Glaucoma is an eye disease that is most commonly caused by elevated pressure inside the eye-Intraocular Pressure (IOP)-that damages the optic nerve and causes loss of vision. Glaucoma can begin without any symptoms or obvious loss of vision and if not diagnosed early, treated properly and controlled, it will result in permanent vision loss and potentially blindness.
Types of Glaucoma
There are two main types of Glaucoma:
Primary Open Angle Glaucoma (POAG)
The most common type of glaucoma is Primary Open Angle Glaucoma (POAG) in which the production and/or drainage of fluid inside the front of the eye (called aqueous humor) is imbalanced, resulting in an elevation in eye pressure (IOP). This elevated IOP impairs delivery of oxygen and nutrients to the optic nerve, resulting in permanent damage to the optic nerve. If this condition is left untreated, vision loss and ultimately blindness may result.
Angle Closure Glaucoma
The second type of glaucoma is called Angle Closure Glaucoma. Primary Angle Closure Glaucoma accounts for about 10% of all cases of glaucoma and about 2/3 of these produce no symptoms for patients. Acute Angle Closure Glaucoma is one of the only types of glaucoma that produces distinct symptoms. These include pain, light sensitivity, redness, blurred vision, colored haloes around lights and nausea or vomiting. Acute Angle Closure Glaucoma is considered a medical emergency. If you experience a sudden onset of pain, redness, blurred vision, light sensitivity, haloes around lights, nausea and vomiting, please call us immediately at 610-688-2777 and relay these symptoms to the receptionist so that you can be given an appointment at once.
If our doctors determine that you either at risk for Angle Closure Glaucoma or have actually developed Acute Angle Closure Glaucoma, the ophthalmologists may initially prescribe some medication to begin to lower the pressure but will also perform a type of glaucoma laser procedure called Laser Iridotomy or “Laser PI”. In this procedure, a laser is used to produce a small opening or hole in the Iris so that Aqueous Humor can drain from the eye more effectively.
Depending on your general health, eye health and family history, there are a number of factors that may influence your likelihood of developing glaucoma.
- High Intraocular Pressure
- Age -- Risk increases after the age of 40 and is 6 times greater if you are over 60.
- Race -- African-Americans have a six- to eight-fold increased risk for glaucoma.
- Myopia -- Severely nearsighted people have a higher risk of developing glaucoma.
- Hypertension or High Blood Pressure
- Family History-Any family history of glaucoma is considered a very significant risk factor.
- Early Menopause
- Sleep Apnea
- Thin Corneal Tissue
- Eye Trauma
- Use of corticosteroids.
Because preventing vision loss from glaucoma depends upon early detection and the most accurate diagnosis, our doctors will perform a number of tests:
- Tonometry -- Intraocular Pressure (IOP) Measurement
- Ophthalmoscopy -- Examination of the optic nerve through a dilated pupil
- Visual Field Perimetry -- A computerized examination to plot an actual map of the field of your vision
- Gonioscopy – Direct examination of the drainage structure of your eye using a special mirrored contact lens
- OCT (Optical Coherence Tomography) – Digital Imaging of the Optic Nerve and measurement of the retinal nerve fiber thickness
- Pachymetry -- Measurement of Corneal Thickness
The three main methods we use to treat glaucoma are medication, laser and surgical procedures.
Medical Treatment of Glaucoma
Primary Open Angle Glaucoma is most often treated at first with eye drops. By using one or two types of glaucoma eye drops, most patients are able to achieve a stable and lowered eye pressure.
Laser Treatment of Glaucoma
Selective Laser Trabeculoplasty (SLT) is a type of glaucoma laser treatment that helps to reduce the Intraocular Pressure (IOP) by creating more effective drainage of fluid through the trabecular meshwork. We perform this painless procedure in the comfort of our office. Patients often are able to obtain good control of IOP and also reduce the number or frequency of eye drops.
Surgical Treatment of Glaucoma
There are several scenarios in which glaucoma surgery may be of benefit.
For the glaucoma patient who develops cataracts, a noninvasive Micro Incisional Glaucoma Surgery (MIGS) may be performed at the time of cataract surgery. Not uncommonly, patients are then able to reduce or eliminate glaucoma drops. The eye surgeons at Nevyas Eye Associates are specialists in Micro Incisional Glaucoma Surgery (MIGS) techniques
- including Hydrus Microstent, which is inserted into Schlemm’s Canal, the eye’s natural drainage system, during cataract surgery
- Kahook Dual Blade® (KDB) Goniotomy that enables precise excision of diseased trabecular meshwork tissue, with or without cataract surgery
- Ab Interno Canaloplasty in which a lighted catheter is passed along Schlemm’s Canal, enabling viscoelastic gel to dilate the Canal and relieve obstructions
For some patients, even with the maximum eye drop medical therapy and glaucoma laser treatment, it is still not possible to achieve good stable control of their disease and stop the progression of vision loss. For these patients, glaucoma surgery may be an option and may include either a MIGS procedure (which would preserve the eye’s natural drainage system), or might require a larger procedure in which an alternate drainage pathway is created. These procedures include trabeculectomy and various shunts.