Glaucoma Evaluation & Laser Treatment

Glaucoma is the leading cause of blindness and visual impairment in the US, 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. In a healthy eye, fluid produced by the ciliary body circulates forward and drains through tiny passages called the trabecular meshwork. In people with glaucoma, these passages become blocked and intraocular pressure rises.

There are two main types of glaucoma: open-angle and angle-closure. Open-angle glaucoma is the most common type of glaucoma and involves fluid in the eye not draining properly through the trabecular meshwork. Angle-closure glaucoma involves a sudden buildup of pressure in the eye and poor drainage because the angle between the iris and the cornea is too narrow.

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, along with sudden eye pain, headache, blurred vision or the appearance of halos around lights.

Diagnosing Glaucoma

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 and visual acuity test. These tests measure peripheral vision and how well patients can see at various distances. Other tests may also be performed, such as tonometry to measure the pressure inside the eye and pachymetry to measure the thickness of the cornea.

Treatment 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. Some cases of glaucoma can be treated with medications. For others, laser or traditional surgery is required to lower eye pressure. Common surgeries include:

• Selective Laser Trabeculoplasty (SLT) – For patients with primary open angle glaucoma (POAG). The trabecular passages are opened to increase fluid. SLT is highly effective and may be repeated.
• Laser Peripheral Iridotomy (LPI) – For patients with narrow-angle glaucoma. A small hole is made in the iris to increase the angle between the iris and cornea and encourage fluid drainage.
• Filtering Microsurgery (Trabeculectomy) – For patients who have not been helped with laser surgery or medications. A new drainage passage is created by cutting a small hole in the sclera (the white part of the eye) and creating a collection pouch between the sclera and conjunctiva (the outer covering of the eye).
• Tube Shunt Surgery – May be recommended for patients with neovascular glaucoma, failed trabeculectomy, or susceptibility to developing scar tissue. A thin, flexible tube (a shunt) with a silicone pouch is inserted in the eye to facilitate drainage.
• Nd: YAG Laser Cyclophotocoagulation (YAG CP) – For patients with severe glaucoma damage who have not been helped with other surgeries. The ciliary body that produces intraocular fluid is destroyed.

Preventing Glaucoma

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

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 and how you can be tested for this serious condition, please call us today to schedule an appointment with one of our doctors.

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