GLAUCOMA SURGERIES

GLAUCOMA

Glaucoma is a leading cause of blindness for people over 60 years old. However, blindness from glaucoma can often be prevented with early treatment.

What is the Main Cause of Glaucoma

Your eye constantly makes aqueous humor. As new aqueous flows into your eye, the same amount should drain out. The fluid drains out through an area called the drainage angle. This process keeps pressure in the eye, called intraocular pressure or IOP, stable. But if the drainage angle is not working properly, fluid builds up, the pressure inside the eye rises, and this damages the optic nerve. If the drainage angle is blocked, fluid cannot flow out of the eye, causing pressure to increase. The optic nerve is made of more than a million tiny nerve fibers. It is like an electric cable made up of many small wires. As these nerve fibers die, you will develop blind spots in your vision. You may not notice these blind spots until most of your optic nerve fibers have died. If all of the fibers die, you will become blind.

How Do You Get Glaucoma

There are two major types of glaucoma.

Open-Angle Glaucoma
This is the most common type of glaucoma. It happens gradually, where the eye does not drain fluid as well as it should (like a clogged drain). As a result, eye pressure builds and starts to damage the optic nerve. This type of glaucoma is painless and causes no vision changes at first. Most people with open-angle glaucoma do not notice any change in their vision until the damage is quite severe. This is why open-angle glaucoma is called the “silent thief of sight.” Having regular eye exams can help. Some people can have optic nerves that are sensitive to normal eye pressure (normotensive or low-tensive glaucoma). This means their risk of getting glaucoma is higher than normal. Regular eye exams are important to find early signs of damage to the optic nerve.

Angle-Closure Glaucoma (also called “closed-angle glaucoma” or “narrow-angle glaucoma”)
This type happens when someone’s iris is very close to the drainage angle in their eye. The iris can end up blocking the drainage angle. You can think of it like a piece of paper sliding over a sink drain. When the drainage angle gets completely blocked, eye pressure rises very quickly. This is called an acute attack. It is a true eye emergency, and you should call your ophthalmologist right away, or you might go blind.

Here are the signs of an acute angle-closure glaucoma attack:

• Your vision is suddenly blurry
• You have severe eye pain
• You have a severe headache
• You have a severely congested red-eye
• You feel sick to your stomach (nausea)
• You throw up (vomit)
• You see rainbow-colored rings or halos around lights

Many people with angle-closure glaucoma develop it slowly. This is called chronic angle-closure glaucoma. There are no symptoms at first, so they don’t know they have it until the damage is severe or they have an attack. Angle-closure glaucoma can cause blindness if not treated right away.

Normal-Tension Glaucoma Symptoms
People with normal-tension glaucoma have eye pressure that is within normal ranges but show signs of glaucoma, such as blind spots in their field of vision and optic nerve damage.

Do Glaucoma Suspects Have Symptoms?
Some people have no signs of damage but have higher than normal eye pressure called ocular hypertension. These patients are considered “glaucoma suspects” and have a higher risk of eventually developing glaucoma. Some people are considered glaucoma suspects even if their eye pressure is normal. For example, their ophthalmologist may notice something different about their optic nerve. Most glaucoma suspects have no symptoms. That is why you need to be carefully monitored by your ophthalmologist if you are a glaucoma suspect. An ophthalmologist can check for any changes over time and begin treatment if needed.

Pigment Dispersion Syndrome and Pigmentary Glaucoma Symptoms
Pigment dispersion syndrome (PDS) happens when the pigment rubs off the back of your iris. This pigment can raise eye pressure and lead to pigmentary glaucoma. Some people with PDS or pigmentary glaucoma may see halos or have blurry vision after activities like jogging or playing basketball. See your ophthalmologist if you have these or other symptoms.

Who Is at Risk for Glaucoma

Some people have a higher-than-normal risk of getting glaucoma. This includes people who:

• Are over age 40
• Have family members with glaucoma
• Are of African, Hispanic, or Asian heritage
• Have high eye pressure
• Are farsighted or nearsighted
• Have had an eye injury
• Use long-term steroid medications
• Have corneas that are thin in the center
• Have thinning of the optic nerve
• Have diabetes, migraines, high blood pressure, poor blood circulation, or other health problems affecting the whole body

Talk with an ophthalmologist about your risk of getting glaucoma. People with more than one of these risk factors have an even higher risk of glaucoma.

Glaucoma Diagnosis

The only sure way to diagnose glaucoma is with a complete eye exam. A glaucoma screening that only checks eye pressure is not enough to find glaucoma. During a glaucoma exam, your ophthalmologist will:

• Measure your eye pressure
• Inspect your eye’s drainage angle
• Examine your optic nerve for damage
• Test your peripheral (side) vision (field of vision)
• Take a picture or computer measurement of your optic nerve (OCT)
• Measure the thickness of your cornea (pachymetry)

Glaucoma is a silent thief of sight. Glaucoma has no symptoms in its early stages. Half the people with glaucoma do not know they have it! Having regular eye exams can help your ophthalmologist find this disease before you lose vision. Your ophthalmologist can tell you how often you should be examined.

Can Glaucoma Be Stopped

Glaucoma damage is permanent; it cannot be reversed. But medicine and surgery help to stop further damage. To treat glaucoma, your ophthalmologist may use one or more of the following treatments:

Medication
Glaucoma is usually controlled with eye drop medicine. Used every day, these eye drops lower eye pressure. Some do this by reducing the amount of aqueous fluid the eye makes. Others reduce pressure by helping fluid flow better through the drainage angle. Glaucoma medications can help you keep your vision, but they may also produce side effects. Some eye drops may cause:

• A stinging or itching sensation
• Red eyes or red skin around the eyes
• Changes in your pulse and heartbeat
• Changes in your energy level
• Changes in breathing (especially if you have asthma or breathing problems)
• Dry mouth
• Blurred vision
• Eyelash growth
• Changes in your eye color, the skin around your eyes, or eyelid appearance

All medications can have side effects. Some drugs can cause problems when taken with other medications. It is important to give your doctor a list of every medicine you take regularly. Be sure to talk with your ophthalmologist if you think you may have side effects from glaucoma medicine.

Never change or stop taking your glaucoma medications without talking to your ophthalmologist. If you are about to run out of your medication, ask your ophthalmologist if you should have your prescription refilled.

Laser Surgery

There are two main types of laser surgery to treat glaucoma. They help aqueous drain from the eye. These procedures are usually done in the ophthalmologist’s office or an outpatient surgery center.

Trabeculoplasty. This surgery is for people who have open-angle glaucoma and can be used instead of or in addition to medications. The eye surgeon uses a laser to make the drainage angle work better. That way, fluid flows out properly, and eye pressure is reduced.

Iridotomy. This is for people who have angle-closure glaucoma. The ophthalmologist uses a laser to create a tiny hole in the iris. This hole helps fluid flow to the drainage angle.

Operating Room Surgery

Some glaucoma surgery is done in an operating room. It creates a new drainage channel for the aqueous humor to leave the eye.

Trabeculectomy. This is where your eye surgeon creates a tiny flap in the sclera. They will also create a bubble (like a pocket) in the conjunctiva called a filtration bleb. It is usually hidden under the upper eyelid and cannot be seen. Aqueous humor will be able to drain out of the eye through the flap and into the bleb, lowering eye pressure. In the bleb, the fluid is absorbed by the tissue around your eye.

In trabeculectomy, a flap is first created in the sclera (the white part of the eye). Then a small opening is made into the eye to release fluid from the eye.

Glaucoma Drainage Devices. Your ophthalmologist may implant a tiny drainage tube in your eye. The glaucoma drainage implant sends the fluid to a collection area (called a reservoir). Your eye surgeon creates this reservoir beneath the conjunctiva. The fluid is then absorbed into nearby blood vessels.

Cataract Surgery. For some people with narrow angles, removing the eye’s natural lens can lower eye pressure. With narrow angles, the iris and the cornea are too close together. This can cover (block) the eye’s drainage channel. Removing the eye’s lens with cataract surgery creates more space for fluid to leave the eye. This can lower eye pressure.

Your Role in Glaucoma Treatment

Treating glaucoma successfully is a team effort between you and your doctor. Your ophthalmologist will prescribe your glaucoma treatment. It is up to you to follow your doctor’s instructions and use eye drops. Once you are taking medications for glaucoma, your ophthalmologist will want to see you regularly. You can expect to visit your ophthalmologist about every 3-6 months. However, this can vary depending on your treatment needs.

If you have any questions about your eyes or your treatment, talk to your ophthalmologist.