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Several glaucoma treatment options exist and the choice of which treatment strategy to pursue can depend on which type of glaucoma exists. At the root of most glaucoma treatments is the goal of lowering eye pressure or treating the eye to prevent possible eye pressure increase.
There are numerous eye drops that exist to treat glaucoma. All prescribed on a daily schedule, used 1-3 times per day depending on the medication. Oral medication to manage glaucoma do exist but generally are used as second line agents or to be used in short term emergency situations, due to the systemic side effects they can cause.
The FDA has mandated a color-coding of the bottle tops to help patients, doctors and pharmacists to better identify the various drops available to treat glaucoma. All brand name drops and some generics adhere to these guidelines.
Glaucoma Laser Surgery
There are many different types of glaucoma laser, all with only one objective, to help lower intraocular pressure and/or prevent future glaucoma damage. Glaucoma lasers will generally have no impact on your vision. They will not improve your vision nor eye glass prescription. The 2 most commonly used glaucoma lasers include:
Laser Peripheral Iridotomy (LPI) is a laser treatment applied to the iris of the eye for patients who have narrow drainage angles and are at risk of having an angle closure attack.
Will laser peripheral iridotomy need to be repeated? Done properly LPIs generally never need to be repeated. Although in rare instances they can close in which case its necessary.
Selective Laser Trabeculoplasty (SLT) is a laser treatment applied to the drainage system of the eye. The treatment takes less than 60 seconds to perform in most office settings without the need for an operating room.
How does SLT work differently than glaucoma eye drops? Most glaucoma eye drops lower intraocular pressure by decreasing aqueous fluid production (turning the water faucet in the eye down). On the other had SLT improves the drainage outflow of the eye. Because of that difference in most instances using both glaucoma eye drops and SLT is synergistic in lowering intraocular pressure.
How long does SLT effects last? The lowering intraocular pressure effect of SLT will generally last 1 to 2 years. Varying person to person.
Can SLT be repeated? SLT can be repeated as many times as necessary generally without leaving in long term ocular damage or scarring.
There are several surgical procedures used to reduce pressure in the treatment of glaucoma. Historically surgical options for glaucoma have been the third line of treatment after topical medicines or laser surgical procedures due to the high complication and surgical failure rates for incisional glaucoma surgery. Fortunately, newer surgical options called MicroInvasive Glaucoma Surgery (MIGS) are now available at the time of cataract surgery that have revolutionized the management of glaucoma, potentially reducing the number of glaucoma eye drops and lowering your intraocular pressure.
Incisional Glaucoma Surgery
Incisional glaucoma surgeries involve our ophthalmologists making tiny cuts, also known as incisions, into the white part of the eye (the sclera) and either creating a filtration system (Trabeculectomy) or placing an external drainage system (Baerveldt, Ahmed or Molteno Tube).
Both surgeries are generally reserved as last option resort due to their need to be performed in a surgery center, and their long healing process and potential complications.
MicoInvasive Glaucoma Surgery (MIGS)
MIGS procedures are glaucoma surgeries that are combined with cataract surgery to help lower intraocular pressure and manage glaucoma.
The advantage to MIGS procedures as compared to incisional glaucoma surgery include:
- Lack of additional incisions other than the ones already being performed for the cataract surgery.
- Direct impact on the eye’s drainage system.
- Rapid recovery and improved safety profile.
MIGS procedures currently approved by the FDA include: Glaukos iStent, Alcon CyPass, Allergan XEN and Sight Sciences VISCO360 and TRAB360. Our doctors will determine which MIGS procedures makes sense for you.
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What is Glaucoma?
Glaucoma is a condition where the pressure inside the eye (also called intraocular pressure) is elevated, causing damage to the optic nerve (the nerve that connects the eye to the brain).
Narrow Angle Glaucoma
Narrow-angle glaucoma occurs when the colored portion of your eye (iris) is pushed or pulled forward causing blockage of the drainage angle of the eye, leading to a rise in intraocular pressure.
Open Angle Glaucoma
In early Primary open-angle glaucoma (POAG) there are generally no warning signs — no pain or vision loss. But by the time one notices something is wrong, the disease has advanced significantly.