Glaucoma is an optic nerve disease, which is a common cause of visual loss or even total blindness. It has been called “The Sneak Thief in the Night” because in it’s typical form, it has no symptoms; no pain, no swelling, no redness. People with glaucoma may not know that anything is wrong until after vision has been permanently lost.
Glaucoma is usually associated with elevated pressure in the eye. This pressure is caused by a rate of fluid production inside the eye which is too much for the natural drainage mechanism to handle. It’s like blowing too much air into a balloon except that the eye can’t enlarge like a balloon so the pressure goes up. When the pressure gets too high, nerve cells die off and vision suffers. Early diagnosis and treatment can save vision.
We can think about glaucoma by creating different categories:
- Open Angle – The most prevalent kind of glaucoma which does damage slowly and silently.
- Narrow Angle – Which can be silent or can present as an acute attack characterized by extreme eye pain, headache, and possibly vomiting.
- Secondary Glaucoma- Which develops after an eye injury, disease, or even after taking some medicines.
- Congenital Glaucoma – This rare problem can put infants in danger of blindness even while they are still in the nursery.
Since glaucoma is an optic nerve disease, our practice includes sophisticated optic nerve tomography, (insert picture from Heidelberg) a three dimensional analysis of optic nerve volumes to more accurately assess progression of damage and alert the physician to treat the patient more vigorously.
Most glaucoma patients are treated with either medications in drop form or laser in our office or surgical center, however for the cases that don’t respond to laser or drops, our practice performs the following glaucoma surgeries:
- Viscocanalostomy with or without implant
- Express valve – a new innovative mini glaucoma shunt for selected refractory cases
If you’re seeing an optometrist for your glaucoma, you may want to explore some further options. Firstly, if you have a narrow angle, you should have that addressed. Then there are laser options to minimize drops, and if you have cataract, there are procedures that can be done during the cataract surgery to also better control your glaucoma.
The Istent procedure is a relatively new procedure to the USA introduced in this country in 2013. It has a several year history in Europe and Canada and we began performing it at the Mifflin County Community Surgery Center 6/13. It is approved by the Federal Drug Administration for use during cataract surgery for even well controlled glaucoma just to minimize the use of drops which of course can have long term side effects. It adds only a few minutes to the procedures and has an extremely low complication rate. Ask us about it if you’re considering cataract surgery in the near future.