Our very own Dr. Anjali S. Hawkins recently published an article on Glaucoma Treatment Options for the Kane County Medical Society’s Medical Resource Guide. Published on National Doctor’s Day, March 30, 2016, we’d like to summarize this valuable information with you.
Glaucoma, while it is a term we all might have heard before, most likely, we don’t know much about the disease and how it can affect us or a loved one. Actually, glaucoma is a chronic disease of the optic nerve that can lead to loss of peripheral vision and eventually blindness if left untreated.
There are many risk factors for developing glaucoma, including older age, female gender, African American and Hispanic race and elevated intraocular pressure (IOP). The most significant risk factor is high IOP. A number of large clinical studies have proven that with the reduction of IOP, progressive damage to the optic nerve and vision loss can be slowed.
Eye drops are the main medicines for glaucoma and work by either reducing the amount of aqueous humor (fluid that the eye produces) or by increasing the outflow of the eye fluid. The goal is to decrease the fluid buildup in the eye to reduce IOP, however, some patients will require laser and/or incisional surgery to further lower their IOP.
Selective laser trabeculoplasty (SLT) is a laser surgery performed in the office that takes only a few minutes and very effective. The two main incisional surgeries, trabeculectomy and drainage implants, are invasive surgeries that carry significant risks such as infection, bleeding and hypotony (IOP that too low for the eye to maintain its shape). Due to these risks, the surgeries are generally reserved for moderate to advanced glaucomatous eyes.
Newer technologies, called MIGS (minimally invasive glaucoma surgeries) have been developed with significantly fewer risks. They are considered less effective in reducing IOP and are therefore, reserved for eyes that have mild to moderate glaucomatous damage. Many MIGS are performed during cataract surgery. One such surgery is called iStent Trabecular Micro-Bypass (Glaukos). A small, titanium stent is placed in the trabecular meshwork to increase the outflow of aqueous fluid which then reduces the IOP. If successful, patients may be able to reduce the number of glaucoma eye drop needed.
Another treatment device is called the Trabectome (NeoMedix)—a thermal cautery device that can ablate some of the trabecular meshwork. This device literally burns some of the drainage tissue that is not functional in glaucomatous eyes. This can also be performed during cataract surgery using the same incision and helping to lower IOP and decrease the number of glaucoma drops.
Finally, new ways to deliver glaucoma medicines are currently being produced. For example, we may be able to inject glaucoma medicine into the eye to last 30-90 days so patients don’t have to remember to use their daily drops. This advancement will provide even more options for opthalmologists to treat glaucoma and minimize vision loss due to high eye pressure.