Glaucoma is a disease that damages the optic nerve fibers at the back of the eye that connect retinal cells to the brain for vision to occur. This damage leads to a loss of peripheral vision in the early stages and complete blindness can occur if the glaucoma is advanced or inadequately treated.
We perform glaucoma evaluation and surgical treatment at our clinic. Read on to learn about how glaucoma is diagnosed and managed.
Glaucoma Evaluation and Diagnosis
You might know that high internal eye pressure, called intraocular pressure (IOP), is associated with glaucoma. While it is true that lowering IOP is the only way to treat glaucoma and limit its progression, the disease can exist and progress even in normal IOP ranges.
Therefore, screening for glaucoma requires more than just IOP measurement. We must also perform tests to determine a patient’s peripheral vision, which involves pushing a button anytime one sees a flicker or light in their visual field.
In addition, the back of the eye and the fluid drainage system of the eye must be carefully evaluated for pathology and long term changes. Highly detailed scans of the nerve fibers at the back of the eye are extremely useful for tracking loss of tissue thickness over time, which is how glaucoma progresses.
Overall then, just because one has high eye pressure this does not mean that they have glaucoma, and vice versa. However, if several risk factors and signs of glaucoma are present and repeatable over time, the diagnosis of glaucoma is made and treatment is initiated.
Treatment options for glaucoma include eye drop or oral medications, laser procedures, and surgeries. Mild-moderate cases are usually treated with medications or laser, while surgery is reserved for more advanced and progressive cases.
Laser procedures are quick and effective, and involve either applying laser to the drainage system of the eye to directly increase fluid outflow and lower IOP (called selective laser trabeculoplasty, or SLT) or shooting a hole in the colored iris of the eye to open up the way to the drainage area (called laser peripheral iridotomy, or LPI).
The IOP lowering effects of SLT last for up to five years and the procedure can be repeated, but with diminishing effects for each repetition.
Topical glaucoma medications come in several classes dosed at one to three drops a day in each eye. They are quite effective at lowering IOP but can sometimes cause adverse eye reactions, such as contributing to dry eyes.
Minimally Invasive Glaucoma Surgery
Minimally Invasive Glaucoma Surgery, abbreviated as MIGS, are procedures designed to provide significant decreases in IOP while prioritizing safety and lower complication rates than traditional glaucoma surgeries. These involve extremely tiny and delicate surgical equipment, incisions, and laser procedures.
Some procedures involve the insertion of tiny tube shunts into the drainage system of the eye that act to augment drainage of intraocular fluid to the outside of the eye just below its outer surface.
There are also delicate procedures to cut and open or bypass the eye’s drainage system to increase fluid outflow and lower IOP.