Glaucoma is a disease that can slowly destroy the delicate nerve fibers that carry signals from the back of the eye to the brain. Generally, high pressure within the eye is responsible for the damage, but even patients with normal pressure can experience loss of this important nerve function due to glaucoma.
It’s important to be checked yearly to ensure glaucoma is not present, because patients do not always feel the symptomatic elevated eye pressure as it slowly robs them of their sight. Because it can be inherited, if one family member has glaucoma, other family members should be checked.
While glaucoma typically affects people age 40 and older, it can strike at any age. Glaucoma is called “the silent thief” because there is no pain or noticeable change in vision during the early stages of the disease.
No treatment can restore vision already lost to glaucoma. The goal of treatment is to prevent further vision loss.
PRIMARY-OPEN ANGLE GLAUCOMA
ANGLE CLOSURE GLAUCOMA
NARROW ANGLE GLAUCOMA
Treating Glaucoma with Medication
Various medications are sometimes useful in treating glaucoma. Beta-blocker eye drops may reduce the amount of fluid produced by the eye. Prostaglandin analogs and alpha-2 agonists may also lower intraocular pressure.
Treating Glaucoma with Trabeculectomy
Dr. Del Negro may recommend a surgical procedure called “trabeculectomy” if medication, eye drops, or another procedure have not been effective in lowering the pressure within your eye.
This procedure helps to lower pressure by altering the eye’s drainage system and creating a controlled leak of fluid.
Treating Glaucoma with Peripheral Iridotomy
Iridotomy is another surgical procedure that may be recommended to lower pressure within your eye. When the eye’s iris blocks the drainage of fluid, Dr. Del Negro uses a laser to create a tiny hole in the iris to improve drainage.
TREATING GLAUCOMA WITH ECP (ENDOSCOPIC CYCLOPHOTOCOAGULATION)
Performed during the cataract procedure, ECP is both a safe and effective means of reducing the amount of pressure present in the eye. The objective of the combined cataract/ECP procedure is to lower eye pressure and eliminate the need for glaucoma medication.
After Dr. Del Negro removes the cataract by creating small incisions, he will then insert the endoscopic laser probe through those same incisions to begin the ECP portion of the procedure. Once inside the eye, the probe is carefully guided by Dr. Del Negro. He will use a video monitor to locate the cillary process tissue in order to deliver laser treatment to that specific tissue. This additional step adds a negligible amount of time to the overall cataract procedure.
Following the procedure, your vision should improve immediately. The need to reduce or eliminate your glaucoma drops will be determined by Dr. Del Negro as he continues to monitor your progress following the initial procedure. No additional post-op appointments are required outside of the usual cataract post-op regimen.
Micropulse Laser Trabeculoplasty (MLT)
Indications- The Micropulse Laser Trabeculoplasty surgeries are used for patients with open angle glaucoma. The laser is utilizes to treat the drainage system of the eye known as the trabecular meshwork. Treating this area of the natural internal draining system is designed to improve the outflow of fluid from the eye.
This type of laser surgery will be effective in some patients but not others. Your response is determined by the type of glaucoma you have and the specific structures found in your drainage system. Dr. Del Negro cannot predict how well the laser will work before the laser surgery.
Procedure- The laser machine is similar to the examination microscope that the Ophthalmologist uses at each visit to look into your eyes. The laser itself makes little noise and flashes a light about as bright as the flash on a camera. Nearly all patients find the procedure comfortable and pain free. The procedure generally takes 10 – 20 minutes.
Medications- You may need to use drops both before and after the laser treatment. As the pressure in the eye may temporarily go up after laser treatment, you will likely need to have your pressure measured after the laser surgery. If the pressure does elevate, you may need additional medicines to lower the pressure, which will be administered in the office. Rarely, the pressure in the eye could elevate to a level that may require surgery in the operating room to relieve the glaucoma. You need to use drops after the laser to help the eye heal correctly. In most cases you will be asked to continue your other glaucoma medications after the laser surgery. Dr. Del Negro will notify you if there are exceptions to continuing your medications.
Risks and complications- Glaucoma laser surgery may be followed by complications. Most patients notice some blurring of their vision after laser surgery. This generally clears within a few hours. The chance of your vision being permanently affected by this laser is very, very small. Although rare and unusual, there may be bleeding within the eye, inflammation, cataract and increase in the pressure in the eye requiring different and more extensive treatment. It will take several weeks to determine how much of your eye pressure will be lowered with this treatment. You may require additional laser surgery to lower the pressure.