Glaucoma Care


 

Glaucoma Care

How your glaucoma is treated will depend on your specific type of glaucoma, the severity of your disease and how well it responds to treatment.

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.

Glaucoma Medication

Medicated eye drops are the most common way to treat glaucoma. These medications lower your eye pressure in one of two ways — either by reducing the amount of fluid created in the eye or by helping this fluid flow out of the eye through the drainage angle.

These eyedrops must be taken every day. Just like any other medication, it is important to take your eyedrops regularly as prescribed by your ophthalmologist.

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. 

Possible Glaucoma Medication Side-effects

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; or,
  • changes in your eye color, the skin around your eyes or eyelid appearance.

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

If you have glaucoma, it is important to tell your ophthalmologist about your other medical conditions and all other medications you currently take. Bring a list of your medications with you to your eye appointment. Also tell your primary care doctor and any other doctors caring for you what glaucoma medication you take.

Glaucoma surgery

In some patients with glaucoma, surgery is recommended. Glaucoma surgery improves the flow of fluid out of the eye, resulting in lower eye pressure.

Laser trabeculoplasty

A surgery called laser trabeculoplasty is often used to treat open-angle glaucoma. There are two types of trabeculoplasty surgery: argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT).

During ALT surgery, a laser makes tiny, evenly spaced burns in the trabecular meshwork. The laser does not create new drainage holes, but rather stimulates the drain to work better. This is an older, less preferred technique.

SLT uses a newer, lower-energy laser which only treats specific cells in the drainage angle. SLT and ALT are equally good at lowering eye pressure, however SLT is repeatable if necessary.

Laser trabeculoplasty can also be used as a first line of treatment for patients who are unwilling or unable to use glaucoma eye drops, and may allow patients presently using eyedrops to discontinue this if adequate lowering of the eye pressure can be achieved through laser treatment.

Laser iridotomy

Laser iridotomy is recommended for treating people with closed-angle glaucoma and those with very narrow drainage angles. A laser creates a small hole about the size of a pinhead through the iris to improve the flow of aqueous fluid to the drainage angle.

Peripheral iridectomy

When laser iridotomy is unable to stop an acute closed-angle glaucoma attack, or is not possible for other reasons, a peripheral iridectomy may be performed. This is performed in an operating room. A small piece of the iris is removed, giving the aqueous fluid access to the drainage angle again. Because most cases of closed-angle glaucoma can be treated with glaucoma medications and laser iridotomy, peripheral iridectomy is rarely necessary.

Trabeculectomy

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.

In trabeculectomy, a small flap is made in the sclera (the outer white coating of your eye). A filtration bleb, or reservoir, is created under the conjunctiva — the thin, filmy membrane that covers the white part of your eye. Once created, the bleb looks like a bump or blister on the white part of the eye above the iris, but the upper eyelid usually covers it. The aqueous humor can now drain through the flap made in the sclera and collect in the bleb, where the fluid will be absorbed into blood vessels around the eye.

Eye pressure is effectively controlled in three out of four people who have trabeculectomy. Although regular follow-up visits with your doctor are still necessary, many patients no longer need to use eye drops. If the new drainage channel closes or too much fluid begins to drain from the eye, additional surgery may be needed. 

Aqueous shunt surgery

If trabeculectomy cannot be performed, aqueous shunt surgery is usually successful in lowering eye pressure.

An aqueous shunt, or glaucoma drainage device, is a small plastic tube or valve connected to a reservoir (a roundish or oval plate). The plate is placed on the outside of the eye beneath the conjunctiva (the thin membrane that covers the inside of your eyelids and the white part of your eye). The tube is placed into the eye through a tiny incision and allows aqueous humor to flow through the tube to the plate. The fluid is then absorbed into the blood vessels. When healed, the reservoir is not easily seen unless you look down and lift your eyelid.

Important things to remember about glaucoma treatment

There are a number of ways to treat glaucoma. While some people may experience side effects from glaucoma medications or glaucoma surgery, the risks of side effects should always be balanced with the greater risk of leaving glaucoma untreated and losing vision.

If you have glaucoma, preserving your vision requires strong teamwork between you and your doctor. Your doctor can prescribe treatment, but it’s important to do your part by following your treatment plan closely. Be sure to take your medications as prescribed and see your ophthalmologist regularly.

Does marijuana help treat glaucoma?

The main objective in treating glaucoma is to lower intraocular pressure (or “IOP”) in the eye. A lower IOP can reduce damage to the optic nerve and save your remaining vision. Marijuana has been proven to lower IOP but only for a short period of time and at considerable risk to your overall health.

When marijuana is smoked or when the active ingredient is ingested in some other manner, the pressure-lowering effect within the eye can last from 3 to 4 hours. This period of time is too short, as glaucoma needs to be treated 24 hours a day. Additional drawbacks include the impaired functioning that results from smoking marijuana and the potentially harmful effects of prolonged use.

The Academy does not recommend marijuana as a treatment for glaucoma. Considering the more effective treatments available to patients—from prescription medication to surgical procedures—the risks and side-effects of marijuana treatment far outweigh its modest short-term benefits, which do not properly control IOP.

Xen-gel-Stent

This most modern and latest system for precise measurements during cataract surgery is now available at Hawaii Vision which provides accurate calculation of Intra Ocular Lens eliminating any guess work. ORA system has shown 53.8% improvement for Astigmatic and post-LASIK patients. This system helps in instant adjustments during cataract surgery for fine tuning the power of IOL depending upon each patient’s unique specifications. Your quality of vision can be assessed instantly with the help of this system without any waiting time after cataract surgery.

iStent | How it Works

Glaucoma is normally associated with increased fluid pressure in the eye. The primary cause of elevated intraocular pressure (IOP) in patients with open-angle glaucoma is a blockage of the trabecular meshwork; a sponge-like tissue located near the cornea and iris through which aqueous humor passes to Schlemm’s canal and into the bloodstream.

iStent:

  • Creates a permanent opening in your trabecular meshwork
  • Improves your eye’s natural fluid outflow to safely lower IOP
  • Works continuously to improve the outflow of fluid from your eyes
  • Improves outflow with a single bypass

 

 

Indication For Use

The iStent Trabecular Micro-Bypass Stent (Models GTS100R and GTS100L) is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate open-angle glaucoma currently treated with ocular hypotensive medication.

Contraindications

The iStent is contraindicated in eyes with primary or secondary angle closure glaucoma, including neovascular glaucoma, as well as in patients with retrobulbar tumor, thyroid eye disease, Sturge-Weber Syndrome or any other type of condition that may cause elevated episcleral venous pressure.

Warnings

Gonioscopy should be performed prior to surgery to exclude PAS, rubeosis, and other angle abnormalities or conditions that would prohibit adequate visualization of the angle that could lead to improper placement of the stent and pose a hazard. The iStent is MR-Conditional meaning that the device is safe for use in a specified MR environment under specified conditions, please see label for details.

Precautions

The surgeon should monitor the patient postoperatively for proper maintenance of intraocular pressure. The safety and effectiveness of the iStent has not been established as an alternative to the primary treatment of glaucoma with medications, in children, in eyes with significant prior trauma, chronic inflammation, or an abnormal anterior segment, in pseudophakic patients with glaucoma, in patients with pseudoexfoliative glaucoma, pigmentary, and uveitic glaucoma, in patients with unmedicated IOP less than 22 mmHg or greater than 36 mmHg after ?washout? of medications, or in patients with prior glaucoma surgery of any type including argon laser trabeculoplasty, for implantation of more than a single stent, after complications during cataract surgery, and when implantation has been without concomitant cataract surgery with IOL implantation for visually significant cataract.

Adverse Events

The most common post-operative adverse events reported in the randomized pivotal trial included early post-operative corneal edema (8%), BCVA loss of = 1 line at or after the 3 month visit (7%), posterior capsular opacification (6%), stent obstruction (4%) early post-operative anterior chamber cells (3%), and early post-operative corneal abrasion (3%). Please refer to Directions for Use for additional adverse event information.

Caution

Federal law restricts this device to sale by, or on the order of, a physician. Please reference the Directions for Use labeling for a complete list of contraindications, warnings, precautions, and adverse events.

Location
Hawaii Vision Specialists
76 Kalanianaole Avenue
Hilo, HI 96720
Phone: 808-333-3233
Fax: 808-315-7663
Office Hours

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808-333-3233