Glaucoma / MIGS

Glaucoma is a disease of the optic nerve, which transmits the images you see from the eye to the brain. The optic nerve is made up of many nerve fibers (like an electric cable with its numerous wires). Glaucoma damages nerve fibers, which can cause blind spots and vision loss.

Glaucoma has to do with the pressure inside the eye, known as intraocular pressure (IOP). When the aqueous humor (a clear liquid that normally flows in and out of the eye) cannot drain properly, pressure builds up in the eye. The resulting increase in IOP can damage the optic nerve and lead to vision loss.

The most common form of glaucoma is primary open-angle glaucoma, in which the aqueous fluid is blocked from flowing back out of the eye at a normal rate through a tiny drainage system. Most people who develop primary open-angle glaucoma notice no symptoms until their vision is impaired.

Ocular hypertension is often a forerunner to actual open-angle glaucoma. When ocular pressure is above normal, the risk of developing glaucoma increases. Several risk factors will affect whether you will develop glaucoma, including the level of IOP, family history, and corneal thickness. If your risk is high, your ophthalmologist may recommend treatment to lower your IOP to prevent future damage.

In angle-closure glaucoma, the iris (the colored part of the eye) may more over and completely close off the drainage angle, abruptly blocking the flow of aqueous fluid and leading to increased IOP or optic nerve damage. In acute angle-closure glaucoma there is a sudden increase in IOP due to the buildup of aqueous fluid. This condition is considered an emergency because optic nerve damage and vision loss can occur within hours of the problem. Symptoms can include nausea, vomiting, seeing halos around lights, and eye pain.

Even some people with “normal” IOP can experience vision loss from glaucoma. This condition is called normal-tension glaucoma. In this type of glaucoma, the optic nerve is damaged even though the IOP is considered normal. Normal-tension glaucoma is not well understood, but lowering IOP has been shown to slow progression of this form of glaucoma.

Childhood glaucoma, which starts in infancy, childhood, or adolescence, is rare. Like primary open-angle glaucoma, there are few, if any, symptoms in the early stage. Blindness can result if it is left untreated. Like most types of glaucoma, childhood glaucoma may run in families. Signs of this disease include:

• clouding of the cornea (the clear front part of the eye);
• tearing; and
• an enlarged eye

Your ophthalmologist may tell you that you are at risk for glaucoma if you have one or more risk factors, including having an elevated IOP, having a family history of glaucoma, taking certain medications, having a thin cornea, are of a particular ethnic background, or are of advanced age. Regular examinations with your ophthalmologist are important if you are at risk for this condition.

The goal of glaucoma treatment is to lower your eye pressure to prevent or slow further vision loss. Your ophthalmologist will recommend treatment if the risk of vision loss is high. Treatment often consists of eye drops but can include laser treatment or surgery to create a new drain in the eye. Glaucoma is a chronic disease that can be controlled but not cured. Ongoing monitoring sometimes as much as three or four times a year is often needed to watch for changes. Ask your ophthalmologist if you have any questions about glaucoma or your treatment.

At Connecticut Eye Specialists we utilize several procedures to lower eye pressure when eye drops have failed to control the problem. These include:

Laser Iridotomy

Laser Trabeculoplasty (Diode and SLT)

These are done in the office or for SLT at a surgical center near the office. There is no pre-operative testing needed and no special way to prepare. These are not painful and normal activity is resumed immediately. Patients tend not need post-operative drops to recover. Patients can drive post-procedure but if there is someone available to drive you this is ideal.

Iridex micropulse

Continuous Wave cyclophotocoagulation

These are both procedures that are done under light sedation in the Surgical Center. They require no pre-operative testing but patients do need to fast pre procedure. Medications aside from those for diabetes can be taken the day of the procedure with a small amount of water. Patients must have someone to drive them home. Normal activity can be resumed immediately after the first post-operative visit.

Hydrus microshunt

Trabeculectomy (With and without cataract surgery)

Glaucoma Drainage Device Implant surgery

These surgeries are done under topical anesthesia with mild sedation as an outpatient procedure at the hospital or ambulatory surgery center. They require no pre-operative testing but patients do need to fast pre procedure. Medications aside from those for diabetes can be taken the day of the procedure with a small amount of water. Patients must have someone to drive them home. Patient may resume light activity after surgery until given further instructions. Avoid heavy lifting or straining. You will need to sleep with an eye shield for several weeks. There are often sutures that are removed after a few weeks in the office without significant discomfort.

For more information, please take Dr. Sokol’s “Glaucoma Patient Survey”.