Glaucoma Treatment

Las Vegas, Nevada

How is glaucoma treated?

Once glaucoma has been identified, in most cases, treatment will need to be instituted. Treatment for glaucoma consists of lowering the intraocular, or eye pressure. This can be achieved by three main techniques: medications, lasers, and surgery. Typically, medications are tried first. If there are side effects from the medications or sufficient pressure lowering is not achieved then laser treatments can be added. Surgery is generally reserved for times when the combination of medications and lasers still do not sufficiently lower the pressure to a safe level, or are not well tolerated.

SLT

Wellish Vision Institute now offers Selective Laser Trabeculoplasty (SLT). SLT is an exciting and low risk laser treatment, which can help a patient control their glaucoma without the use of eye drops, in many cases. SLT is one of the most significant and safest advancements in the treatment of glaucoma. In fact, 80% of patients experience meaningful pressure reduction in only a single treatment.

Benefits of SLT

SAFE

Clinical studies have shown that SLT has minimal risks to the eye or vision, and reduces or eliminates red-eye and irritation that often occurs with drops.

SMART

A virtually painless procedure, SLT stimulates the body’s natural mechanisms to enhance outflow of the fluid in your eye.

SENSIBLE

SLT therapy is covered by Medicare and other insurance providers, which can save you up to $500/year on medication costs.

EFFECTIVE

80% of patients experience meaningful pressure reduction with only a single treatment.

Medications

Glaucoma is usually controlled with eye drops taken daily. These medications lower eye pressure, either by decreasing the amount of aqueous fluid produced within the eye or by improving the flow through the drainage angle.

Never change or stop taking your medications without consulting your ophthalmologist. If you are about to run out of your medication, ask your ophthalmologist if you should have your prescription refilled. Glaucoma medications can preserve your vision, but they also may produce side effects. You should notify your ophthalmologist if you think you might be experiencing side effects.

Some eye drops may cause:

• A stinging or itching sensation
• Red eyes or redness of the skin surrounding the eyes
• Changes in pulse and heartbeat
• Changes in energy level
• Changes in breathing (especially with asthma or emphysema)
• Dry mouth
• Changes in sense of taste
• Headaches
• Blurred vision
• Change in eye color

All medications can have side effects or can interact with other medications. Therefore, it is important that you make a list of the medications you regularly take and share this list with each doctor you see.

Trabeculectomy

When planning for a surgery it is important that you have a thorough understanding of the risks, benefits, and alternatives of the procedure. Dr. DeBry may determine that a trabeculectomy is required for treatment of your glaucoma. The benefit of the surgery is to lower the eye pressure, and reduce the risk of glaucoma damage occurring to the optic nerve. The main alternative to trabeculectomy is continued eye drops, accepting the possibility that with a higher pressure the risk for glaucoma damage worsening is significant. Trabeculectomy is a safe and effective surgery, with a low risk of severe complications. Although unanticipated, the most severe complication from any eye surgery is visual loss. This could occur from severe bleeding within the eye or severe infection. Other complications can occur which do not cause visual loss, but may require additional procedures in the weeks or months after this procedure.

The final pressure after a successful glaucoma surgery depends on the amount of healing in the conjunctiva after the surgery. This is variable from person to person, and is somewhat difficult to predict prior to the surgery. If you create significant amounts of scar tissue, the eye pressure may end up higher than ideal. In this case you may need additional medications after the procedure to lower the pressure. If very little scar tissue is made, in some cases the pressure ends up very low. Low eye pressure can lead to swelling within the eye, and decreased vision. Additional procedures may be required if the pressure ends up at very low levels.

Finally, minor side effects can occur which do not adversely affect the results of the surgery, but may be a minor annoyance to the patient. In some cases the upper eyelid droops compared to the other eye secondary to scar tissue underneath the eye lid created from the surgery. In some cases the bleb, or small fluid filled bubble, rubs against the eyelid causing chronic irritation. Finally, cataracts can develop more quickly after a trabeculectomy surgery.

Laser Peripheral Iridotomy

Laser Peripheral Iridotomy uses a laser to place a small hole in the iris (colored part of eye), which prevents future acute angle closure glaucoma (sudden onset of high pressure in the eye), or decreases risk of further scarring of drainage area of eye.

As with any surgery, there are some minor risks with Laer Peripheral Iridotomy:

• Retinal detachment - may require additional surgery to reattach the retina. Less than 1 in 100
• High eye pressure - minor increase in all patients, less than 1 in 100 will have a severe increase that requires immediate surgery or multiple medications
• Inflammation in eye - minor inflammation in all patients. Less than 1 in 100 will require more extensive drops to decrease inflammation.
• Visual symptoms - some patients notice a faint line or circle from extra light entering the eye through the new opening. This usually becomes less noticeable over time.

After the laser surgery you may notice blurred or washed-out vision in the eye; this will resolve over 4-6 hours. The eye may feel scratchy or irritated and may have some light sensitivity for the first 1-2 days. If you have significant blurred vision, severe pain, headache, or nausea please call the office and ask to speak with Dr. DeBry. Use the Prednisolone drop (milky color) 4 times daily for 4 days, and as always, call if you have any problems or questions.

Glaucoma Drainage Device

This procedure includes a surgery to implant a small tube to allow fluid to drain from the inside of the eye to a small plastic plate behind the eye. Baerveldt glaucoma implant or Ahmed glaucoma implant are the most common types. A drainage device is created to lower eye pressure to prevent vision loss from glaucoma, however, this surgery will not improve vision.

As with any surgery, implanting a drainage device has some risk including drooping of the eyelid, pressure is too high or too low, an increase in cataract formation, double vision, and cloudiness. The most severe risks are loss of vision, bleeding in the eye and retinal detachment, although all of these occur in less than 1% of patients.

Results are overall positive with patients who receive a glaucoma drainage device. In fact, 90% have good pressure control after one year and only 10% may require further surgeries in the first year.