The goal of treatment in glaucoma is to prevent visual loss. Reducing intraocular pressure (IOP) is, at this time, the most effective means of preventing visual loss from glaucoma. Once optic nerve damage and visual loss have occurred, there is no means to restore the lost sight. Therefore, it is essential to make every effort to keep the IOP in a healthy range, ideally under 18. This is accomplished with various treatments including eye drops or surgery.
Patients with signs of glaucoma are started on medications, most often eye drops, to control the pressure. Some drops work by reducing the amount of fluid being produced while others work on increasing the amount of fluid getting out of the eye. At times, two different medicated drops are used in combination to maximize pressure lowering. We hope someday to have medications that will help protect the optic nerve from damage or stimulate the optic nerve to regenerate. In the meantime, glaucoma drops are very effective though some patients develop side effects such as redness or irritation. Any side effects should be reported to your doctor.
There are patients who cannot use medications. Some have trouble putting the drops in the eye, others develop allergies to the drops and others simply do not achieve sufficient pressure lowering. In patients who are unable to use drops, glaucoma surgery is a very effective means of controlling IOP.
There are a number of surgical approaches to glaucoma. The approach depends on your type of glaucoma. Laser glaucoma surgery has been available since the 1980s. It is very safe and successful in certain types of glaucoma.
In some patients, the drainage system of the eye cannot manage the amount of fluid necessary to keep the eye functional. When medications and laser are ineffective, creating a more effective drainage system in the eye is recommended. One of the more traditional operations for glaucoma is TRABECULECTOMY. The procedure creates a tiny passageway from the inside to the outside of the eye to drain the fluid into a cyst or bleb under the upper eyelid.
More recently, a new procedure we have helped develop has replaced trabeculectomy for many patients is called CANALOPLASTY (iScience Interventional). In this operation, a microcatheter is placed in the drainage canal like a stent to re-open the system without creating an artificial passageway. This operation appears safer than trabeculectomy. Long term studies are underway to determine if it is also more effective. For more information, go to www.canaloplasty.com.
In some patients, the drainage system is completely closed. In these patients, we use a drainage device called an Ahmed implant (New World Medical) which uses a microscopic tube to bypass the closed channel.
The most recent surgical advancement is the Ex-PRESS® Glaucoma Filtration Device. It is a small stainless steel unit (similar in size to a grain of rice) and is typically used after medical and other surgical treatments have failed. The Ex-Press is implanted between the inner region and the outer region of the eye and allows for more controlled and consistent drainage of the aqueous humor, or fluid inside the eye, thus lowering the intraocular pressure of the eye to a healthy level. Often glaucoma medication is not needed following recovery from the procedure.
Our goal in each of these procedures is to lower and control the IOP for many years. Unfortunately, none of our therapies are a “cure”. However, if we keep the IOP under control and prevent visual loss, we hope to see further research to enhance our therapy.