Glaucoma Treatment

Wilmington Glaucoma Treatment Providers – Delaware Eye Surgeons

Glaucoma is an eye disorder mostly associated with high levels of internal eye pressure, which is known as intraocular pressure (IOP). Changes in IOP occur as a result of abnormal drainage of aqueous humor, a thick fluid responsible for maintaining consistent pressure in the eye. Sudden changes in IOP result in damage to the eye’s optic nerve, which transmits visual images to the brain. There are patients with normal tension glaucoma and secondary forms of glaucoma that result from trauma or other eye diseases.

Glaucoma is a serious medical condition and the second leading cause of blindness in the United States. Delaware Eye Surgeons of Delaware is please to offer  Eloctroretinography (ERG) — the latest development in Glaucoma testing.

ERG – is testing of the optic nerve to determine if it is under stress and at risk for glaucoma and allows us to start treatment to prevent damage vs the current testing that only allows us to monitor damage that has already occurred.  ERG also helps us to monitor macular degenerations, other retinal diseases or medication that threatens the nerve fibers of the retina.

Types and Symptoms of Glaucoma

Although there are several types of glaucoma, the most common include:

• Chronic or primary open-angle glaucoma (POAG)
• Closed-angle or angle-closure glaucoma
• Normal tension glaucoma

Chronic open-angle glaucoma is the most common form of the disease and usually occurs with age. In POAG, the eye’s IOP gradually increases, eventually leading to loss of peripheral vision or tunnel vision. When left untreated, POAG leads to blindness.

Initially, POAG does not display any obvious symptoms. The first sign of POAG is poor peripheral vision, at which point irreversible damage to the optic nerve has already occurred. Early diagnosis is key to successful management of POAG.

Likewise, with normal tension glaucoma, most patients are asymptomatic. Routine eye exams are essential for early detection and prevention of permanent vision loss.

In addition to age, risk factors for POAG include:

Closed-angle glaucoma is rare, but extremely serious. This form of glaucoma occurs when the drainage of aqueous humor becomes completely blocked, causing sudden change in IOP and irreversible vision loss if not corrected with surgery immediately.

Unlike POAG, symptoms associated with closed-angle glaucoma appear suddenly and may include severe eye pain accompanied by a headache, nausea, vomiting and blurred or sensitive vision. Closed-angle glaucoma is considered an emergency and requires immediate medical attention.

The most common risk factors associated with closed-angle glaucoma include:

Diagnosing Glaucoma

The first step in diagnosing glaucoma is to measure the IOP. This is usually accomplished through the use of a tonometer, a small prism that gently rests on the tear film of the eye. If glaucoma is suspected, sophisticated imaging technology may be used to obtain accurate IOP measurements and images of the optic nerve and other internal structures in the eye.

Another common test is gonioscopy, which involves the use of special lenses and a biomicroscope to allow the eye doctor to observe the eye’s drainage system and the production of aqueous fluid.

Visual field testing is used to determine the progression of glaucoma and the level of vision loss. Nerve fiber analysis identifies the quality of the nerve fibers within the optic nerve. Pachymetry measures the thickness of the cornea to determine if the IOP measurement needs adjustment.

Glaucoma Treatment Options

Although glaucoma cannot be cured, several treatments can be used to control IOP and ensure proper production or drainage of aqueous fluid to preserve the patient’s vision. In most cases, a combination of treatments is necessary for effective management of glaucoma.

The most common treatments include:

• Medicated eye drops
• Oral medicine
• Laser surgery
• Glaucoma surgery
• Nonpenetrating glaucoma surgery (NPSG)

Several types of eye drops are available for treatment of glaucoma. Most of our glaucoma patients use one or more drugs to successfully manage the disease.

Laser surgery can be used for the treatment of both POAG and closed-angle glaucoma. POAG can be treated with trabeculoplasty, in which laser light is used to shrink or stretch tissue within the eye’s drainage system to improve the flow of aqueous fluid. Closed-angle glaucoma can be treated with iridotomy, in which focused beams of light are used to create an opening on the outer edge of the iris, thereby allowing aqueous fluid to drain into the eye.

SLT – selective laser trabeculoplasty – a thermal laser treatment to lower the intraocular pressure without causing permanent damage to the tissue. The procedure works in 7 out of 10 patients and is effective for 5-7 years and can be repeated.

MLP – micropulse laser treatment can be used if SLT is not effective. It is a fine control of a low energy thermal laser used with short pulses to spare the surrounding tissue by decreasing the spread of the thermal energy. This procedure can be repeated if the intraocular pressure increases over time.

Several types of glaucoma surgery can be performed, including the surgical placement of shunts or implants. A glaucoma implant is a small device that is surgically attached to the eye’s surface and has a tiny tube that is inserted into the eye to improve drainage of the aqueous fluid. Some implants have valves that shut off drainage.

NPSG procedures for the treatment of glaucoma include deep sclerectomy and viscocanalostomy. Deep sclerectomy is the excision of a small section of the eye’s sclera (the white area of the eye) to create drainage space and relieve elevated IOP. In viscocanalostomy, a small opening is created in the eye to allow for the insertion of a gel-like material called viscoelastic. This material helps provide space for adequate drainage, thereby relieving elevated IOP.

At Delaware Eye Surgeons, we develop individualized treatment plans for our glaucoma Wilmington patients. Our goal is to provide uncompromising medical and surgical care to preserve your vision and eye health.

Please contact our practice at (302) 993-1300 or use our online appointment request form to schedule your glaucoma management consultation.