Glaucoma is a disease caused by increased intraocular pressure (IOP) resulting either from an overproduction of fluid or from a malfunction of the eye’s drainage structures. Left untreated, an elevated IOP causes irreversible damage to the optic nerve and retinal fibers, which leads to progressive and permanent vision loss. Early detection and treatment can slow or halt the progression of the disease.
Essentially, glaucoma occurs when the delicate balance between the production and drainage of aqueous is thrown off-balance. Common types of glaucoma are open angle and acute angle closure.
Open angle glaucoma results from aqueous fluid building up within the anterior chamber, causing IOP to become elevated. Left untreated, this may result in permanent damage of the optic nerve and retina.
Acute angle closure occurs in only about 10% of the glaucoma population. It is the result of an abnormality of the structures in the front of the eye, collectively called the angle. In most of these cases, the angle space between the iris and cornea is more narrow than normal, leaving a smaller channel for the aqueous to pass through. If the flow of aqueous becomes completely blocked, IOP rises sharply, causing a sudden angle closure attack.
One less common form of glaucoma are secondary glaucoma, which results from another disease or problem in the eye and congenital glaucoma, a rare type that is seen in infants and requires surgery.
The danger of glaucoma lies in its lack of symptoms. Generally, it takes a routine eye exam to detect the disease. However, acute angle closure may cause a sudden decrease in vision, extreme eye pain, headache, nausea or vomiting, or acute glare and light sensitivity.
Most patients with glaucoma require only medication to control the eye pressure. Sometimes more than one medication will be prescribed. Surgery is indicated when medical treatment fails to lower the pressure satisfactorily. The purpose of surgery is to allow fluid to drain from the eye more efficiently so IOP is not elevated.
Glaucoma Treatments and Surgery
Two laser treatments and one surgery may be recommended at different stages in the treatment of glaucoma: Laser Peripheral Iridotomy (LPI), Micropulse Laser Trabeculoplasty (MLT) and glaucoma surgery.
Laser Peripheral Iridotomy (LPI)
This preventative technique is used to preempt the occurrence of a glaucoma attack. During an eye examination, an eye doctor may notice that the angle in the eye appears to be too narrow. A narrow angle tends not to drain properly and can lead to a build up of fluid and pressure, a precursor to glaucoma. In LPI, a laser is used to place a tiny opening in the iris in order to improve drainage. The treatment requires no sutures and is handled on a same day, outpatient basis. The patient is required to use anti-inflammatory eye drops for approximately one week following the treatment. LPI has a very high success rate.
Micropulse Laser Trabeculoplasty (MLT)
MLT is used for patients who have already been diagnosed with glaucoma and for whom eye pressure remains too high even after trying treatments with various eye drops. During the treatment, a laser is applied to heat up certain portions of the tissue. This process stretches the pores and opens up the outflow channels for fluid, which decreases eye pressure.
MLT is a same day, outpatient procedure that causes minimal discomfort. A topical anesthetic is administered in the eye prior to the treatment. Then a clear lens is placed on the eye to help focus light. The patient experiences approximately 30 to 40 flashes of light while the laser is applied. The treatment takes about ten minutes per eye and patients usually go home afterwards. Anti-inflammatory eye drops are administered for approximately one week following the treatment. Any reduction in IOP is seen within the first four weeks following the procedure. The success rate for MLT is approximately 80%.
Minimally Invasive Glaucoma Surgery (MIGS)
When all other treatments fail, glaucoma surgery may be called for. The purpose of the surgery is to optimize the aqueous through the filtering system of the eye (trabecular meshwork). The resulting increased drainage reduces the pressure in the eye and prevents any further eye deterioration. It is important to understand that glaucoma surgery cannot improve or reverse the damage already done by the disease. Its use is as a preventative measure to limit further damage or worsening of the disease. Dr. Sepulveda has had great success in reducing the amount of drops a patient has to use and in some cases eliminating the use of them altogether.
Castle Hills Eye Specialists is proud to offer the iStent for cases of mild to moderate Glaucoma. Surgery is handled on an outpatient basis; no overnight hospital stay is needed. It is performed in conjunction with cataract surgery. Patients use antibiotic and anti-inflammatory eye drops for several weeks following the procedure. Blurry vision may occur after the surgery but is typically temporary. This surgery helps restore the natural outflow pathway and has a high degree of success rate.