Glaucoma is an eye disorder associated with elevated intraocular pressure (IOP) as a result of inadequate fluid (aqueous humor) drainage within the eye. Increased IOP causes irreversible damage to the optic nerve, which is responsible for transmitting visual images to the brain. When left untreated, glaucoma leads to gradual loss of peripheral vision and, in severe cases, may cause blindness. With early diagnosis and effective glaucoma treatment, functional vision may be preserved.
There are several types of glaucoma, including:
- Chronic (primary open-angle) glaucoma – the most common type of progressive glaucoma, characterized by gradual loss of vision.
- Acute (angle-closure) glaucoma – Sudden and extremely painful onset of glaucoma, characterized by nausea, headaches, vomiting and loss of vision. Immediate medical intervention is vital to preserving the patient's vision.
- Secondary glaucoma – this type of glaucoma is caused by systematic diseases, including diabetes, as well as physical eye injury or certain medications such as steroids.
- Congenital glaucoma – a rare type of glaucoma present at birth.
Although the cause of glaucoma remains unknown, patients with certain risk factors are more likely to develop the condition. The most common risk factors for glaucoma include:
- Age (patients 60 or older face increased risk)
- Family history of glaucoma
- Steroid use
- Physical eye injury
- Asian or African-American descent
The best way to detect early signs of glaucoma is through routine eye exams, during which a tonometer or another type of diagnostic technology is used to measure the internal pressure of the eye.
Glaucoma Treatment Options
There is no cure for glaucoma. The goal of treatment is to preserve the patient's remaining, functional vision by ensuring proper fluid drainage, thereby lowering the intraocular pressure. In mild cases, glaucoma can be managed through medicated eye drops and/or oral medication. If these treatments fail, glaucoma surgery may be required.
Glaucoma Surgery at Island Eye
Island Eye Surgicenter is equipped with the latest surgical technologies and lasers for effective glaucoma treatments, which include:
- Filtering Valve Procedures
- SLT Laser Treatment
- Peripheral Iridectomy Laser Treatment
- ECP Laser Treatment
The goal of glaucoma surgery is to lower the vision-threatening pressure within the eye by either decreasing the production of intraocular fluid or increasing the outflow (drainage) of the fluid.
Trabeculectomy (filtration surgery) is the most common type of glaucoma surgery to releave high pressure within the eye by ensuring proper fluid drainage. During the procedure, a piece of tissue in the drainage angle of the eye is removed to create a new opening. The opening is partially covered with a flap of tissue from the sclera (white part of the eye) and the conjunctiva (clear tissue covering the sclera). The new opening allows proper fluid drainage by bypassing the trabecular meshwork (a group of tiny channels responsible for fluid drainage), which has become clogged in some patients with glaucoma. After the procedure, as the fluid drains through the new opening, it creates a bubble known as a bleb. By observing the bleb during routine office visits, the eye care physician is able to tell whether the fluid is draining properly.
Filtering Valve Procedures
Filtering valve procedures are generally performed only after a failed trabeculectomy. This surgery involves the surgical placement of a valve and tube-like device to ensure proper fluid drainage within the eye. First, a device is placed in the eye's orbit against the sclera and sutured in place. A tube is then inserted into the front of the eye to channel fluid into the valve. The tube and the valve are also secured with small sutures located within the conjunctiva. In addition, a small patch of donor sclera may be placed over the tube for protection. Filtering valve procedures are performed on an outpatient basis and may last anywhere from 30 to 90 minutes. Patients generally recover within a few days but are routinely monitored by their eye care physician.
The success rate for filtering valve procedures is approximately 80 percent.
Glaucoma Laser Surgery at Island Eye
SLT (Selective Laser Trabeculoplasty)
SLT is a leading laser treatment that safely and effectively reduces intraocular pressure, often in a single office visit. The physicians at the Island Eye Surgicenter perform SLT with the state-of-the-art Lumenis Selecta Duet laser. During the procedure, the wavelengths emitted by the Lumenis Selecta Duet laser are absorbed by melanin to selectively target pigmented cells while preserving the surrounding tissue. This triggers the eye's trabecular meshwork to stimulate the body's natural mechanism to increase the flow of aqueous humor, thereby enhancing fluid drainage, which in turn lowers the IOP.
Learn more about the Lumenis Selecta Duet laser.
Peripheral Iridectomy Laser Treatment
Peripheral iridectomy is an advanced procedure that involves surgically removing a small, full-thickness piece of the iris to allow improved fluid drainage. The procedure is performed with the leading-edge Nidek YC-1800 Ophthalmic Yag laser. Peripheral iridectomy is performed on an outpatient basis under local anesthesia and is most often used for effective treatment of closed-angle glaucoma or melanoma of the iris.
Learn more about the Nidek YC-1800 Ophthalmic Yag laser.
ECP (Endoscopic CycloPhotocoagulation)
The ECP device, known as a laser microendoscope, combines micro-optical technology with fiber-optic imaging and high-resolution cameras for highly efficient, small-incision surgery. This device, among the smallest endoscopes used in medicine today, enables eye surgeons to treat ciliary processes, which were previously impossible to detect with a naked eye or other types of medical equipment.
Learn more about the Endo Optiks ECP laser.
Your Island Eye attending physician will help you decide which treatment option is best for your unique situation. If you do not have an eye doctor, please use our Physician Locator to get in touch with a glaucoma specialist near you.