What is Glaucoma?

Glaucoma is a disease that occurs when fluid builds up inside of the eye and damages the optic nerve. The symptoms are not obvious at first, but glaucoma can silently steal your vision. Regular eye exams are essential to find early signs of this disease. There are two main kinds of glaucoma:

 
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Open Angle Glaucoma

In this type of glaucoma, the drainage system of the eye slowly becomes less effective. Like a clogged sink drain, fluid escapes too slowly, resulting in high eye pressure.
 

Closed-Angle Glaucoma

Also called Narrow Angle Glaucoma, in this type of glaucoma, the iris comes close to the drainage system of the eye. Often this happens gradually, but when it happens suddenly it is called an “acute angle closure”. Imagine an orange peel sliding on top of the drain – the water would back up very quickly! This sudden type of glaucoma can lead to severe eye pain, blurry vision and nausea, and it is a true eye emergency.

 


How is glaucoma diagnosed?

You are at increased risk for glaucoma if you have a history of high eye pressure or if a family member has glaucoma. If you have had trauma to the eyes or used steroids of any kind, you may also be at risk. See your ophthalmologist if you have any questions related to these risk factors. Remember, early diagnosis and management is the key to preventing vision loss.

At Schefkind EyeCare, we use state-of-the-art equipment to diagnose glaucoma. Optical coherence tomography (OCT) is used to create a three dimensional map of your optic nerves for analysis. Humphrey’s visual fields (HVF) is used to detect areas of your vision that are affected by glaucoma before you can notice any changes. Together these technologies have been shown to be more accurate than previous methods of detecting damage to the optic nerve. We will take time to make sure you understand what the test findings mean and work together with you to develop a diagnosis and management plan right for you.

  Output of Humphrey's Visual Field test showing subtle progression of glaucoma

Output of Humphrey's Visual Field test showing subtle progression of glaucoma

  Output of Optical Coherence Tomography, used to create a three dimensional map of your optic nerves

Output of Optical Coherence Tomography, used to create a three dimensional map of your optic nerves


What are the options to stabilize my glaucoma?

There are several types of glaucoma treatment: 

 

Medications

Eye drops are often used to lower the pressure of the eye and help prevent damage from glaucoma. Many different and effective types have been developed. Certain eye drops such as Lumigan (also known as bimatoprost) have been shown to decrease the risk of developing glaucoma in patients with high eye pressure, a condition called ocular hypertension. Other eye drops work in different ways to lower the eye pressure. In all, there are four major groups of eye drops which can be mixed, matched and combined to give you the best chance of controlling your glaucoma.

 

Laser Procedures

Selective Laser Trabeculoplasty (SLT) is a new technology that is used to control eye pressure. It is quick, minimally painful and at times can replace eye drops, making it a popular option among patients and doctors for treating glaucoma. Ask your doctor if you are a candidate for this procedure.

If you are diagnosed with “narrow angles” or “angle closure glaucoma”, a laser procedure called Laser Peripheral Iridotomy (LPI) may be recommended by your doctor. Short pulses of laser energy are used to create a small opening in the iris, which can change the direction of the fluid flow and open up the drainage system. Its effects are often instantaneous.

 

Traditional Surgery

In many cases of advanced glaucoma, the drainage system of the eye is sick. If eye drops and laser procedures cannot control the eye pressure, a surgical procedure such as an Ahmed Valve may be recommended. This is a procedure in which a small tube is implanted as a new drainage system for the eye. Although it is very effective and often vision-saving, the Ahmed Valve requires several stitches and may require significant time for healing.

 

Minimally Invasive Glaucoma Surgery (MIGS)

In the last few years, an emerging trend in the care of glaucoma has been to reduce pain, complications and recovery time from surgery. The iStent is a nearly invisible device implanted during cataract surgery to decrease the pressure in mild glaucoma. The Kahook Dual Blade is a device used through a tiny incision in the cornea to gently remove barriers to the drainage system. Another procedure, the XEN, is a nearly invisible stent inserted through a tiny incision in the cornea to form a new drainage system. All of these procedures are nearly painless, do not require stitches, and recovery time is typically faster than for standard glaucoma surgery. Ask your doctor if you are a candidate for these procedures.

Learn more about the iStent here: 
http://www.glaukos.com/istent-procedure/how-istent-works/

Learn more about the XEN here: 
https://www.xengelstent.com/


What is my prognosis? 

Glaucoma is a lifelong disease and it can be the source of a lot of anxiety. However, most cases of glaucoma, especially if caught early, can be significantly slowed down so that your vision can be preserved throughout your lifetime. Our goal at Schefkind EyeCare is to help control your glaucoma and, just as importantly, establish a life-long relationship built on open communication and trust.