optic nerve fibers and determine the progression of damage by glaucoma.
Once diagnosed, most forms of glaucoma can be managed successfully with the use of prescription eye drops to lower the intraocular pressure. The applications of drops are simple and painless and are essential to slow the progression of the disease. However, if glaucoma progresses additional intervention may be necessary.
ECP is a laser procedure done during or after cataract surgery that reduces pressure in the eye by reducing the tissue that makes the fluid that causes elevated intraocular pressure. The laser is usually preformed during cataract surgery, after the natural lens of the eye is removed, but can also be performed after cataract surgery. A laser is used to painlessly treat the tissue that produces fluid, thus reducing the pressure in the eye. This may reduce or eliminate the need for glaucoma medication. It is done quickly, adding about 10 minutes to the total surgery time, and safely, with very few side affects. If you currently take medication for glaucoma and need or have already had cataract surgery you may be a candidate for this new technology.
Selective Laser Trabeculoplasty (SLT) is an advanced treatment option for glaucoma patients that lowers eye pressure and increases fluid drainage. This procedure offers a simple solution to glaucoma symptoms through a minimally invasive procedure with no side effects, scarring or pain.
The SLT procedure is effective for almost all patients with just one session. It has been performed successfully in Europe for the past 10 years and is now FDA approved for use in the US. It is performed in the office and takes just a few minutes, providing long-term results through the use of a low-energy laser beam.
SLT is most effective for patients unable to keep up with a daily eye drop treatment because of its cost, inconvenience or side effects. SLT controls glaucoma symptoms for up to 5 years with no need for additional medication, and relieves symptoms by promoting the body's natural healing response. There are no major risks or complications associated with SLT and the procedure is covered by most insurance companies.
Some patients with glaucoma have eye pressures that are too high even on eye drops; in those cases surgery is recommended. This surgery, known as trabeculectomy, improves the flow of fluid out of the eye resulting in lower eye pressure. In trabeculectomy, a flap is made in the sclera (white part of the eye) and a filtration bleb is created under the conjunctiva (thin tissue covering white part). This creates a pocket for the fluid to travel into and the fluid gets absorbed by the body. During surgery, the scleral flap is closed with tiny stitches. Some of these stitches may be removed after surgery to increase drainage. Medication to reduce scarring is often used during and after surgery. The pressure is controlled in most people who have this surgery and many patients no longer need to use eye drops.