Glaucoma

Eduardo Besser, MD

Ophthalmologist & Eye Surgeon located in Culver City, CA

Many people have glaucoma, yet they don’t experience vision problems until the disease has permanently damaged the optic nerve — which is why glaucoma accounts for 9-12% of all cases of blindness in the United States. Dr. Eduardo Besser is an expert in the diagnosis and treatment of glaucoma, including advanced minimally invasive glaucoma surgery. Getting a routine eye examination is the best way to detect glaucoma in its earliest stage, so don’t hesitate to call Dr. Besser’s office in the heart of Culver City, California, or book an appointment online.

Glaucoma Q & A

What is glaucoma?

Glaucoma is an umbrella term for a group of eye diseases that share a common pathology: they damage the optic nerve.

The optic nerve can’t repair itself, so the damage is permanent. When glaucoma is left untreated, optic nerve damage progresses, leading to vision loss and blindness.

What causes glaucoma?

Most cases of glaucoma are caused by high intraocular pressure (IOC), which is determined by the amount of aqueous humor in the eye. To maintain normal IOC, the amount of aqueous humor produced by the ciliary body must stay balanced with the amount that leaves through the eye’s primary drainage system, the trabecular meshwork.

IOC increases when there is excessive fluid in the eye. As pressure builds, the optic nerve is slowly damaged, leading to loss of peripheral vision, which is then gradually followed by loss of central vision and blindness.

What are the types of glaucoma?

Glaucoma may be congenital or develop from traumatic injury. The primary types include:

Primary open angle glaucoma (POAG)

POAG accounts for 70-90% of all glaucoma cases. It progresses slowly, remaining asymptomatic until nerve damage is severe enough to affect vision. The angle between the iris and cornea where fluid enters the trabecular meshwork is clear, but drainage is slow or blocked in the meshwork.

Angle-closure glaucoma

This type develops when the drainage angle becomes blocked by the iris. Angle-closure glaucoma can be acute or chronic. A sudden, acute attack is a medical emergency, as rapidly rising IOP can lead to permanent vision loss.

Normal tension glaucoma

Normal tension glaucoma is a form of primary open angle glaucoma that’s unique because the optic nerve is damaged even though IOP stays within a normal range.

How is glaucoma treated?

Treatment for glaucoma focuses on lowering IOP and keeping it within a normal range. For most patients, first-line treatment consists of medications that either decrease the production of aqueous humor or improve drainage.

Dr. Besser considers surgery when medication doesn’t control IOP. Two advanced surgical procedures performed by Dr. Besser are:

Selective laser trabeculoplasty (SLT)

As Dr. Besser applies laser energy to tissues in the trabecular meshwork, a chemical reaction is triggered, leading to biological changes that improve drainage. When used as an initial treatment, SLT lowers IOP by about 30%.

iStent®

Using minimally invasive glaucoma surgery, Dr. Besser can insert the cutting-edge iStent, a micro-sized medical device implanted into the eye, to bypass blockages in the trabecular meshwork. The stent connects the front part of the eye with drainage pathways beyond the trabecular meshwork.