Glaucoma Treatment & Surgery

International Eye Associates

Offering the Best Options

If you are wondering about the best possible treatment plans for glaucoma, International Eye Associates can help you!

  • General Approach

    Glaucoma can cause permanent vision loss, but it is a disease that can usually be controlled. Treatment is designed to reduce the interocular pressure, which may stop or delay further nerve or vision damage. We may use eye drops, pills (rarely), laser, or surgery.

  • Glaucoma Surgery or Laser

    Various laser therapy measures treat glaucoma. Laser iridotomy creates an opening in the colored part of the eye (iris) to allow normal fluid flow in eyes with narrow or closed angles. Laser trabeculoplasty is performed only in eyes with open angles. It does not cure glaucoma but is opted instead of increasing the eye drops or when a patient’s intraocular pressure is too high despite multiple eye drops (maximal medical therapy). It can also be used as the initial or primary therapy for open-angle glaucoma.

  • Laser Trabeculoplasty

    A quick, painless, and relatively safe method of lowering intraocular pressure, Laser trabeculoplasty is applied through a mirrored contact lens to the angle of the eye with the eye numbed by anesthetic drops. Microscopic laser burns to the angle allow fluid to better exit the drainage channels. The treatment includes two sessions, weeks or months apart. Unfortunately, the improved drainage may last about a couple of years, by which time the drainage channels tend to clog again.

    There are two types of laser trabeculoplasty: argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). ALT generally does not have a second session due to scar tissue formation in the angle. SLT is less likely to produce scarring in the angle, so, theoretically, the process can be repeated. However, the likelihood of success with additional treatments when prior attempts have failed is low. Thus, the options for the patient at that time are to increase the use of eyedrops or proceed to surgery.

  • Laser Cyclo-Ablation

    Also known as ciliary body destruction, cyclophotocoagulation, or cyclocryopexy, laser cyclo-ablation is a laser treatment generally reserved for severe glaucoma patients with poor visual potential. It involves applying laser burns or freezing the eye part that makes the aqueous fluid (ciliary body). This therapy destroys the cells that make the fluid, thereby reducing the eye pressure. It is typically performed after other more traditional therapies have failed.

  • Glaucoma Surgery

    Trabeculectomy is a delicate microsurgical glaucoma treatment procedure. A small piece of the clogged trabecular meshwork is removed to create an opening, and a new drainage pathway is made to release the fluid. The new drainage system has a tiny collecting bag created from conjunctival tissue (the conjunctiva is the clear covering over the white of the eye.) called a “filtering bleb.” It looks like a cystic raised area at the top part of the eye under the upper lid. It allows fluid to leave the eye, enter the bag/bleb, and then pass into the capillary blood circulation (thereby lowering the eye pressure). Trabeculectomy is the most commonly performed glaucoma surgery. Its success ensures lowered eye pressure.

  • Aqueous Shunt Devices

    These devices, glaucoma implants, or tubes are artificial drainage means to lower eye pressure. They are essentially plastic microscopic tubes attached to a plastic reservoir or plate placed beneath the conjunctival tissue. The actual tube (which extends from the reservoir) is placed inside the eye to release the fluid from the eye. It collects within the reservoir beneath the conjunctiva creating a filtering bleb. This procedure is an alternative to trabeculectomy in patients with certain types of glaucoma.

  • Viscocanalostomy

    An alternative surgical procedure to lowering eye pressure involves removing a sclera (eyewall) piece to leave only a thin membrane of tissue through which aqueous fluid can more easily drain. While it is less invasive than trabeculectomy and aqueous shunt surgery, its success rate is minimal. The surgeon often creates different drainage systems. While glaucoma surgery is often effective, complications, such as infection or bleeding, are possible. Accordingly, surgery is usually reserved for extreme cases.

  • What is Glaucoma?

    Glaucoma is a disease of the major nerve of vision, called the optic nerve. It receives light-generated nerve impulses from the retina and transmits these to the brain, recognizing the signals as vision. The ailment has a specific pattern of progressive damage to the optic nerve that generally begins with a subtle loss of side vision (peripheral vision). If glaucoma is not diagnosed and treated, it can progress to loss of central vision and blindness.

    Glaucoma is often associated with elevated pressure in the eye (intraocular pressure), which generally damages the eye (optic) nerve. In some cases, glaucoma may occur in the presence of normal eye pressure, which is caused by poor blood flow regulation to the optic nerve.

  • What Causes Glaucoma?

    High eye pressure is the primary factor leading to glaucomatous damage to the eye (optic) nerve. The optic nerve, located in the back of the eye, is the main visual nerve for the eye. It transmits the images we see back to the brain for interpretation. The eye is firm and round, like a basketball. A pressure maintains its tone and shape within the eye (the intraocular pressure), which normally ranges between 8 mm and 22 mm of mercury. At low pressures, the eye becomes softer, while elevated pressure makes the eye harder. The optic nerve is the most susceptible part of the eye to high pressure because the delicate fibers in this nerve are easily damaged.

    The front of the eye is filled with a clear fluid called the aqueous humor, which nourishes the structures. This fluid is produced constantly by the ciliary body surrounding the eye lens. The aqueous humor then flows through the pupil and leaves the eye through tiny channels called the trabecular meshwork located at the eye’s drainage angle.

    This angle is where the clear cornea, which covers the front of the eye, attaches to the iris’ base (root or periphery), the colored part of the eye. The cornea covers the iris and the pupil at the front of the lens. The pupil is the small, round, black-appearing opening in the center of the iris. Light passes through it, on through the lens, and to the retina at the back of the eye.

    In most people, the drainage angles are wide open, although, in some individuals, they can be narrow. For example, the usual angle is about 45 degrees, whereas a narrow-angle is about 25 degrees or less. After exiting through the trabecular meshwork in the drainage angle, the aqueous fluid then drains into tiny blood vessels (capillaries) into the main bloodstream. The aqueous humor should not be confused with tears, which are produced by a gland outside of the eyeball itself.

    Producing and removing the fluid from the eye can be understood with the operation of a sink – faucets are turned on, producing and draining the water. If the sink’s drain becomes clogged, the water may overflow. Similarly, if a closed system like the eye is unable to overflow, the pressure in the sink would rise. Likewise, if the eye’s trabecular meshwork becomes clogged or blocked, the intraocular pressure may become elevated.

    Also, if the sink’s faucet is on too high, the water may overflow. Again, if this sink were a closed system, the pressure within the sink would increase. Likewise, if too much fluid is being produced within the eye, the intraocular pressure may become too high. In either event, since the eye is a closed system, the pressure builds up if it cannot remove the increased fluid, and optic-nerve damage may result.

  • What are Glaucoma Risk Factors?

    Glaucoma is often called “the sneak thief of sight” because, mostly, the intraocular pressure can build up and destroy sight without causing obvious symptoms. Thus, awareness and early detection are extremely important for successful treatments. While everyone is at risk for glaucoma, certain people are at a much higher risk and need to be checked more frequently by their eye doctor. The major risk factors for glaucoma include the following:

    • Age over 45 years
    • Family history of glaucoma
    • Black racial ancestry
    • Diabetes
    • History of elevated intraocular pressure
    • Nearsightedness (high degree of myopia), which is the inability to see distant objects clearly
    • History of injury to the eye
    • Use of cortisone (steroids), either in the eye or systemically (orally or injected)
    • Farsightedness (hyperopia), which is seeing distant objects better than close ones (Farsighted people may have narrow drainage angles, which predispose them to be acute [sudden] attacks of angle-closure glaucoma.)
  • What are Glaucoma Symptoms & Signs?

    Open-angle and chronic angle-closure glaucoma patients do not have any symptoms early in the course of the disease. Visual field loss (side vision loss) is felt late in the disease course. Rarely patients with fluctuating levels of intraocular pressure may have haziness of vision and see haloes around lights, especially in the morning.

    Interestingly, acute angle-closure can have extremely dramatic symptoms, with the rapid onset of severe eye pain, headache, nausea and vomiting, and visual blurring. Occasionally, nausea and vomiting exceed the ocular symptoms to the extent that an ocular cause is not contemplated.

    The eyes of patients with open-angle glaucoma or chronic angle-closure glaucoma may appear normal in the mirror or to family or friends or slightly red from the chronic use of eye drops. On examination, the ophthalmologist may find elevated intraocular pressure, optic nerve abnormalities, or visual field loss in addition to other less common signs.

    The eyes of patients with acute angle-closure glaucoma will appear red, and the pupil of the eye may be large and nonreactive to light. The cornea may appear cloudy to the naked eye. The ophthalmologist will typically find decreased visual acuity, corneal swelling, highly elevated intraocular pressure, and a closed drainage angle.

  • How Often Should Someone be Checked (Screened) for Glaucoma?

    Please note the American Academy of Ophthalmology’s recommended intervals for eye exams:

    • Age 20-29: Individuals of African descent or with a family history of glaucoma are advised eye examination every three to five years and at least once during this period for others.
    • Age 30-39: Individuals of African descent or with a family history of glaucoma are advised eye examination every two to four years and at least once during this period for others.
    • Age 40-64: Individuals should have an eye examination every two to four years.
    • Age 65 or older: Individuals should have an eye examination every one to two years.

    Regular screening eye examinations encourage glaucoma awareness since it usually causes no symptoms (asymptomatic) in its early stages. Once damage to the optic nerve has occurred, it cannot be reversed. Thus, to preserve vision, early diagnosis of glaucoma is recommended with a routine checkup. Patients with glaucoma need to be aware that it is a lifelong disease. Compliance with scheduled visits to the eye doctor and prescribed medication regimens offers the best chance for maintaining vision.