Glaucoma
Glaucoma is a potentially serious eye disorder that is the second leading cause of vision loss in the united states. Our glaucoma specialists are recognized for their ability and skill in diagnosing and successfully treating glaucoma. Delray Eye Associates, P.A. has participated in national clinical trials for new glaucoma drugs and innovative technologies and treatments. We are proud to offer glaucoma treatments to patients throughout South Florida, including laser iridotomy, laser trabeculoplasty, iridoplasty, iStent inject, hydrus, Kahook Dual Blade and OMNI 360 goniotomy, xen gel stent, trabeculectomy, tube-shunt surgery, and cyclophotocoagulation. Our progressive surgeons stay current with all of the most recent advances in glaucoma surgery and are often asked to participate in trials and evaluate new devices. Delray Eye Associates, P.A. is proud to have Dr. Daniel Jewelewicz and Dr. Mark Werner providing various glaucoma treatments for our patients. They would be happy to discuss which treatments would be most appropriate for you.
Regular and complete eye exams are of the utmost importance for protecting your vision from glaucoma and other eye problems. To schedule your eye exam or learn more about your glaucoma treatment options at Delray Eye Associates, P.A., please call us today at (561) 498-8100 or (561) 734-0267.
An excellent resource for additional information about glaucoma is the Glaucoma Research Foundation.
Who gets glaucoma?
There are many different types of glaucoma. Any age may be affected, ranging from infants to the elderly. The most common type of glaucoma, which we refer to as primary open angle glaucoma, may affect as many as 1% of the population over the age of 40 in the U.S. As you get older, the chance of having glaucoma increases – it affects 15% over age 80. Glaucoma is responsible for 15% of legal blindness in the U.S. There are certain risk factors that increase the likelihood that you may develop glaucoma. These include age, diabetes, Afro-American race, myopia (nearsightedness), family history of glaucoma, certain eye conditions, and elevated pressure in the eye (this is not the same as high blood pressure).
What is a narrow angle?
This describes a condition in which the drainage structures of the eye are crowded due to the anatomy of your eye. All healthy eyes produce fluid that nourishes the eye. This takes place inside your eye and is not related to tears on the outside. Normally this fluid exits through a portion of the eye that we call the “trabecular meshwork.” This is located in a part of the eye we refer to as “the angle.” In some people the iris (the colored portion of the eye) gets very close to the trabecular meshwork and may prevent adequate drainage of fluid. This may elevate the pressure in the eye and cause glaucoma. If the angle is totally occluded, the pressure may become greatly elevated and cause significant loss of vision in a relatively short period of time. More often, if the angle is narrow, portions of the angle may scar and cause a chronic elevation in pressure that may cause loss of vision over time.
How do we treat a narrow angle?
Years ago this required a trip to the operating room. Fortunately, we can now use a laser in the office to treat this condition. This is painless and only takes several minutes to perform. We use the laser to make a tiny hole in the iris, the colored portion of the eye, to change the anatomy of the eye so that the angle is no longer narrow and fluid can exit normally. This is called a “laser iridotomy.” Usually, this procedure is sufficient to achieve a permanent change in anatomy, in effect, a cure. Sometimes the angle stays narrow even after the laser, so a second laser procedure may be necessary. This is called an “iridoplasty.” We use the laser to contract the peripheral iris out of the angle and allow normal drainage of fluid. These procedures may be performed prophylactically to prevent glaucoma.
What is pseudoexfoliation?
Pseudoexfoliation is a condition that is very common in people of Eastern-European and Scandinavian descent. It can be seen in the eye under a microscope as a very fine, dandruff-like material that coats the structures in the front of the eye. It does not affect vision. In some people this substance can accumulate in the drainage structures of the eye (the trabecular meshwork) and obstruct drainage of fluid. If this happens the pressure in the eye may rise; this may result in glaucoma. Pseudoexfoliation is common – not all people with pseudoexfoliation will develop glaucoma. But it is a risk factor for future development of glaucoma and must be watched carefully. If glaucoma does develop, it is usually asymmetrical and affects one eye first. However, the condition is bilateral, so both eyes must be watched carefully. Pseudoexfoliation can sometimes cause problems during cataract surgery because the ligaments that hold the cataract in place are often weak. If you have cataracts and pseudoexfoliative glaucoma you should discuss this with your doctor.
How do we monitor glaucoma?
Glaucoma is a condition that causes changes in your eye and in your vision over time. When it is first diagnosed, it is important to obtain baseline tests so that comparisons can be made using those same tests in the future. In this fashion, changes can be detected. The visual field test involves watching a central target while lights are projected in the periphery. When you see a light in the periphery, you depress a button so the computer registers that this as seen. This is a very important test that measures your peripheral vision. Remember — glaucoma affects the peripheral vision long before it affects the central vision. It is very difficult for you to detect any change in your peripheral vision on your own. In fact, the ideal goal of treating glaucoma is to ensure that you never do detect any change in your vision. This test, when performed regularly, helps your doctor to ensure that you do not suffer any further damage to your vision from glaucoma. If the tests do show changes in your peripheral vision over time, treatment can then be changed to help ensure that these changes stay confined to your peripheral vision and never affect your central vision. Photographs may be taken of the back of your eye — this helps document the appearance of your optic nerve so that comparisons may be made in the future. Your eye pressure will be checked regularly to make sure that it is at a level that is safe for your optic nerve. You may require regular dilated eye exams so that your glaucoma doctor may carefully examine your optic nerve and ensure that it remains healthy. Other measurements and tests are also helpful in detecting and monitoring glaucoma.
Can you use a laser to treat open-angle glaucoma?
Yes. We can use a laser to treat the trabecular meshwork of the eye, that is, the portion through which fluid drains inside the eye. This is called a “laser trabeculoplasty.” It is more effective in some types of glaucoma compared to others. Although effective in many patients, this is an option that must be discussed with your doctor to determine if it is right for you. We offer the newer “cold” laser treatment, or selective laser trabeculoplasty, as well as the “hot” or argon laser treatment. Efficacy may be similar in many patients. Discuss with your doctor which laser may be best for you.
Can surgery be used to treat glaucoma?
Yes. In most patients surgery is reserved for more advanced glaucoma that has become difficult to control with medicine. Some patients cannot tolerate medicines and therefore opt for surgery. Sometimes this surgery is combined with cataract surgery in a single procedure. The goal of the surgery is to lower the pressure in the eye to a level which is safer for the optic nerve. We build a new drain out of the tissue already present in your eye, and sometimes use a shunt or device to drain the fluid. Glaucoma surgery is not designed to improve vision. It is done to prevent progression of glaucoma and preserve the vision that you currently have. The decision whether or not to have surgery must be carefully discussed with your doctor. There are several surgeries for glaucoma, including trabeculectomy, tube shunt surgery, and ExPRESS mini-shunt surgery.
There are newer, “minimally invasive” glaucoma surgeries designed for people with mild glaucoma to reduce their dependence on drops and improve pressure control. They carry less risk than traditional glaucoma surgeries. They do not lower pressure as well on average and may not be appropriate for severe or advanced glaucoma. There procedures are often combined with cataract surgery. Trabectome and iStent inject procedures are two examples. Below is a brief animated video on the iStent from Glaukos:
The XEN gel stent technology, released in 2017, offers yet another option for some patients requiring surgical treatment for glaucoma. This procedure is a somewhat less invasive alternative to traditional glaucoma surgeries and may offer easier and quicker recovery in suitable patients. Please Xen Gel Stent for more information.
Will I go blind from glaucoma?
Obviously, this depends on many factors, and every patient is unique. The science of glaucoma has advanced tremendously over the last decade. We are now able to diagnose glaucoma in far earlier stages. We have many more medications at our disposal. Laser and surgical techniques have become much more sophisticated and safer. Current research will provide us with even more information about this disease and open new avenues of treatment. If diagnosed and treated earlier, chances are excellent that you will maintain your vision. Although there are no absolute promises in medicine, as long as you follow up regularly with your doctor, you are likely to continue to see for the rest of your life.
For more patient education please visit the American Glaucoma Society website. For patients spending time in other locations there is an option to search for a local glaucoma specialist.
To schedule an appointment with one of our glaucoma doctors or learn more about your treatment options, please visit our Contact Us page or call (561) 498-8100 or (561) 734-0267.
