Glaucoma is one of the leading causes of blindness worldwide. It is estimated to affect more than 60 million patients around the globe, with the number of affected patients set to rise considerably in coming years as the world population ages. In the United States alone, approximately 2.7 million people have glaucoma. It is a progressive disease of the optic nerve, usually associated with elevation of the intraocular pressure, that can lead to blindness if untreated. Patients must be monitored closely to ensure they are receiving the most appropriate treatment. This requires extensive cooperation between the physician and the patient. At the Boland Eye Center, it is our belief that knowing our patients well and understanding them as individuals is a key component in the treatment of Glaucoma. Patients with Glaucoma need a personalized treatment plan and follow-up schedule, and no two patients are the same. We use state-of-the-art equipment that helps our doctors diagnose Glaucoma earlier to improve the chances of preserving vision. This equipment, combined with years of knowledge and experience, allows our doctors to select the most appropriate medical or surgical treatment to slow the progression of Glaucoma. Our office is equipped with, among other things, a Heidelberg SD-OCT, a Humphrey Visual Field Analyzer, an Ultrasonic Pachymeter, and a Digital Fundus camera. All of these instruments provide important pieces in the puzzle that is Glaucoma diagnosis and treatment.
First line, or initial, treatments for glaucoma include Selective Laser Trabeculoplasty (SLT) and prescription eye drops. SLT is done in the office and works by making the eye more effective at controlling the pressure. Specifically, SLT treats the part of the eye that is responsible for draining the fluid that creates pressure in the eye in the first place. By applying laser to that structure, the anatomy of the eye is altered enough to improve its efficiency at regulating fluid outflow. This procedure is not painful and does not restrict patient's activities. It can also be repeated in the future if necessary. It is usually a more economical way of treating glaucoma compared to medications.
Today, there are multiple medications used in the treatment of Glaucoma. The goal of Glaucoma treatment is to reduce the Intraocular Pressure (IOP) of the eyes. Most medications used to treat Glaucoma are topical medications, namely eye drops. Eye drops can be very effective in controlling the IOP of patients with Glaucoma. Several families of medication exist that reduce IOP. The most widely prescribed family of drops is the Prostaglandin Analogs, which includes the medications Lumigan, Travatan Z, and Xalatan. These medications have a significant impact on IOP with very few side effects. The most common side effects of the Prostaglandin Analogs are redness of the eyes and the thickening and lengthening of the eyelashes. Another family of drops is the Beta-Blockers. This class of drops includes the brands Timoptic, Betimol, and Istalol. These medications also have a significant impact on IOP but have the potential for more side effects. Side effects of Beta-Blockers may include Bradycardia and respiratory distress. These medications must be closely monitored by the doctor to ensure safe usage. Two more families of eye drops are the Alpha-Agonists and Carbonic Anhydrase Inhibitors. These classes are represented by the brands Alphagan P and Azopt or Trusopt, respectively. These drops are often used in conjunction with other drops to lower the IOP. Finally, there are drops that combine medication from two classes in one drop. These include Combigan, Cosopt, and Simbrinza.
Not all Glaucoma can be treated the same way. One type of Glaucoma is known as Narrow-Angle Glaucoma. In this type of Glaucoma, damage can occur very quickly, and can sometimes even be painful. Narrow Angle Glaucoma occurs when the anatomy of the eye begins to block access to the drainage structure responsible for regulating eye pressure. If the drain becomes completely blocked, a condition known as angle closure, the Intraocular Pressure (IOP) can spike upward and extensive damage or even blindness can result. This change in anatomy can only be seen during an eye exam using a special lens in a technique known as Gonioscopy. This condition has a genetic predisposition, so immediate family members of patients with Narrow Angle Glaucoma should be checked as well. If a patient is found to have narrow angles that could lead to angle closure, a procedure known as a Laser Peripheral Iridotomy (LPI) should be performed. In this procedure, a laser is used in the office to create a shortcut for the fluid in the eye to reach the drainage structure in the case of angle closure. This procedure permanently removes the risk of angle closure, but does not keep the patient from developing Glaucoma. Patients who have undergone a Laser Peripheral Iridotomy will continue to need regular eye exams to check for potential glaucomatous changes.
Glaucoma, if unresponsive to eye drops and laser treatments, can be treated surgically with a procedure called a Trabeculectomy. In this surgery, a reservoir for the fluid inside the eye, called a Filtration Bleb, is created on the outside surface of the eye. This reservoir allows the blood vessels of the eye to help absorb the fluid since the structure inside the eye normally meant to disperse the fluid is not working well enough.