What is Glaucoma?
Glaucoma is a group of eye conditions that damage the optic nerve, which is vital for good vision. This damage is often caused by abnormally high pressure in your eye. It is one of the leading causes of blindness for people over the age of 40, but can often be prevented with early treatment.
Types of Glaucoma
Primary Open-Angle Glaucoma: The most common type, where the drainage angle formed by the cornea and iris remains open, but the trabecular meshwork becomes partially blocked. This causes a gradual increase in eye pressure. Symptoms are usually not noticeable until significant vision loss has occurred.
Angle-Closure Glaucoma: Occurs when the drainage angle becomes blocked entirely. It can develop suddenly (acute angle-closure) with symptoms like severe eye pain, nausea, redness, and blurred vision, or gradually (chronic angle-closure). This is a medical emergency and requires immediate treatment.
Normal-Tension Glaucoma: Despite normal intraocular pressure, optic nerve damage still occurs, likely due to increased sensitivity of the optic nerve or compromised blood flow. Regular monitoring is essential for early detection and management.
Secondary Glaucoma: Results from another eye or systemic condition, such as uveitis (inflammation), eye trauma, steroid use, or advanced cataracts. Treatment often involves addressing the underlying cause in addition to lowering eye pressure.
Congenital Glaucoma: A rare form that presents in infants and young children, caused by improper development of the eye’s drainage system. Symptoms may include cloudy cornea, excessive tearing, and sensitivity to light. Early surgical intervention is often required.
Treatment Options
The goal of glaucoma treatment is to reduce intraocular pressure (IOP) to prevent further optic nerve damage. Treatment methods vary depending on the type and severity of glaucoma.
Medications
Prescription eye drops are often the first line of treatment. These may help reduce eye pressure by either decreasing fluid production in the eye or improving fluid drainage.
Minimally Invasive Glaucoma Surgery (MIGS)
MIGS procedures are often suitable for patients with mild to moderate glaucoma. They offer a safer profile, faster recovery, and can often be combined with cataract surgery. Common MIGS procedures include:
Canaloplasty: This procedure involves the insertion of a microcatheter into Schlemm’s canal, which is then dilated to restore natural outflow of fluid. A tensioning suture may be placed to keep the canal open, helping to reduce IOP.
Hydrus Microstent: A tiny, flexible device implanted into Schlemm’s canal through a small corneal incision. It acts as a scaffold to improve fluid drainage and reduce IOP. This is often performed alongside cataract surgery.
Kahook Dual Blade: A small tool eye doctors use to treat glaucoma, a condition that raises pressure in the eye and can lead to vision loss. During a gentle procedure called goniotomy, the doctor uses the blade to remove a tiny piece of tissue that’s blocking the eye’s drainage system. This helps fluid flow out better and lowers eye pressure. The procedure is minimally invasive, often done with cataract surgery, and usually doesn’t require stitches or a long recovery. It helps protect your vision and leaves other treatment options open for the future.
Cataract Surgery with MIGS: When a patient has both cataracts and glaucoma, a combined procedure can be performed. Cataract removal can lower IOP, and a MIGS device Hydrus may be implanted during the same surgery to enhance long-term pressure control. Our provider strategically combines cataract surgery with both Hydrus Microstent implantation and canaloplasty techniques to maximize outcomes. This comprehensive approach is designed to both restore visual clarity and achieve more effective and sustained intraocular pressure control.
Conventional Surgical Options
For more advanced cases or when medication and MIGS are not effective, more invasive surgical procedures may be recommended:
Trabeculectomy: A surgical flap is created in the sclera (white of the eye), and a small opening is made into the eye to allow fluid to drain under the conjunctiva, forming a bleb. This bypasses the eye's natural drainage system to significantly lower IOP.
Glaucoma Drainage Devices (Tubes/Shunts): These include devices like the Ahmed or Baerveldt implants. A tube is inserted into the anterior chamber of the eye to shunt fluid to a plate placed under the conjunctiva, where it can be absorbed into surrounding tissue.
Cyclophotocoagulation: This laser procedure targets the ciliary body, which produces aqueous humor. By reducing fluid production, it helps lower IOP. It can be performed externally (transscleral) or internally (endoscopic cyclophotocoagulation).
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