Glaucoma surgery

What is glaucoma?

Glaucoma is the leading cause of blindness in the United States, although loss of vision from glaucoma is largely preventable with early detection and treatment. Although glaucoma can occur in infants and children, it is most common in adults and becomes increasingly common as we age. Risk factors for glaucoma include African American race, myopia (nearsightedness) and hyperopia (farsightedness), and a family history of glaucoma. Glaucoma is a chronic condition in which there is damage to the optic nerve, typically caused by elevated intraocular pressure, which leads to a progressive loss of peripheral vision. This may ultimately lead to blindness.

Many patients who have glaucoma have elevated intraocular pressure (pressure inside the eye), and current treatments aim to slow the progression of glaucoma by lowering intraocular pressure. Glaucoma is not curable but it is treatable with topical drops, laser and/or surgery if needed.

There are several types of glaucoma including open angle and closed angle. In open angle glaucoma, the natural drainage structures in the eye are dysfunctional, leading to a buildup of fluid and elevated intraocular pressure which leads to gradual loss of vision. Open angle glaucoma can be treated with a combination of medications, laser and/or surgery.

In closed angle glaucoma the drainage structures are closed, which can lead to acute angle closure in which there is a sudden and painful elevation of pressure which must be treated immediately to prevent loss of vision; or chronic angle closure in which the process is gradual much like open angle glaucoma. Both are treated with a combination of laser, medication and/or surgery. Patients with an anatomically narrow angle are at risk for angle closure glaucoma.

How is glaucoma treated?

Eye Drops

Glaucoma is often treated with topical drops that lower intraocular pressure by either increasing fluid drainage from the eye or decreasing fluid production.

Laser Treatment

Selective Laser Trabeculoplasty (SLT) is a common alternative or adjunct to topical therapy for glaucoma. In SLT, laser energy is directed at the drainage structures of the eye where it is absorbed by melanin. This elicits a localized inflammatory response which in turn allows the natural drain to function more efficiently to lower the eye pressure.

If your doctor detects a component of anatomically narrow angles or angle closure, laser iridotomy may be indicated. In this procedure, laser energy is used to create an opening through the iris in order to open the angle and prevent or treat angle closure glaucoma.

Surgical Therapy Options

When topical therapy and laser therapy are not effective in lowering intraocular pressure, surgery may be recommended. Our glaucoma-trained physicians specialize in the latest, state-of-the-art glaucoma surgical procedures. The principle behind most glaucoma surgery is to lower intraocular pressure by bypassing or enhancing the eye’s own native drainage system to allow fluid to leave the eye in a controlled fashion.

Trabeculectomy

Trabeculectomy is the most common procedure performed for glaucoma. It involves creating a tiny flap or trap door on the white of the eye that is hidden by the upper eyelid. Fluid flows from underneath this flap in a controlled fashion so that intraocular pressure is maintained at a lower level. Trabeculectomy is very effective in lowering intraocular pressure, often without the need for medications. The most common problem encountered following trabeculectomy is the development of scar tissue which can cause the flap to heal and cease working. Anti-scarring agents such as mitomycin C and are now routinely used to improve the outcome of trabeculectomy.

Glaucoma drainage device

In certain types of glaucoma, trabeculectomy has decreased effectiveness due to the propensity for scar tissue formation. In these cases, and in cases in which trabeculectomy has failed, implantation of a glaucoma device or “tube” can bypass the scar tissue. Our doctors have extensive experience with the latest glaucoma devices.

Minimally Invasive Glaucoma Surgery (MIGS)

One of the most exciting advancements in glaucoma therapy is the introduction of newer minimally invasive glaucoma surgeries (MIGS). These techniques include iStent, Trabectome, goniotomy and Visco360. These newer techniques may lower intraocular pressure by augmenting the eyes natural drainage system and may have faster healing times and lower risk when compared to traditional filtration procedures.

Our glaucoma-trained physicians have been abreast of the latest developments in glaucoma surgery and are committed to offering our patients the most advanced surgical options. Please speak with your doctor to determine the best treatment for you.