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Glaucoma

About Glaucoma

 

Many people have glaucoma, yet they don’t experience vision problems until the disease has permanently damaged the optic nerve. Since glaucoma comes with few warning signs, regular eye exams are important for detecting glaucoma early enough to prevent vision loss. If it’s been a while since your last exam, don’t hesitate to call our office in the heart of Culver City, or book an appointment online. Dr. Besser is an expert in the diagnosis and treatment of glaucoma, and our office is equipped with a full complement of advanced diagnostic equipment to evaluate and successfully manage this disease.

Glaucoma Q & A

What is glaucoma?

Glaucoma is a progressive disease of the eye that targets the optic nerve, usually associated with high pressure inside the eye. Left untreated, glaucoma can eventually lead to blindness. In the US, it is estimated that over three million people have glaucoma, many of which are undiagnosed.

What causes glaucoma?

Most cases of glaucoma are caused by elevated intraocular pressure (IOP), which is determined by the amount of fluid, or aqueous humor, inside the eye. 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 vision, loss of central vision and, ultimately, blindness. The optic nerve can’t repair itself, so damage is permanent.

What are the types of glaucoma?

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 all glaucoma 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.

 

  • Angle closure glaucoma is less common but more damaging, and 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 all potential signs of angle closure glaucoma.

 

How is glaucoma treated?

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 medications, laser treatment, or minimally invasive glaucoma surgery (MIGS) in combination with cataract surgery.

Glaucoma management must be tailored to each patient individually, and Dr. Besser will formulate the best treatment plan for your unique case after a thorough examination. 

Medications

A number of medications are effective in lowering IOP. These 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.

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. You will need to be monitored periodically to ensure successful treatment.

 

Selective laser trabeculoplasty (SLT)

Dr. Besser has used SLT as an effective glaucoma management technique for over 15 years, and 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 eyedrops. 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. 

 

Minimally Invasive Glaucoma Surgery (MIGS)

Patients whose glaucoma cannot be managed by medications or SLT often turn next to traditional glaucoma surgeries. Some patients can definitely benefit from these procedures. However, recent years have seen the development of minimally invasive glaucoma surgeries as a safer option, helping avoid some of the potential complications associated with more invasive glaucoma 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, and are indicated for mild and moderate glaucoma management. Some examples of MIGS procedures are:

 

iStent®

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. See the video below to learn more about this procedure.

 

Hydrus Microstent

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 out of the eye more easily, reducing intraocular pressure. Once inserted, the stent is neither seen nor felt by the patient at all. 

Kahook Dual Blade (KDB) Goniotomy

Using the Kahook Dual Blade, Dr. Besser removes a small segment of the trabecular meshwork in the eye. In patients with glaucoma, it is this tissue that 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 and lowers the intra-ocular pressure. Unlike the IStent and the Hydrus stents, which are implanted at the time of cataract surgery, KDB Goniotomy may be performed in combination with cataract surgery, or as a stand-alone procedure.