Glaucoma Surgery & Treatment

Glaucoma is a common condition where increased pressure within the eye causes damage to the optic nerve. It can affect anyone but is more common in those aged 60+. The condition is the result of increased fluid in the front element of the eye and, if not treated, can lead to loss of vision. The optic nerve is the link between the eye and the brain.

West Boca Eye center | Glaucoma Surgery & Treatment

For optimal vision, this pathway must work uninhibited.

In the early stages of glaucoma, most people are asymptomatic, meaning that the only way the condition is diagnosed is through regular eye checks. While this can occur in anyone, the condition is known to be hereditary. This means if an immediate member of your family has glaucoma then this places you at a higher risk of developing the condition.

How Do I Know if I Need Glaucoma Surgery?

The most common form of glaucoma, known as open-angle glaucoma, usually affects both eyes. The early stages don’t cause any noticeable symptoms. The condition is caused by a blockage that affects the circulation of the aqueous humor (the fluid in the eye) that flows in and out of the eye. This causes the pressure within the eye to rise. The condition usually develops slowly over several years, first affecting the peripheral vision.

Because of the slow progression, many people aren’t aware that their vision’s becoming impaired. For this reason, it’s normally picked up during a regular eye test or when your medical doctor determines you may be at risk and refers you to a glaucoma specialist. While it’s unclear as to why some people develop the condition, the following are known to be risk factors:

Your ethnicity: Glaucoma is more common in those of Asian, African, Caribbean, and Hispanic descent.
Your age: The condition becomes more common as you age. It’s less common in those aged under 40 (although not unknown, and, rarely, children can also be affected).
Your family history: It’s known to be hereditary, so the risk factor is increased if a member of your immediate family has been diagnosed.
You suffer from the following medical conditions: Hypertension (high blood pressure), diabetes, heart disease, or sickle cell anemia.
You’ve been diagnosed with the following eye conditions: Thin corneas, high eye pressure, severe near or far-sightedness, or have a significant history of poor vision.
You regularly take high doses of certain steroid medications: Such as prednisolone.

Other, less common, forms of glaucoma include:

Closed-angle glaucoma: This occurs when the drainage of the eye fluid suddenly becomes blocked, causing a rapid increase in pressure within the eye. It’s caused by the iris (the colored part of the eye) changing position. It tends to happen in one eye and, when it occurs very quickly, is a medical emergency. When one eye has been affected the other eye is also at risk.
Secondary glaucoma: This is due to a separate underlying condition, such as uveitis (an inflammatory condition of the eye), cataracts, or diabetes.
Childhood glaucoma: Also called congenital glaucoma, it’s a rare condition that develops at a young age. It’s caused by an abnormality of the eye.

What Happens During Glaucoma Surgery?

There are a variety of surgical treatments, all of which aim to reduce the pressure within the eye. If glaucoma eye surgery is deemed appropriate then a specialist has a range of options available. The choice will be determined by the type of glaucoma, its severity, and any other health issues you have.

Glaucoma laser surgery and eye surgery treatment possibilities include:

Selective laser trabeculoplasty (SLT): A form of glaucoma laser surgery used to treat open-angle glaucoma, whereby the surgeon increases the fluid drainage from the eye. A small incision is made near the iris to achieve this.
Laser iridotomy: Another type of glaucoma laser surgery, the pressure within the eye is reduced by making a small opening in the iris itself. This is commonly used in cases of closed-angle glaucoma.
Filtering surgery: This is a glaucoma surgical procedure that involves the removal of a tiny area of the eye wall (sclera) to allow the fluid to drain. It’s used for all types of glaucoma—the most common type is called a trabeculoplasty.
Shunt procedure: Again, an option for all glaucoma types, it involves the placement of a tiny tube within the eye through which the fluid can drain.

Selective laser trabeculoplasty is a popular choice to treat the most common form of glaucoma. It’s often the procedure of choice when eye drops and/or other medications have failed to lower the internal eye pressure to an adequate degree, or the side effects are too severe. It’s safe and fast, with a high success level. However, there is a likelihood that it will have to be repeated in the future.

SLT is performed by a glaucoma specialist. Your eyes will be numbed with eye drops and a special contact lens placed on the eye. This surgeon uses a high-energy laser to make up to 100 minuscule burns to the trabecular meshwork within the eye. It takes less than 10 minutes to perform and there is very little discomfort. Most people report seeing some brief flashes of light while the treatment is carried out. Afterward, you should be able to go home.

How Can A Glaucoma Specialist Help With This Condition?

Glaucoma is usually picked up during a routine eye exam. Sometimes your medical doctor might refer you if he or she feels you may be at risk. If you’re diagnosed with the condition then regular monitoring will be necessary. The tests for glaucoma are simple to carry out and painless. The specialist will use drops that dilate the pupil, allowing them to examine your optic nerve in detail. Images will be taken so they can be compared in the future.

You’ll also undergo tests that test your peripheral field of vision and carry out an eye pressure test. The latter is known as tonometry. The first course of action to treat the condition is usually eye drops, medication, or a combination of the two.
How eyedrops and medication work
Eye Drops work in one of two ways. They either increase the flow of fluid from the eye or decrease the creation of it. Either way, this helps reduce the pressure. Oral medication can also do the same, with carbonic anhydrase inhibitors or beta-blocker being the most commonly used. This drug route often has unwanted side effects. These include redness and stinging of the eyes, blurred vision and irritation, and allergies. In some cases, the drugs can affect the cardiovascular system. It’s important to tell your glaucoma specialist about any other medication you take to prevent undesirable drug interactions.
Glaucoma surgery and glaucoma laser surgery options
If the above-mentioned side effects become too much or the eye drops and medication fail to adequately treat the problem then your specialist is likely to recommend surgery. Each person’s condition is unique and your surgeon will discuss the best option for you. Whether this involves microsurgery or laser surgery it may mean that you no longer need to use drops and/or medication to control the glaucoma. Surgical options all work to reduce the pressure within the eye through increasing the drainage.

Procedures are determined as:

A trabeculoplasty: To open up the drainage of the eye
An iridotomy: Creates a tiny hole in the iris that helps the fluid to flow freely
A cyclophotocoagulation: The middle layer of the eye is treated to lower the production of fluid
A trabeculectomy: A filtering procedure created by the removal of a tiny area of the eye wall
A shunt: The placement of a small tube within the eye through which the fluid can drain.

Not all procedures are suitable for all types of glaucoma, nor are they the right option for each individual. Your surgeon will determine the optimal solution in conjunction with you. Whatever option is chosen, you’ll need regular monitoring afterward to ensure the treatment is working. In some cases, glaucoma laser surgery is carried out more than once to confirm its continued efficiency.