In the US, it is estimated that over three million people have glaucoma, many of which are undiagnosed.
Since glaucoma comes with few warning signs, regular exams with an eye specialist are important for early detection and vision loss prevention. Many people have glaucoma, yet they don’t experience vision problems until it has permanently damaged the optic nerve.
Most cases of glaucoma are caused by high intraocular pressure (IOP), which is determined by the eye’s amount of fluid or aqueous humor.
The amount of aqueous humor produced in the eye must stay in balance with the amount that exits the eye’s primary drainage system, the trabecular meshwork.
If the fluid cannot drain naturally and begins to accumulate, the trapped fluid causes increased intraocular pressure over time. The mounting pressure slowly damages the optic nerve, leading to loss of peripheral and central vision, and, ultimately, blindness.
The optic nerve can’t repair itself, so damage is permanent.
There are numerous types of glaucoma, but the most common fall into two categories: open-angle and angle-closure.
Open-angle glaucoma represents the majority of cases. Open-angle glaucoma is asymptomatic — meaning it occurs without noticeable symptoms appearing. It can often go undiagnosed without proper checkups and worsen over time without treatment.
Angle-closure glaucoma is less common but more damaging and it is marked with a rapid rise in eye pressure.
A sudden, acute attack is a medical emergency, as rapidly rising IOP can lead to permanent, severe vision loss. Sudden decreased vision, eye pain, and sometimes nausea or vomiting are potential signs of angle-closure glaucoma.
Glaucoma management must be tailored to each patient individually. Dr. Besser will formulate the best treatment plan for your unique case after a thorough examination.
Glaucoma treatment focuses on lowering the intraocular pressure (IOP) of the eye, and keeping it within a range that will prevent further optic nerve damage. This can be achieved via
A number of medications are effective in lowering IOP. Prescription eye drops reduce high pressure either by decreasing the amount of aqueous humor created in the eye or by helping the fluid drain from the eye. Each one lowers IOP to a different degree.
You will need to be monitored periodically to ensure successful treatment.
Should medication be required to manage your glaucoma, Dr. Besser will recommend the optimal class of medications and make sure you understand how to apply the drops.
2. Selective Laser Trabeculoplasty (SLT)
Dr. Besser, your eye specialist in the Los Angeles area, has used SLT as an effective glaucoma management technique for over 15 years. He often recommends this treatment as a first-line therapy for his patients.
The SLT applies laser energy to tissues in the trabecular meshwork, which helps drain fluid from the eye and, subsequently, lower pressure. When used as an initial treatment, SLT lowers IOP by about 30% — without the need for eye drops.
Studies have shown that most patients do not use glaucoma medications as directed, which can cause the disease to progress. Lowering the intraocular pressure through a quick, painless in-office procedure allows for a safe way to control open-angle glaucoma.
3. Minimally Invasive Glaucoma Surgery (MIGS)
Patients whose glaucoma cannot be managed by medications or SLT often turn to traditional glaucoma surgeries. Some patients can definitely benefit from these procedures.
However, modern minimally invasive glaucoma surgeries (MIGS) have become the safest option, helping avoid potential complications associated with more invasive glaucoma treatment procedures.
MIGS procedures work by implanting microscopic-sized devices that facilitate drainage of built-up fluid, bypassing the trabecular meshwork. These devices are usually, though not always, implanted during cataract surgery. They are also indicated for mild and moderate glaucoma management.
Some examples of MIGS procedures performed by a glaucoma specialist are:
Using minimally invasive glaucoma surgery, Dr. Besser can insert the iStent Inject, a micro-sized medical device implanted into the eye — the smallest implantable device available for the human body — to bypass blockages in the trabecular meshwork.
The stent connects the front part of the eye with drainage pathways beyond the trabecular meshwork. The implanted stent is comfortable and unnoticeable. The patient does not see or feel it inside their eye.
Another MIGS procedure, this time passing a tiny device through the trabecular meshwork and into the Schlemm’s Canal, is the Hydrus Microstent implant.
This device also facilitates the drainage of the aqueous humor, reducing intraocular pressure. Once inserted, the stent is neither seen nor felt by the patient at all.
Using the Kahook Dual Blade, Dr. Besser removes a small segment of the trabecular meshwork in the eye.
This is the tissue that, in patients with glaucoma, prevents the aqueous humor from leaving the eye, leading to increased pressure and damage to the optic nerve.
By removing a portion of this meshwork, the fluid in the eye drains directly into the collector channels, lowering the intraocular pressure.
Unlike the iStent and the Hydrus stents, KDB Goniotomy may be performed in combination with cataract surgery or as a stand-alone procedure.