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Currently, there is no cure for glaucoma. All treatments are undertaken to reduce the risk of progressing visual loss. Usually, if treatment is begun early, the disease can be controlled and vision can be saved.
Systemic health issues can also affect glaucoma. Even a regular exercise program and weight loss have been shown to decrease eye pressure! The 3 general categories of glaucoma therapy are medicines, in-office laser procedures and operating-room surgery.
Medicines are the most common first-line treatment for glaucoma. These eye drops and/or pills work by slowing the production of fluid inside the eye or by improving the flow of fluid through the drainage meshwork. There are five main groups of eye drops: prostaglandins, beta-blockers, carbonic anhydrase inhibitors, adrenergic agonists and miotics. These medications may be taken between one and four times daily. The most common side effect is that the drops can cause burning and stinging. Some drops can cause allergies, which lead to red, itchy eyes. Even though the medicines do not instantaneously make you see better, they should not be stopped without speaking to the doctor. The goal of these eye drops/pills is to decrease your eye pressure and reduce the risk of further vision loss. Our Austin area ophthalmologists will discuss with you what medications are recommended specifically for you.
There are several different types of glaucoma laser procedures. The most common are: argon laser trabeculoplasty (ALT), selective laser trabeculoplasty (SLT), micropulse laser trabeculoplasty (MLT), and cyclophotocoagulation. Each of the first three lasers are applied to the trabecular meshwork, the drainage system of the eye. They can help to increase the amount of fluid drained out of the eye, which can lead to a lower eye pressure. These procedures can be done in the office, usually take less than five minutes, and only cause temporary mild discomfort.
Of these, SLT is the most common due to its remarkable combination of ease of treatment and repeatability. After instilling a topical anesthetic eyedrop, the laser treatment is applied through a focusing contact lens. The laser is effective in about 80 percent of patients, and lowers IOP by 20 to 25 percent. The effect usually lasts 5-10 years, and can be repeated if necessary.
Endocyclophotocoagulation (ECP), is applied to the ciliary body in an operating-room procedure through a small corneal incision in order to decrease the production of intraocular fluid. A newer, and less invasive, operating room laser is called transscleral cyclophotocoagulation. With this procedure, the laser is actually applied to the ciliary body without an incision. The laser treatment is applied topically in less than 5 minutes and only causes mild swelling and discomfort. Our Lakeway eye doctors have access to all types of lasers, and will discuss with you which type is best for your eyes.
This treatment is performed in those with angle closure glaucoma. The laser is used to create a small hole in the iris (colored part of the eye). This hole acts as a channel for fluid and helps to provide access for the fluid to reach the drainage system of the eye. The laser usually causes temporary blurred vision and mild discomfort.
These are new and exciting procedures due to their increased safety over older/traditional glaucoma surgeries. In the Trabectome procedure, the inner portion of the drainage system (which is usually the portion of the system that is not working properly in glaucoma) is removed with a microscopic instrument. The fluid inside the eye then has a more direct path into the drainage canals, and ultimately results in a lower eye pressure.
Canaloplasty can be performed via a small corneal incision (ABiC or ab-interno canaloplasty) or an external incision through the sclera (white part of the eye). A small lighted catheter is inserted through the drainage system of the eye. As the catheter is removed, a gel substance is injected in order to dilated the drainage system. This dilation helps to restore the normal fluid flow out of the eye by reducing outflow resistance. Canaloplasty can be combined with cataract surgery, or performed as a stand-alone procedure.
Istent surgery is always combined with cataract surgery in the United States. The tiny stent is inserted into the trabecular meshwork in order to provide easier outflow access for the intraocular fluid. There are newer similar stents that have recently become FDA approved, and are becoming the treatment of choice for mild to moderate glaucoma because of their combination of efficacy and safety. A few examples of these stents are the Cypass (drains to the supraciliary space) and the Xen (drains to the subconjunctival space).
This type of surgery is performed in the operating room, and is usually only undertaken if the above medications and lasers have failed to lower the eye pressure appropriately. In this surgery, a small silicone tube is inserted into the eye. The tube, which drains fluid from the eye, leads to a small drainage “lake” that usually is hidden under the upper eyelid. The tube is microscopic, and is usually not noticeable by others.
This type of surgery is performed in the operating room, and is usually only undertaken if the above medicines and lasers have failed to lower the eye pressure appropriately. In this surgery, an alternate route for fluid to flow out of the eye is created. The fluid drains into a lake or “blister” that is normally hidden under the upper eyelid.
Our ophthalmologists have experience with all of the above surgical treatments, and will discuss with you which specific treatments are appropriate for your eye(s).