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Glaucoma is a common eye condition that, if not treated, can lead to vision loss. There are a series of microscopic canal structures in your eyes that allow fluids to travel out of your eye as needed. When the canals aren’t working properly, the fluids build up in the eye. This can lead to pressure on your optic nerve disrupting the images that are sent to your brain. Any vision lost usually cannot be repaired. Regular eye exams by your eye doctor can help improve your odds with an early diagnosis and treatment. There are many types of glaucoma and the best therapy is one that is customized for you.
At InSight Vision Group, we utilize a doctor team approach for glaucoma management. We coordinate care with your current eye doctor and with doctors in our practice. Your vision is important to us.
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The key to preventing serious vision loss and blindness from glaucoma is early detection. Regular eye exams are important to monitor and control the progress. There are many tests that can be performed to get baseline information about your eyes and any glaucoma progression. The tests may include photos, nerve scans, corneal thickness measurements, and formal visual field testing.
Your level of eye pressure control needed is then determined. You may need to be monitored as “glaucoma suspects” and may not ever need treatment. Or, you may need treatment that might include eye drops, laser procedures, and/or surgery to lower the eye pressure. There isn’t a way of recovering or improving vision that glaucoma has taken away, so preventing vision loss is the real goal.
Medicated eye drops may be prescribed to lower the eye pressure. Many different types of eye drop medications are available, and they work in different ways. In some cases, more than one eye drop type may be needed. They generally need to be used on a regular and long-term basis to control eye pressure, much as a pill may be used long term to lower blood pressure.
For open angle glaucoma, a laser procedure called “trabeculoplasty” may be performed to enhance the activity of the natural inner drain channels and thus lower eye pressure. Such treatments are of low risk and are quite effective in the many patients. There are several types of lasers that are approved to perform this treatment.
The treatment for angle-closure glaucoma (and narrow-angle glaucoma), is generally initiated with laser iridotomy (an opening in the colored iris) in order to move the iris away from covering and blocking the drainage channels of the eye. In some cases, short- or long-term eye pressure medications may also be needed. Not uncommonly, patients may have a combination of narrow and open angle glaucoma, and each patient needs a specific treatment plan.
There are very small devices now available that can be used to help open the natural drain canal of the eye. These are surgically placed at the time of cataract surgery. The FDA has not yet approved these small devices for surgery other than when cataract surgery is done. There are different devices available and your doctor will discuss your options with you.
Canaloplasty is appropriate for patients whose medication isn’t working, but who aren’t yet ready for a more advanced procedure. This procedure lowers pressure inside the eye by widening the eye’s drainage canal and can help reduce dependence on long term medications. In most cases, a small encircling stent helps keep the canal open and the pressure down.
For some patients, the best way to lower the eye pressure is to create a small channel in the coating of the front of the eye. The goal is to allow internal fluid the eye makes to escape, thus bypassing the natural drainage canal. This procedure, “Trabeculectomy” or “Filtering Surgery”, has been a mainstay of glaucoma surgery. Many patients who have this procedure enjoy a lower pressure with fewer medications. The post-operative care is very important to prevent the small opening from sealing closed with scar tissue, and the healing time can be a few weeks to a few months.
Your doctor will review your options with you for your specific vision and goals. There are many other glaucoma procedures that your doctor may recommend helping reduce the progression of this disease.