The glaucoma specialists at Carolina Eye Associates diagnose and treat glaucoma, a disease that damages the optic nerve of the eye and can lead to blindness if left untreated. It usually happens when fluid builds up in the front part of your eye. The extra fluid increases the pressure in your eye [this is known as intraocular pressure (IOP)] which damages the optic nerve.
The goal of glaucoma treatment and surgery at Carolina Eye Associates is to reduce eye pressure. Depending on the type of glaucoma you have, this is done using medications or surgery. The glaucoma specialists at Carolina Eye Associates offer the following treatment options:
- Medication Treatment (eyedrops and oral medications)
- Laser Therapy
- Selective Laser Trabeculoplasty (SLT)
- Laser Peripheral Iridotomy (LPI)
- Laser Cyclophotocoagulation
- Drainage Implant Surgery
- Minimally Invasive Glaucoma Surgery (MIGS)
- Cataract Surgery
Glaucoma is usually one of two types: primary open-angle glaucoma or closed-angle glaucoma.
Because chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, be aware of these risk factors:
- High intraocular pressure
- Over age 60
- Race (black or Hispanic)
- Family history of glaucoma
Primary open-angle glaucoma (POAG) is the most common form of the disease. The drainage angle formed by the cornea and iris remains open, but the trabecular meshwork is partially blocked. This causes pressure in the eye to gradually increase. This pressure damages the optic nerve. It happens so slowly that you may lose vision before you’re even aware of a problem.
With primary open-angle glaucoma, the most common treatment option are eye drops. Eye drops are usually prescribed to help lower eye pressure. Laser treatment (SLT) is also an effective and safe option for those who prefer to not use eye drops. If eye drops or SLT are not helping, other forms of treatment will be considered. These include alternative laser treatments or glaucoma surgery.
Closed angle glaucoma (also called acute angle-closure glaucoma or narrow-angle glaucoma) occurs when the iris bulges forward to narrow or block the drainage angle formed by the cornea and iris. As a result, fluid can’t escape the eye and pressure increases. Some people have narrow drainage angles, putting them at increased risk of angle-closure glaucoma. When the drainage angle is completely blocked, your eye pressure rises very quickly. This is known as an “acute attack”. Signs and symptoms can include:
- Sudden blurry vision
- Severe eye pain
- Around lights you see rainbow-colored rings or halos
This can lead to blindness if not treated quickly.
Treatment for glaucoma is aimed at either decreasing the amount of aqueous humor the eye produces or increasing the amount drained from the eye. This is usually accomplished with eye drops that need to be used daily.
Other treatment options include laser therapy and various surgical procedures. These treatment techniques are intended to improve the drainage of fluid within the eye, thereby lowering pressure.
There are several types of laser surgery used to treat glaucoma. The type of laser surgery will depend on the form of glaucoma and how severe it is. Lasers produce a focused beam of light that can make a very small burn or opening in your eye tissue, depending on the strength of the light beam
Selective Laser Trabeculoplasty (SLT)
For the treatment of primary open-angle glaucoma (POAG). SLT uses a laser that works at very low levels. It treats specific cells “selectively,” leaving untreated portions of the trabecular meshwork intact. For this reason, SLT may be safely repeated. SLT is currently one of the safest options for treating increased intra-ocular pressure and recent data shows that it is effective as and more affordable than most eye drops.
Laser Peripheral Iridotomy (LPI)
For the treatment of narrow angles and angle-closure glaucoma. LPI makes a small hole in the iris, allowing it to fall back from the fluid channel and helping the fluid drain out of the eye.
An alternative to filtering microsurgery that is typically used later in the treatment plan. Several different types of lasers can be used to hamper the ciliary body’s ability to make fluid and, thus, lower the eye pressure. The procedure may need to be repeated in order to permanently control glaucoma.
A surgical procedure where your surgeon creates an opening in the white of the eye (sclera) and removes part of the trabecular meshwork. This helps the extra fluid drain out. You may need to take some medicine along with this surgery so scar tissue doesn’t form.
Drainage Implant Surgery
In this procedure, your eye surgeon inserts a small tube shunt in your eye to drain away excess fluid to lower your eye pressure. Now there are minimally invasive implants.
Minimally Invasive Glaucoma Surgery (MIGS)
MIGS procedures work by using microscopic-sized equipment and tiny incisions. These procedures generally require less immediate post-op care and have less risk than trabeculectomy or drainage device. They are often combined with cataract surgery.
- Miniaturized versions of trabeculectomy
- Trabecular bypass operations
- Milder, gentler versions of laser photocoagulation
Using tiny, microscopic-sized tubes that can be inserted into the eye and drain fluid from inside the eye to underneath the outer membrane of the eye (conjunctiva), these new devices make the trabeculectomy operation safer. These devices such as the Xen Gel Stent, have shown excellent pressure lowering with improved safety over trabeculectomy.
Most of the obstruction to fluid drainage from the eye occurs because of resistance in the trabecular meshwork. Several operations have been devised using tiny equipment and devices to cut through the trabecular meshwork without damaging any other tissues in the ocular drainage pathway. Using a special contact lens on the eye, a tiny device is inserted into the eye through a tiny incision into the trabecular meshwork under high power microscopic control. The trabecular meshwork can either be physically opened (goniotomy) or bypassed using a tiny device (iStent and Hydrus stent).
In the past, laser cyclophotocoagulation was used for advanced glaucoma that could not be controlled despite trabeculectomy or tube shunts. The procedures were designed to reduce the fluid-forming capacity of the eye by targeting the delicate tissue (ciliary body) that makes the fluid. They sometimes produced severe inflammation that could reduce vision. Two micro-invasive technologies have proven useful even before the glaucoma is far advanced. These are endoscopic cyclophotocoagulation and micropulse cyclophotocoagulation.
This is often overlooked and not included in a discussion of glaucoma management, but studies have repeatedly shown that cataract surgery lowers the pressure inside the eye. Depending on the anatomy of the eye, cataract surgery may be the only glaucoma surgery that a patient needs; on the other hand, it is often combined with one of the other surgeries listed above to augment the amount of pressure-lowering that can be achieved.