Gulf Coast Eye Care

Glaucoma

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GLAUCOMA RISKS, DIAGNOSIS, AND TREATMENT IN TAMPA BAY AND ST. PETERSBURG

The experienced eye doctors at Gulfcoast Eye Care specialize in diagnosing and treating glaucoma in the Tampa Bay area. Our glaucoma specialists believe that patient education is the key to proper management of glaucoma. Learn more about glaucoma, including risk factors and treatment options, and contact us with any questions or to schedule an appointment in Pinellas Park, Palm Harbor, or St. Petersburg.

What is Glaucoma?

Glaucoma is an eye disease in which increased eye pressure causes damage to the optic nerve. Glaucoma causes permanent loss of peripheral (side) vision and can lead to blindness if left untreated. Glaucoma is the second leading cause of blindness worldwide and millions of people in the world go blind from this problem every year. This disease is especially dangerous since many people do not know that they are affected and it is often called the “sneak thief” of sight. While there is no cure for glaucoma, it can be controlled with lifelong eye care.

Who is at risk for Glaucoma?

Anyone can develop glaucoma, but studies show that there are risk factors that increase a person’s risk. Glaucoma risk factors include:

  • 60 years or older in age
  • High eye pressure
  • Family history of glaucoma
  • African American ancestry
  • Hispanic or Latin American ancestry
  • Type 2 diabetes
  • Severe nearsightedness

What are the types of glaucoma?

There are more than 30 different types of glaucoma. These types have different characteristics, are more common in certain ethnic backgrounds, and can have different recommended treatments. Many of the forms of glaucoma are based on the access to the part of the eye called the “Angle”. The angle is where the internal drainage system of the eye is located. This internal drainage system is different from the external drainage system where our tears drain. The only way to determine if you have glaucoma and what type is to undergo a complete ocular examination. Some of these types of glaucoma include:

  • Primary Open Angle Glaucoma: This common type of glaucoma is more prevalent in patients of African-American and Hispanic descent. It is characterized by open access to the eye’s internal drainage system (the angle) but the drainage system does not work well. This type of disease can often cause vision loss without the patient feeling any changes. It is important to have regular eye exams in order to diagnose and treat glaucoma early.
  • Acute Angle Closure Glaucoma: This type of glaucoma is caused by a sudden rise in eye pressure from a blockage of the eye’s internal drainage system called the “angle”. This sudden high eye pressure usually causes eye pain and redness, blurred vision, and sometimes nausea and vomiting. If the eye pressure is not lowered quickly, it can cause permanent vision loss. Certain medications can increase the risk of developing this condition. A complete eye exam can identify if you are at risk for angle closure glaucoma and a laser procedure can be performed to prevent vision loss from this type of glaucoma.
  • Chronic Angle Closure Glaucoma: This type of glaucoma is more common in the Asian population. It is characterized by a slow progressive blockage of the eye’s internal drainage system.
  • Pseudoexfoliation Glaucoma: This is a type of glaucoma in which a protein is deposited all over within the eye. This protein can affect the internal drainage system and create high eye pressures. It also deposits on the lens of the eye and it’s support structure. This can make cataract surgery more challenging.
  • Pigmentary Glaucoma: This type of glaucoma is characterized by pigment being released from the colored part of the eye – the iris. It is more common in near-sighted men in their 20-30’s. This pigment can settle in and block the drainage system causing high eye pressures.
  • Neovascular Glaucoma: This type of glaucoma has abnormal blood vessels growing over the eye’s internal drainage system and causing glaucoma. There are multiple causes for these blood vessels to start growing including poorly controlled diabetes and hypertension.

HOW IS GLAUCOMA DIAGNOSED?

There is not one single test that can easily diagnose glaucoma. Proper diagnosis of glaucoma requires a complete eye examination with a variety of testing. Your glaucoma examination can include measuring eye pressure, examining the angle with a technique called gonioscopy, testing for side vision loss, and checking for any optic nerve damage. The purpose of these exams is to establish the diagnosis of glaucoma and to develop a treatment plan designed for each individual patient. Early detection of this disease is so important to prevent any loss of vision. Repeated eye exams are needed to check for the development of glaucoma, especially if a patient has multiple risk factors. Unfortunately, far too many people are diagnosed after they have already lost some vision from glaucoma.

Adults without any risk factors, family history, or symptoms, should undergo a complete eye exam by the age of 40. Your eye physician will recommend the timing for your next follow up exam. Adults who are 65 or older, should undergo complete eye exams every 1-2 years to examine for disease, or as recommended by your eye physician.

How do you monitor and treat Glaucoma?

The purpose of glaucoma monitoring and treatment is to maintain the health of the optic nerve and to prevent vision loss. Since glaucoma is a progressive disease, it requires constant monitoring to maintain control of the disease. With control, it is possible to prevent vision loss from glaucoma. There are multiple treatment types for glaucoma including medications and surgery. Currently, the main purpose of treatment is to lower eye pressure to control the disease. Medications such as eye drops are very effective and are commonly used as the initial treatment, unless contraindicated. There are also laser procedures that are designed to lower the eye pressure and may also be used as the initial treatment. If medications and laser procedures are unable to control glaucoma, glaucoma surgeries to create new drainage systems for the eye may be needed. The patient and the physician work together to develop a treatment plan for each individual patient. It takes a lifetime of work to keep glaucoma under control but it is a worthwhile effort to preserve vision and quality of life.

LASER TREATMENT FOR GLAUCOMA

We offer several types of non-surgical laser treatments for glaucoma. Your eye doctor will discuss which options may be best for you depending on your eye health and your particular type of glaucoma.

Laser Peripheral Iridotomy
The laser peripheral iridotomy procedure, also known as LPI, is often recommended for treating narrow-angle glaucoma. This procedure prevents or corrects a pupillary blockage and relieves eye pressure by allowing intraocular fluid to pass to the anterior chamber from the posterior chamber of the eye. The LPI treatment is painless, as the eyes are numbed with anesthetic eye drops. A special laser is used on the iris of the eye and your eye pressure will be checked within an hour. You may experience temporary blurry vision or mild discomfort, but should resolve within a day or so.

Selective Laser Trabeculoplasty
Selective Laser Trabeculoplasty (SLT) is a well-established laser treatment to stop or slow the progression of open-angle glaucoma in order to limit or prevent vision loss. During this procedure, eye drops will be applied and then a special contact lens will be placed on the eye. Your eye doctor will then direct a specialized laser that is designed to target the eye’s drainage system in order to increase drainage function. SLT has been shown to deliver up to a 35% reduction in intraocular pressure.1 For some patients, SLT may be an option instead of, or in addition to, medications.

MINIMALLY INVASIVE GLAUCOMA SURGERY (MIGS)

When medications or laser treatments fail to consistently relieve the elevated eye pressure associated with glaucoma, your eye doctor may recommend minimally invasive glaucoma surgery (MIGS).

iStent (Or iStent Inject)®
The iStent® Trabecular Micro-Bypass is a procedure designed to help cataract surgery patients who are also affected by mild to moderate open-angle glaucoma. Implanted inside the eye to reduce pressure and slow the progression of glaucoma, iStent® is the smallest device ever approved by the U.S. Food and Drug Administration. After an intraocular lens (IOL) has been placed during cataract surgery, the iStent® is inserted to allow better drainage of excess liquid from the eye. The small titanium implant is designed to treat glaucoma without causing eye irritation or harming surrounding tissue.

At Gulfcoast Eye Care, Dr. Manning offers the most recent advancement in iStent technology – the iStent Inject. The iStent Inject optimizes fluid outflow by creating not one, but two pathways for drainage of excess fluid. Studies show a significant decrease in intraocular pressure after surgery with iStent Inject.2

The iStent® implant can make it possible to reduce, and even eliminate, the need for expensive medications to control glaucoma. Dr. Michael Manning at Gulfcoast Eye Care will evaluate your condition and help you determine if you are a candidate for the iStent® procedure.

Hydrus Microstent
The Hydrus Microstent utilizes a multifaceted approach to improve glaucoma. This microstent is placed during cataract surgery and is intended for patients with mild to moderate open-angle glaucoma. The Hydrus increases the size of the Schlemm’s canal, which is part of the eye’s natural drainage system, while fluid also flows through the insert. Hydrus provides 90 degree coverage in order to ensure excess fluid is able to drain in order to reliably lower intraocular pressure. One study of patients who received the Hydrus Microstent showed that 24 months after surgery, 77% experienced a significant decline in intraocular pressure.3

Xen® Gel Stent
The Xen Gel Stent is a tiny, flexible implant that is designed to treat mild to moderate open angle glaucoma. Xen Gel Stent works to reduce eye pressure by creating a permanent channel for fluid to drain. This innovative device is about the size of an eyelash and it is made of porcine gelatin. It is surgically placed just under the surface of the white of the eye, in a quick procedure that does not require stitches.

Studies show that Xen Gel Stent reduces eye pressure by approximately 30% and allows patients to reduce medication by 75%.4 This minimally invasive surgical treatment may be an option for patients who have glaucoma that has not responded to medication or other treatment. Schedule a consultation with Dr. Michael Manning at Gulfcoast Eye Care to determine if Xen Gel Stent could be right for you.

Glaucoma Surgery (Trabeculectomy)

Trabeculectomy, also called glaucoma filtration surgery, is a procedure to reduce intraocular pressure by surgically creating alternative drainage for excess fluid. Trabeculectomy may be recommended to patients for whom medications or other procedures have failed to lower eye pressure. During this procedure, the eye surgeon will create a small drainage path at the top of your eye, underneath your eyelid. Sutures will be placed to hold the new pathway open during the healing process. This surgery cannot cure glaucoma, but according to the International Glaucoma Association, it is successful in lowering intraocular pressure to slow the progression of the disease for 90% of patients.

1Wong MO, Lee JW, Choy BN, et al. Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma. Surv Ophthalmol 2015; 60:36–50
2Hengerer FH. Personal Experience with Second-Generation Trabecular Micro-Bypass Stents in Combination with Cataract Surgery in Patients with Glaucoma: 3-Year Follow-up. ASCRS 2018 Presentation.
3Samuelson, TW. Chang DF. Marquis, R. A Schlemm Canal Microstent for Intraocular Pressure Reduction in Primary Open-Angle Glaucoma and Cataract. Ophthalmology. January 2019Volume 126, Issue 1, Pages 29–37
4Reitsamer HA, Lenzhofer M, Hohensinn M, Höh. Ab Interno Approach to Subconjunctival Space: First 567 Eyes Treated With New Minimally Invasive Gel Stent for Treating Glaucoma. Paper presented at: ASCRS 2015. ASCRS/ASOA Annual Symposium and Congress; 2015 Apr 17-21; San Diego, CA.

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