Glaucoma

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The eye can be compared to a camera. The eye lens is found behind the iris and the pupil. The lens focuses the light back toward the retina and the image is recorded there. Once the image is recorded, the image information is sent to the brain through the optic nerve. The optic nerve connects the eye to the brain in the same way that a computer cable connects a digital camera to a computer to transfer images. If a person has glaucoma, the lens and retina operate normally; however, the optic nerve does not and images are not properly transferred to the brain.

It is estimated that almost 3 million people in the US, over the age of 40, are affected by glaucoma. Glaucoma is the leading cause of blindness, accounting for around 10% of all cases of blindness in the US. Glaucoma is a progressive disease and is incurable. This condition can cause irreversible blindness. Early detection and treatment are the best defense against permanent vision loss due to glaucoma.

Glaucoma can happen slowly; sometimes people are not aware that they have it until a significant amount of vision loss. Everyone is at risk for glaucoma and there may be no warning symptoms. Early detection and watchful, lifelong treatment can preserve vision in most people affected by glaucoma.

In the healthy eye, fluid called aqueous humour is made in the front of the eye and flows out through a tiny drain called the trabecular meshwork. The trabecular meshwork is located in an area called the drainage angle. If fluid does not flow out of the drainage angle properly, eye pressure increases and damages the optic nerve.

Closed Angle Glaucoma. If the drainage angle is too narrow for fluid to flow out of the eye properly, pressure increases. Eventually the pathway for fluid to flow out of they eye may become completely blocked.

Types Of Glaucoma

Primary Open-Angle Glaucoma (POAG)

Open-angle glaucoma, the most common form of the disease, occurs when the eye’s drainage canals become clogged over time, resulting in increased eye pressure that causes damage to the eye’s optic nerve.

Normal Tension Glaucoma

Known also as low-tension glaucoma, characteristics of normal-tension glaucoma include progressive optic nerve as well as visual field loss, often with normal intraocular pressure. This type of glaucoma is thought to be associated, in part, to poor blood flow to the optic nerve.

Acute Glaucoma

Acute glaucoma does not come on slowly, over time, like primary open-angle glaucoma. In acute glaucoma, the pressure in the eyes increases suddenly; this can happen within hours and is often very painful. An acute attack is an emergency situation because damage to the optic nerve may happen quickly and cause permanent vision damage.

Other types of glaucoma:

Angle-Closure Glaucoma
Pigmentary Glaucoma
Trauma-Related Glaucoma
Childhood Glaucoma
Neovascular Glaucoma
Pseudoexfoliative Glaucoma
Uveitic Glaucoma

Glaucoma Treatment Options

Treatment options for glaucoma include eye drops, pills, laser surgery, traditional surgery or a combination of these methods. When treating glaucoma, the goal is to prevent vision loss, as the disease is progressive and vision loss from glaucoma is irreversible. When glaucoma is detected early, it is drastically more manageable; and with proper medical treatment, most people will not lose their sight.

There are many medications that can be prescribed to prevent vision-threatening damage. Discussing all of the potential side effects and finding the right treatment or combination of treatments for each patient, the doctors at Community Eye Center work as a team with their patients in the battle against glaucoma.

Surgical Glaucoma Treatment Options. If medications alone do not achieve the desired results or have intolerable side effects, our doctors may suggest surgery for glaucoma management.

Trabecular Bypass Stent Surgery. To implant a trabecular bypass stent, your ophthalmologist will create a small incision in your cornea. Then he or she will place a stent, which looks like a tiny tube, into part of the eye’s drainage system. The stent allows fluid to bypass an area that is not draining efficiently. This reduces eye pressure.

Laser Trabeculoplasty. With laser trabeculoplasty, your surgeon will put a special contact lens on your eye. This helps focus and deliver the light from the laser to the precise location. The surgeon applies the low energy laser to the area called the trabecular meshwork; this is where fluid naturally drains from the eye. The laser causes microscopic changes in the eye’s tissue allowing fluid to drain better, reducing eye pressure.

Implant Surgery. In glaucoma implant surgery, the drainage implant is usually placed in the area under either the upper or lower eyelid. Your ophthalmologist will stitch the implant to the sclera, the white part of your eye. Your ophthalmologist may cover the tube of the implant with a patch. Fluid will drain out to the area around the implant. A tiny tube is attached to the drainage implant and inserted into the front chamber of the eye, usually just in front of the iris. The tube sends fluid from the inside of the eye to the implant where it is absorbed into the body.

Laser Iridotomy. With laser iridotomy, the ophthalmologist uses a focused beam of light to create a tiny opening about the size of a pinhead in the iris; this opening allows trapped fluid behind the iris to flow into the front of the eye, usually reducing pressure. A laser iridotomy is an important way to treat or prevent a sudden rise in eye pressure that can seriously affect your eyesight.

Mini Filtration Implants. In mini filtration implant surgery, your ophthalmologist will create a small flap underneath the upper eyelid in the sclera, the white part of your eye. Then he or she will implant a tiny drainage device under the flap. This device is called a mini shunt, which opens a pathway for fluid to drain from inside the eye. The fluid collects in an area around the implant caused a filtering bleb, where it is gradually absorbed into the body.

Trabeculectomy. During trabeculectomy surgery, your ophthalmologist makes a tiny incision in the conjunctiva, the clear lining over the sclera (or the white part of the eye); this is done under your upper eyelid and near the edge of the iris. Next, he or she will create a small flap in the sclera underneath the incision. Then, a tiny piece of tissue is removed under the flap to make an opening into the eye. A small piece of the iris may also be removed to keep it from blocking the opening. This opening serves as a new channel for fluid to drain gradually from the eye, reducing pressure. The flap is sewn back into place with tiny stitches, which help guard against too much fluid draining out at once. The area where the fluid drains from the trabeculectomy is called a filtering bleb. As fluid filters out of the eye and into the bleb, it looks like a bubble. Because the bleb is under the eyelid, it is not usually visible.