What is Glaucoma?
Glaucoma is the leading cause of blindness and visual impairment in the United States, and can affect patients of all ages, many of who do not experience any symptoms and may not be aware that they have the disease. Glaucoma actually refers to a group of diseases that cause damage to the optic nerve as a result of increased pressure within the eye, but can also be caused by a severe eye infection, injury, blocked blood vessels or inflammatory conditions of the eye.
There are two main types of glaucoma, open-angle and angle-closure. Open-angle glaucoma is the most common type of glaucoma and is caused by reduced drainage of the fluid in the eye through the trabecular meshwork (the eye’s drainage channel). Angle-closure glaucoma involves a buildup of pressure in the eye due to poor drainage because the angle between the iris and the cornea is too narrow. This causes the trabecular meshwork to become completely closed, making it difficult or even sometimes completely impossible for the fluid to drain.
Many patients do not experience any symptoms during the early stages of glaucoma, including no pain and no vision loss. This makes it difficult for many patients to know if they have the disease. But as glaucoma progresses, patients may experience a loss of peripheral or side vision. Since this loss can occur slowly, patients may not be aware of it until almost their entire eyesight has been destroyed! Acute angle closure glaucoma however often starts with an “attack” of sudden eye pain, headache, blurred vision or the appearance of halos around lights. This must be treated promptly to prevent rapid progression to blindness.
While some patients may experience symptoms from glaucoma as the disease progresses, others do not learn they have the condition until they undergo a routine eye exam. There are several different exams performed to diagnose glaucoma, including a visual field, retinal and optic nerve tomography, and visual acuity testing. The visual field test measures the peripheral vision, looking for early, subtle signs of damage. The HRT (Heidelberg Retinal Tomography) creates a three dimension analysis of the structures at the back of eye. This test is performed each year so that small changes that occur over time can be detected even before progressive glaucoma damage has occurred. Visual acuity testing reveals how well patients can see at various distances. Other tests are also performed, such as tonometry to measure the pressure inside the eye and pachymetry to measure the thickness of the cornea. After performing the proper testing, the Doctor can accurately diagnose glaucoma and develop a treatment plan to prevent any further damage to the eye and the vision.
What are my treatment options for Glaucoma?
Once glaucoma has been diagnosed, treatment should begin as soon as possible to help minimize the risk of permanent vision loss. There is no cure for glaucoma, so treatment focuses on relieving symptoms and preventing further damage from occurring by reducing the pressure within the eye. Most cases of glaucoma can be treated with eye drops, laser or a combination of these two methods. Only very rarely is microsurgery necessary. The best treatment for your individual case depends on the type and severity of the disease, and can be discussed with the Doctor.
- Eye drops are used to reduce fluid production in the front of the eye or to help excess fluid drain. Most of the newer glaucoma eye drops are very comfortable to use but some patients can experience redness, stinging, irritation or blurry vision. Patients should tell the doctor about any allergies they have to minimize and avoid the occurrence of these side effects.
- Laser surgery for glaucoma aims to increase the outflow of fluid from the eye and eliminate fluid blockages through laser trabeculoplasty, iridotomy or cyclophotocoagulation. Dr. Levine’s glaucoma patients can benefit from his use of the latest technology Argon laser (ALT), Selective laser (SLT), and YAG laser (YAG).
- Microsurgery involves a procedure called a trabeculectomy, which creates a new channel to drain fluid from the eye and reduces the pressure that causes glaucoma. Microsurgery is performed in the unlikely event that medication and laser procedures have not been successful
Selective Laser Trabeculoplasty
Selective Laser Trabeculoplasty, or SLT, an FDA approved laser procedure for the treatment of open-angle glaucoma, is an advanced treatment option for glaucoma patients that lowers eye pressure and increases fluid drainage. SLT is a minimally invasive laser procedure that uses very low levels of energy to selectively pinpoint the areas of the trabecular meshwork, relieving the symptoms of glaucoma. If needed, the SLT procedure can be repeated several times without causing damage to surrounding tissue.
Performed as an in-office procedure, SLT takes just a few minutes yet provides long-term results. SLT controls glaucoma symptoms for up to 5 years with no need for additional medication, and relieves symptoms by promoting the body's natural healing response. There are no major risks or complications associated with SLT and the procedure is covered by most insurance companies.
While there are no surefire ways to prevent glaucoma from developing, regular screenings and early detection are the best forms of protection against the harmful damage that the disease can cause. While anyone can develop glaucoma, some people are at a higher risk for developing disease. These people may include those who:
- Are over the age of 60
- African Americans over the age of 40
- Have a family history of glaucoma
- Have poor vision
- Have diabetes
- Are very myopic (nearsighted) or very hyperopic (farsighted)
Patients should have a comprehensive dilated eye exam at least once every two years, especially if they have a higher risk of developing glaucoma. Older patients may be encouraged to be tested more frequently.
To learn more about Glaucoma, please call us today or click here to schedule an appointment with one of our doctors.