Glaucoma Treatment

Senior woman receiving an eye examination with a slit lamp device.

Glaucoma is a leading cause of blindness for people over 60 years old. But blindness from glaucoma can be prevented with screening and early treatment.

What is Glaucoma?

Glaucoma is a disease that damages your eye’s optic nerve. It usually happens when fluid builds up in the front part of your eye. That extra fluid increases the pressure in your eye, damaging the optic nerve.

To learn more about glaucoma watch the following videos:

Treatment of Glaucoma

Glaucoma is a progressive disease with symptoms evident in late stages. By then, the impairment in vision is usually significant and irreversible.

It is therefore very important to aggressively screen for and treat glaucoma. The first line of treatment usually involves use of daily drops or an in-office laser treatment (Selective Laser Trabeculoplasty) to lower the eye pressure. Both are equally effective in head-to-head studies in lowering the pressure in the eyes. Lasered patients do not have to use daily drops.

To learn more watch this video:

Treatment of Glaucoma with Minimally Invasive Glaucoma Surgery (MIGS)

For patients who cannot tolerate drops, or for whom laser was not effective, minimally invasive glaucoma surgery may be recommended to control the pressure. These procedures have a good success rate, and minimal recovery. They are also commonly performed at the time of cataract surgery to spare the patients an extra trip to the operating room.

There are 2 basic types of MIGS:

1) Placement of stents in the drain of the eye. Watch this video about how iStent is placed during the surgery.

2) Widening and opening of the drain using the OMNI system.

Both of these procedures are effective in lowering the eye pressure, and some patients are able to stop using their glaucoma drops. In cases of more advanced glaucoma, these procedures can save patients from a more extensive surgery,

What are narrow angles?

Narrow angles refers to the anatomy at the front of the eye called the drainage angle. This is where fluid called aqueous humor drains from the eye. In someone with narrow angles, the iris and the cornea are too close together. When the drainage angle is so narrow that the iris touches the cornea, it blocks fluid from leaving the eye. This raises eye pressure and can lead to glaucoma.

Video: Glaucoma Narrow Angle

How do you treat narrow angles?

Narrow angles may be a precursor to angle-closure glaucoma, the kind of glaucoma that can have a sudden, painful onset or a slow unrelenting downhill course. The best time to prevent the damage that angle-closure glaucoma can cause is to treat it with a laser iridotomy before the actual disease sets in. This is preventative medicine at its best.

Although not everyone with narrow angles actually develops glaucoma, careful evaluation of the angle structure can identify who is at greatest risk. The angle structure is determined by an examination called gonioscopy which is performed with a special contact lens called a gonio lens.

Is there more than one type of glaucoma?

There are many types of glaucoma. The two main types of glaucoma are Primary Open-Angle and Angle-Closure. But there are at least eight additional types of glaucoma. Most other types of glaucoma are variations of the open-angle or angle-closure types. These glaucoma types can occur in one or both eyes. What most types of glaucoma have in common is an increase of intraocular pressure (IOP), or pressure inside the eye.

Primary Open-Angle Glaucoma

Primary Open-Angle Glaucoma (POAG) is the most common form of glaucoma, affecting about three million Americans. It happens when the eye's drainage canals become clogged over time.

Video: Glaucoma Open Angle

Angle Closure Glaucoma

The other main type of glaucoma is Primary Angle-Closure Glaucoma, also called Narrow-Angle Glaucoma. In this type of glaucoma, the angle in many or most areas between the iris and cornea is closed, reducing fluid drainage and causing increased eye pressure .

Pigment Dispersion Syndrome and Pigmentary Glaucoma

Pigment dispersion syndrome is a condition where pigment from the back of the iris (the colored part of the eye) is released and becomes trapped in the drainage system of the eye. The pigment could block the drain which could, in turn, lead to an increase in eye pressure. .

The features of pigment dispersion syndrome, such as excessive pigment in the drain and areas of pigment loss from the iris, can be detected during an eye examination. .

Pigment dispersion syndrome is more common in young, Caucasian, male patients who are near-sighted. The eye pressure can significantly increase during exercise, but usually returns to normal. .

These eye pressure spikes may cause symptoms such as blurry vision and rainbow-colored haloes around lights. As patients age, there is less pigment dispersion, but the patient can still be at risk for developing glaucoma. .

Pigment dispersion syndrome can lead to permanent damage to the drain and elevated eye pressure. Over time, the elevated eye pressure can damage the optic nerve, causing pigmentary glaucoma. Untreated glaucoma can lead to vision loss and eventually blindness. .

The treatment of pigmentary glaucoma involves lowering the eye pressure using medications, lasers, or surgery. Unfortunately, it is difficult to reduce or eliminate the release of iris pigment. Therefore, attention is focused on reducing eye pressure. .

Eye pressure-lowering medications cause either a decrease in fluid into the eye or an increase of fluid out of the eye. Depending on the severity of the disease, surgery can range from laser treatment as an outpatient to incisional surgery in the operating room. .

Video: Pigment Dispersion Syndrome

Exfoliative Glaucoma also known as Pseudoexfoliation Glaucoma and Syndrome

Exfoliative Glaucoma occurs when a flaky material peels off the outer layer of the lens within the eye. The material collects in the angle between the cornea and iris and can clog the drainage system of the eye, causing eye pressure to rise. .

This type of Open-Angle Glaucoma is known for causing more episodes of high pressure, fluctuations, and higher peak pressures than other types of glaucoma. .