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Glaucoma

Glaucoma Treatment and Surgery

Glaucoma is a group of eye diseases that that may lead to severe optic nerve damage and can even cause loss of vision. In the U.S., treatment for glaucoma is one of the most commonly performed procedures when people face blindness or gradual vision loss.

When diagnosed at early stages, glaucoma treatment and timely glaucoma surgery can prevent optic nerve damage and thus vision loss. So make sure the optic specialist revises your intraocular pressure at the regular check-up!

Symptoms, causes and treatments for glaucoma depend on the type of the condition. It can fall into two categories:

  • Primary open-angle glaucoma
  • Angle-closure glaucoma

Both types are called primary when the cause is unknown and secondary when the cause is identifiable such as injury, medication, diabetes, eye conditions, inflammation, tumor or advanced cataract.

It is important to visit a doctor when some of the following symptoms appear:

  • Blurred vision
  • Red eyes
  • Eye pain
  • Nausea
  • Halos
  • Severe headache

Causes and Diagnostic Tests for Glaucoma

Intraocular pressure and optic nerve damage characterizes glaucoma due to a buildup of a fluid called aqueous humor which flows through a drainage system. When the system does not work properly, pressure increases within the eye.

Primary open-angle glaucoma shows that the drainage channels are partially blocked, causing the fluid to back up in the eye. The damage to the optic nerve does not cause pain so symptoms take long to appear. On the other hand, angle-closure glaucoma occurs when the pressure increases abruptly:

  • Acute angle-closure glaucoma – when the blocking occurs suddenly
  • Chronic angle-closure glaucoma – when the blocking occurs gradually.

In order to diagnose glaucoma, the doctor reviews the medical history and performs an extensive eye examination. Some common tests for diagnosis are:

  • Tonometry – to measure intraocular pressure
  • Pachymetry – measures cornea thickness
  • Optic nerve damage test – using instruments to look through the pupil
  • Visual field and visual acuity – tests to evaluate peripheral vision and the ability to see from distance.

Treatment for Glaucoma – Drugs and Glaucoma Laser Surgery

In order to lower pressure in the eye and improve fluid drainage, doctors can prescribe a treatment and regular checkups to prevent vision loss, nevertheless glaucoma cannot be cured and the damage is irreversible. Treatment for glaucoma can only slow it down.

The most common treatments for glaucoma are eye drops, oral medication, and surgery.

 

Eyedrops

It is the first step in the treatment, and prescription should be followed strictly. The most common prescribed eye drops are:

  • Beta blockers – reduce fluid production (Timoptic, Betimol). Some side effects include slowed heart rate and lower blood pressure, fatigue, difficulty breathing.
  • Prostaglandins – increase outflow of the aqueous humor and reduces pressure (Xalatan, Lumigan).
  • Alphan-adrenergic agonists – reduce the production of aqueous humor (Lopidine, Alphagan).
  • Miotic agents and Carbonic anhydrase inhibitors – increase the outflow and reduce fluid production. Doctors might prescribe a combined medication.

 

Oral medications

If the treatment with eye drops does not help to lower the pressure, oral medication might be recommended.

Glaucoma Surgery

When patients are unable to tolerate medications or if they remain ineffective, with a single or several surgical procedures the condition can be improved. Some patients must also combine surgery for glaucoma along with eye drops and/or oral medication.

Some complications include inflammation, infection, bleeding and loss of vision. There are three kinds of surgery for glaucoma.

  • Glaucoma Laser Surgery or laser trabeculoplasty is an outpatient procedure. High-energy laser is used to beam the clogged drainage channels and help them drain more easily. During the follow-up the doctor checks the pressure until the results settle. Results for glaucoma laser surgery, as expected, are never permanent.
  • Filtering surgery or trabeculectomy is also an outpatient microscope-aided procedure. The surgeon creates an opening in the sclera, removes small pieces of eye tissue, and now the fluid can leave the eye through the opening. After several weeks of glaucoma surgery in one eye, the other one follows.
  • Drainage implants are used for advanced glaucoma, secondary glaucoma or for children. The surgeon inserts a small tube in the eye to reduce pressure.