Eye Surgery Procedures & Treatment

Talking to Your Eye Doctor About Glaucoma

Retinal examination and Your Eye Doctor
Sometimes, the diagnosis of glaucoma is not clear. If someone walks into the exam with an IOP of 40, that’s an easy diagnosis. But if someone has no symptoms, a strong family history of OAG, is over 50 and he has a borderline eye pressure (say, 23) and a large cup-to-disc ratio (C/D), what should the physician do? What is the visual field is not reliable, and a cataract makes the nerve fiber layer analysis less than optimal?
Sometimes, the answer can only be determined over the course of several visits, over months or even years. All the while, the patient may not have any symptoms at all!

Eye Correction Surgery Treatment
The objective of eye correction surgery is to reduce intraocular pressure. Depending on the type of glaucoma, this is achieved with medications or by surgery.

Open-angle glaucoma treatment:
There are several classes of eye drop medications that can be used to decrease the IOP, either by slowing down the formation of aqueous, or by increasing its outflow. All medications have their specific benefits and risks, and it is important that you discuss these with your doctor for any medication suggested. Sometimes, more than one medication may be necessary. Oral medications are available to decrease IOP, but they have systemic effects that usually make them a last choice.

A type of laser procedure is available (SLT, selective laser trabeculoplasty) that seems to be safe and effective for milder cases of glaucoma. It works by causing a low grade inflammation from absorption of green light by melanin pigment-containing cells in the trabecular meshwork. The cells responding to the inflammation “clean house”, and lay down new collagen, much like the cells of the skin responding to certain rejuvenating lasers.

More aggressive IOP control can be achieved using various types of procedures and devices to drain the aqueous, bypassing the meshwork entirely, or physically changing the shape of the meshwork to open the fluid outflow channels (ligature procedures). Again, the various options entail different risks and benefits and deserve a thorough discussion with your surgeon.

Narrow angle glaucoma treatment:
Chronic angle closure glaucoma may only be noted by the patient by occasional blurring of vision and redness, but is detected by the doctor by a narrowing of the outflow angle on gonioscopy. The treatment is the creation of one or two holes in the iris with a laser (iridotomy). This equalizes the pressure on either side of the iris and has the effect of the iris falling back just a bit, but sufficient to prevent an acute NAG attack. It is a very safe procedure.

Acute angle-closure attack, with pain, blurring from corneal edema from elevated IOP, and redness of the involved eye, is a medical emergency. Blindness will occur in a few days if it is not treated. Both drops and oral medications are used to lower the pressure, before performing iridotomy as soon as corneal clearing allows.

Congenital glaucoma treatment:
This form of glaucoma is almost always treated with eye surgery to open the outflow channels of the angle, under general anesthesia. If a cataract is present or corneal scarring, that might be addressed as well with an eye doctor.

Glaucoma Outlook (Prognosis)

Open-angle glaucoma: You can manage open-angle glaucoma and almost always preserve your vision, but the condition cannot be cured. It’s important to carefully follow up with your doctor. With good care, most patients with open angle glaucoma will not lose vision.

Angle-closure glaucoma: Rapid diagnosis and treatment of an attack is the key element to preserving vision. Seek emergency care if you have the symptoms of angle-closure attack.

Congenital glaucoma: Early diagnosis and treatment is important. The baby’s prognosis depends on other problems involving the eye. The follow-up for evaluation and treatment is crucial for a good visual outcome.