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Glaucoma
Glaucoma, often called the "sneak thief of sight," is a disease that strikes without any obvious symptoms. You usually don't know it's there until serious vision loss has occurred. And unfortunately, there is no cure for glaucoma. Once you have lost your vision, it can't be restored. The good news is that glaucoma can be detected early before there is any vision loss. Plus, there are convenient treatments that can lower intraocular pressure (IOP), one of the major risk factors for glaucoma. The keys to managing diseases that cause vision loss are early diagnosis, proper treatment, and regular eye exams. Your eye doctor has ways to assess your risk for developing glaucoma and can prescribe treatments to help prevent or delay vision loss if you have glaucoma.
Glaucoma is an eye disease that involves damage to the optic nerve, which sends visual signals to the brain. No one knows exactly what causes this damage, but pressure buildup in the eye is proven to be one of the major risk factors associated with glaucoma. The front of the eye is filled with a liquid called aqueous humor. This is produced by the eye to bathe and nourish its different parts. The aqueous humor normally flows out of the eye through various paths and chambers. When these paths get clogged, aqueous humor gets trapped in the eye. This causes a pressure buildup and leads to high IOP. When the optic nerve gets damaged by high IOP's, some signals from the eye aren't transmitted to the brain. This can result in visual field loss, and if not managed, could eventually lead to blindness.
(gradual vision loss associated with glaucoma damage)
Normal Optic Nerve Early glaucoma Advanced glaucoma
Normal Optic Nerve Early glaucoma Advanced glaucoma
There are two basic types of glaucoma: Primary Open Angle Glaucoma (POAG), the most common form which accounts for about 80% of all cases, happens when the eye's drainage canals get clogged over time. The intraocular pressure (IOP) rises because the correct amount of fluid can't drain out of the eye, causing a gradual vision loss. POAG develops very slowly and sometimes without noticeable sight loss. Angle Closure Glaucoma, also known as acute glaucoma or narrow angle glaucoma, is mush rarer. If the iris and cornea are not as wide and open as they should be, the outer edge of the iris bunches up over the drainage canals when the pupil enlarges too much or too quickly, such as when entering a dark room, thus causing blockage of the drainage canals and an increase in IOP. Could you be at risk? Glaucoma is one of the most common causes of preventable blindness. Over 3 million Americans have glaucoma, yet only half of them are aware they have it. One out of every five sufferers has a close relative with it. In the United States, approximately 120,000 people are living with blindness due to glaucoma. Some people are at greater risk than others. You are at greater risk for glaucoma:
If you have any of these risk factors, it is important that you get regular eye checkups. One of the most common and important tests for measuring IOP is tonometry. Tonometry is a procedure in which your doctor uses a tonometer to measure IOP. Tonometry is a painless test and takes only a few seconds to perform. Normal IOP is about 12 to 22mm Hg (millimeters of mercury, which is the unit used to measure IOP). However, high IOP does not necessarily mean you will have glaucoma, nor does normal IOP mean you don't have glaucoma. Controlling IOP is the major goal of glaucoma therapy. When IOP is controlled, the optic nerve is less at risk of being damaged, so vision may be preserved. Early detection and treatment of glaucoma can slow the disease's progression and help prevent blindness. Treatment Although there is no cure for glaucoma, there are several treatment options. Medication, most often in the form of eye drops, can relieve eye pressure, as do surgical procedures, such as ALT (ARGON Laser Trabeculoplasty), SLT (Selective Laser Trabeculoplasty), ECP (Endoscopic Cyclo Photocoagulation), and YAG PI (YAG Peripheral Iridotomy). ARGON Laser Trabeculoplasty (ALT) With ALT, tiny, evenly spaced burns are made in the trabecular meshwork with an ARGON laser. These laser burns facilitate the drainage of the aqueous humor. However, scarring of the trabecular meshwork occurs as a result of ALT burns and may limit its success and the ability to retreat the eye in the future, should the procedure need to be repeated. Selective Laser Trabeculoplasty (SLT) SLT is an advanced type of laser treatment to manage
patients with open-angle glaucoma. Instead of generally
burning tissue as in ALT, SLT selectively stimulates or changes only
specified pigmented cells to activate increased fluid
drainage.
Laser Irradiation Both SLT and ALT produce equivalent drops in IOP; however, the more gentle SLT procedure does not have the associated danger to other tissues and adverse scarring effects. For this reason, where ALT is limited, SLT may potentially be repeated. SLT has also been found to be effective when ALT and other forms of medical treatment have failed.
With SLT, selective targeting of pigmented cells (the orange cells at left) located in the trabecular meshwork stimulates an increase in the drainage of aqueous humor to control glaucoma.
Benefits of SLT
How SLT is performed SLT is usually performed in the office and only takes bout 15-20 minutes. Prior to the procedure, eye drops will be given to prepare the eye for treatment. The laser applications are made through a special microscope, similar to the one used for eye examination. About 2 hours of office time should be planned so the IOP can be checked after the eye is treated.
What should be expected after SLT treatment The IOP should drop significantly in as quickly as a day or more of having SLT performed. The doctor may treat the eye with anti-inflammatory eye drops that will be continued for 4-7 days after the procedure. Most patients will have to return for follow-up visits to recheck the treated eye. Unlike some glaucoma medications, there are no incidences of allergy or systemic side effects with SLT. Complications are minimal but may include inflammation temporary increase in IOP, conjunctivitis, or eye pain. For more information about SLT and how it may benefit you, please ask the doctor.
Endoscopic Cyclo Photocoagulation (ECP) ECP is a process that uses laser energy to control glaucoma. It is a fast outpatient procedure that can reduce or eliminate the need for expensive eye drops and give you freedom from the hassle of glaucoma medication. ECP has been shown to have a more lasting effect than ALT (ARGON Laser Trabeculoplasty) or SLT (Selective Laser Trabeculoplasty). ECP provides a surgical alternative that's both minimally invasive and very effective in helping control glaucoma and reduce or eliminate the need for eye drops. How does ECP work? ECP involves treating the ciliary body of the eye, which produces fluid, with a laser. The minimally invasive surgical procedure reduces the amount of fluid pressure in the eye. ECP is performed on an outpatient basis, so a hospital stay is not necessary. The procedure takes about 10 minutes and your doctor will check you eye pressure shortly after the procedure. Drops may be prescribed to treat soreness or swelling, and you will be instructed to go home and relax for the rest of the day. You may also receive oral medications to control inflammation. Follow-up visits are necessary to monitor your eye pressure, and it may take a few weeks to see the full effect of the ECP procedure. Most patients resume normal activities within a few days.
Does ECP have a proven track record? Generally a reimbursed procedure (coverage varies among federal, state, and private health plans), ECP has an 89% success rate with an extremely low percentage of complications compared to other surgeries to treat glaucoma. It is fast becoming the surgical treatment of choice for glaucoma patients. Remarkably, all forms of glaucoma respond to ECP with lasting results. Can ECP be performed with cataract surgery? Absolutely. Cataracts and glaucoma are serious conditions that can cause loss of vision. As people age, the possibility of cataract development or glaucoma diagnosis rises. In fact, many who are past age 60 have both. There are several options to treat cataracts and glaucoma separately, but ECP can treat both cataracts and glaucoma during the same surgery. Cataract procedures are highly successful, with more than 98% of patients reporting no complications. Likewise, ECP has an 89% success rate with an extremely low percentage of complications compared to other surgeries to treat glaucoma. If you are ready for clear, cloud-free vision without cataracts and are tired of the cost and the hassle of glaucoma medications, ask your doctor today about cataract surgery with ECP and see if it's right for you. Watch a video demonstrating ECP
YAG Peripheral Iridotomy (YAG PI)
A YAG laser peripheral iridotomy is performed almost exclusively for patients with narrow angles, narrow angle glaucoma, or acute angle closure glaucoma. Aqueous fluid is made in the ciliary body of the eye, which is anatomically situated behind the iris. The aqueous fluid primarily escapes the eye by flowing between the lens and iris of the eye, and then drains via the trabecular meshwork, which is located in the angle of the eye (where the front clear cornea meets the iris, essentially). If the flow of aqueous fluid to the drainage angle (trabecular meshwork) is obstructed by a forwardly bowed iris, the patient is said to have narrow angles. This condition may predispose one to an acute episode of angle closure glaucoma. If the angles are never acutely closed, but glaucoma is still present, the patient is diagnosed with narrow angle glaucoma. What is involved with a YAG PI?
A YAG PI involves creating a tiny opening in the peripheral iris, allowing aqueous fluid to flow from behind the iris directly to the anterior chamber of the eye. This typically results in resolution of the forwardly bowed iris and thereby an opening up of the angle of the eye. The narrow or closed angle thus becomes an open angle. What should you expect with YAG PI treatment?
The YAG PI is completed in the office. Prior to the procedure, the pupil is constricted with an eye medication known as Pilocarpine. The procedure itself is completed with the patient seated at the laser, and requires no sedation. After topical anesthesia eye drops are instilled, a lens is placed on the eye to better control the laser beam. The entire procedure takes only a few minutes. The lens is removed from the eye and vision will quickly return to normal.
Does a YAG PI hurt? The surface of the eye is numbed with topical anesthetics for this procedure, but the iris is not numbed. Therefore, when the laser beam hits the iris to create the peripheral iridotomy, mild discomfort may occur. In general, only a few very brief episodes of slight discomfort are associated with this procedure. Also, some patients temporarily experience a slight brow ache above the treated eye. However, generally there is no pain involved post-operatively.
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