Glaucoma Treatments
Glaucoma
Glaucoma is a condition in which the eye (or intraocular) pressure is too high, and this can cause damage to the optic nerve, which can result in a loss of peripheral vision. If untreated, the loss of vision can extend to involve loss of central vision too.
-
In most cases there is no specific cause of the raised intraocular pressure and can be considered to be due to an imbalance between how much aqueous fluid is produced by, and drains from the eye. Glaucoma is more common in people who have a family history of glaucoma, are short-sighted, diabetic or have high blood pressure. Glaucoma can sometimes also be caused by inflammation within the eye or injury to the eye.
-
In a rarer type of the condition, known as acute glaucoma, symptoms can come on quite rapidly with a sudden rise in intraocular pressure causing blurred vision, eye pain, headache and nausea. In the event of this happening, emergency medical care is required. This type of glaucoma can be prevented with a laser procedure called Laser Iridotomy.
-
As they are no immediate symptoms, it is easy for glaucoma to go unnoticed if you do not get regular eye tests. To avoid this, ensure you always attend your optician’s appointment at least every 2 years.
If your optometrist detects glaucoma during a routine check-up, you may have to go through further tests before being referred to an ophthalmologist, such as Mr Sundaram, for diagnosis and treatment.
-
The main aim of glaucoma treatment is to reduce the intraocular pressure in the eye. In most cases, this can be achieved by using eye drops or a laser procedure called Selective Laser Trabeculoplasty.
Laser Glaucoma
There are 3 types of laser for Glaucoma:
Peripheral Iridotomy
Selective Laser Trabeculoplasty
Cyclodiode
Each type of laser is used for a different type of Glaucoma.
Peripheral Iridotomy (PI)
-
PI is a procedure which involves using a laser to create a small hole in the iris to help the circulation of fluid within the eye.
PI is advised when a patient is at risk of developing acute angle closure or angle closure glaucoma. Patients who are at risk of developing these forms of glaucoma have what is described as a “shallow anterior chamber”, which is when the space at the front of the eye (between the cornea and the iris) from which fluid in the eye normally drains out from, is narrowed, and at risk of closing off completely. Acute angle closure occurs when there is a sudden closure of this drainage space and typically results in severe eye pain, blurred vision, very high eye pressure and is an emergency situation. Angle closure glaucoma occurs when there is a more gradual narrowing of this drainage space and causes a moderate rise in eye pressure that can cause progressive damage to the optic nerve and lead to loss of vision. In both cases, PI can prevent these events from occurring.
-
The treatment is carried out in the outpatient clinic, using a laser machine similar to the slit-lamp that is used to examine patients’ eyes.
A drop of Pilocarpine is instilled 30 minutes prior to the procedure to help prepare the eye.
A drop of local anaesthetic is then applied and a contact lens is placed on the eye to help the doctor focus accurately on the iris.
Normally, 1 or 2 brief laser shots are required to create the necessary opening in the iris. Patients will hear a slight “cracking” sound of the laser machine as the shots are applied.
Usually, both eyes are treated at the same visit.
A drop of Iopidine is instilled to help prevent any immediate eye pressure rise.
The eye pressure is checked 30 minutes after the procedure.
Patients are given steroid eye drops to use for 1 week after the procedure.
Patients are reviewed again after 1 week.
-
PI laser is a common procedure and is highly effective in preventing sight threatening glaucoma.
The small risks of complications include inflammation in the eye, raised eye pressure, localised cataract formation, glare and rarely double vision.
Selective Laser Trabeculoplasty (SLT)
-
SLT is a simple, effective laser procedure that reduces eye pressure. It works by applying a low energy laser to the drainage system of the eye, and helps to increase the amount of fluid that is removed from the eye.
-
SLT is appropriate in patients who have:
Newly diagnosed glaucoma or ocular hypertension
Patients already on drop therapy, but still have raised eye pressure
Patients who are intolerant of glaucoma drop therapy
-
SLT is a safe procedure and the risks are minimal. However, patients should be aware of the following:
Some patients (up to 20%) may not respond and it is not possible to predict who will not respond.
The benefits of treatment may wear off after several years, however the laser can be repeated.
Some patients may experience some redness, eye pain or blurred vision for a few hours/days after treatment, but this normally self resolves.
Occasionally, the eye pressure may rise immediately after the procedure and eye drops may be needed to control this. Very rarely, the eye pressure may remain high and additional procedures are required to reduce it.
Please see this video by Ellex, illustrating the potential benefits of SLT therapy.
-
The treatment is carried out in the outpatient clinic, using a laser machine similar to the slit-lamp that is used to examine patients’ eyes.
A drop of local anaesthetic is then applied and a contact lens is placed on the eye to help the doctor focus accurately on the drainage system at the front of the eye.
Normally, 100 brief laser shots to the drainage system are required. No pain is felt during the procedure and the procedure takes 5-10 minutes to complete.
The eye pressure is checked 30 minutes after the procedure.
Patients are reviewed again after 1 month.
Cyclodiode Laser
-
Cyclodiode is a procedure where an external laser is applied the ciliary body, which is responsible for producing fluid in the eye. It is indicated in patients who have painful, end-stage glaucoma in or advanced glaucoma where surgery is not possible.
-
Cyclodiode laser is performed in the operating room as a day case procedure.
A local anaesthetic injection is given around the eye
Approximately 20-30 laser shots are applied to the eye using a special probe that is placed on the surface of the eye. The procedure usually takes 5-10 minutes.
Steroid eye drops are given for 1 week after the procedure and patients are advised to continue with their normal Glaucoma medications.
-
Cyclodiode laser is a safe and effective procedure. However, patients should be aware of the following potential complications prior to undergoing treatment:
Hypotony (too low eye pressure)
Inflammation in the eye
Retinal or choroidal detachment
Thinning of the eye
Bleeding in the eye
iStent Eye Drainage Surgery
The iStent is a tiny eye drainage device that is inserted into the drainage system inside the front of the eye, also known as the trabecular meshwork, and is usually performed at the end of cataract surgery.
Glaucoma is an eye condition that can affect sight, usually due to an increase in intraocular pressure (IOP). This increased pressure is often a result of the aqueous humour within the eye becoming blocked.
An iStent procedure allows for increased drainage of aqueous humour fluid from the eye, thereby helping to reduce IOP.
-
The iStent eye drainage surgery is suitable for patients with mild to moderate glaucoma or ocular hypertension, who are due to undergo cataract surgery. The iStent is effective in reducing IOP, and possibly reducing the number of glaucoma eye drops required, thereby providing more effective IOP control.
-
To manage the increased eye pressure, usually, two iStents are inserted at the end of a standard cataract operation. However, it can also be performed as a standalone procedure if necessary.
A special lens is used to help guide the placement of the iStents, and a fingertip controlled micro-device is used to insert the iStents into the drainage channels inside the front of the eye. The iStent device itself is the world’s smallest human implant and you can rest assured that you will not be able to feel or see the device once it is inserted.
The iStent eye surgery itself only takes around 5 minutes at the end of cataract surgery and is usually performed under local anesthesia.
-
With the correct patient selection, insertion of the iStent can lead to a significant reduction in eye pressure in the majority of patients. This allows for better control or prevention of glaucoma.
Some patients may also be able to reduce the number of eyedrops they take or possibly stop using them. This is particularly useful for patients who have to use multiple glaucoma medications, have difficulty instilling eye drops or experience side effects or discomfort with glaucoma eye drops.
What’s more, you can also rest assured that there are no additional risks to those involved with standard cataract surgery associated with an iStent insertion.
-
The recovery is no different from patients undergoing standard cataract surgery, so your vision should improve and eye feel comfortable with a few days. The iStent device is less invasive compared to other complex drainage procedures, meaning iStent eye surgery recovery time is much faster for the majority of patients. The iStent implant should start working straight away or at least within the first few weeks.
Following the operation, you will be asked to apply eye drops daily to the operated eye for a few weeks after the procedure. You will then be asked to come in for an examination to see if the IOP has become stable and whether you will need to continue applying eye drops.