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 Edwin Y. Endo, OD Optometrists, Associates & Interns

We are the leading Provider in Eye Care and highly regarded professional Optometry establishment in honolulu for the entire family where Quality eye exams are Affordable with Excellence. Diplomate,  Board Certified Optometrists, Eye Doctor near you

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Glaucoma Treatments & Updates

We do Glaucoma Treatments

Glaucoma Checked Off

Often showing up later in life or even in early childhood, glaucoma is a eye condition affecting your eye’s optic nerve. It is often associated with building pressure in the eye, or lack of blood flow to the eyes 2nd to stress, heart disease, chronic inflammation or genetics. Glaucoma causes damage to your optic nerve and gets worse over time.

The optic nerve is responsible for delivering images to the brain, and if damaged, could cause permanent loss of vision. Untreated, glaucoma could result in blindness.

Diagnosis

In the beginning stages of increased pressure, glaucoma doesn’t have any early symptoms or pain. This is why careful eye exams are prudent and necessary;  regular evaluations can detect early signs of glaucoma and early intervention in the treatment of glaucoma may reverse the manifestation and progression of this disease.

Pressure and Glaucoma

Glaucoma Diagram

Glaucoma begins to develop when the aqueous humor, or the eye fluid, isn’t circulating normally in the front part of the eye. This causes an increase in pressure. Normally, the aqueous humor flows out of the eye via channels. When these channels become blocked, the fluids build up and create the pressure that causes glaucoma.

While the specific cause of the blockage may vary, scientists do know that the block can be hereditary, meaning a child can inherit glaucoma from their parents. If you are a parent, be sure to schedule comprehensive eye exams for your child.

Other less common causes can include a traumatic injury to the eye (blunt or chemical), a severe eye infection or inflammation,  blood vessels in the eye becoming blocked, diabetes,  and rarely as a side effect of an eye surgery attempting to correct other conditions.

Types of Glaucoma

There are two major types of glaucoma. Open-angle glaucoma, or wide-angle glaucoma, is the most common type. The fluid in the eye doesn’t drain properly through the trabecular meshwork, creating pressure. Other structures of the eye appear normal.

The second type, angle-closure glaucoma or acute / chronic angle-closure or narrow-angle glaucoma, is more common in Asia than in the West. In this type, the fluid has trouble draining due to the angle between the iris and cornea being too narrow or blocked. This creates a very sudden buildup of eye pressure.

Occurrence

Glaucoma usually affects adults over the age of 40 but may have its beginnings in early childhood and affecting young adults, children, and even infants. Glaucoma also occurs more frequently in African American populations, occurring more often and at a younger age, along with a greater loss of vision.

Those most at risk are people of African-American, Irish, Russian, Japanese, Hispanic, Inuit or Scandinavian descent, those over 40, those with family history of glaucoma, those with poor vision, diabetes, or who take steroid medications such as prednisone, and those who have had trauma to the eyes.

Symptoms

The lack of symptoms is one of the greatest challenges of detecting and diagnosing glaucoma. For most people, the first symptom is the diminishment of mid peripheral vision, which often goes unnoticed until the disease is quite advanced. In some cases, a rapid increase of intraocular pressure to severe levels can produce sudden eye pain, headache, blurred vision, or “halos” appearing around lights.

If you experience vision loss, redness in the eye, seeing halos, eyes that look hazy, nausea or vomiting, a sharp pain in the eye, or tunnel vision (where your vision narrows), you should seek help immediately.

Diagnosing Glaucoma

Woman Having Her Eyes Examined

In order to diagnose glaucoma, we provide an extensive examination of your eyes by dilating your pupils and performing additional high definition analysis of your internal eyes. This exam will focus on observing the optic nerve for changes or  specific signs of the disease.

A tonometry, which is a test checking eye pressure, as well as a visual field test to determine loss of side vision, a optical coherence tomography analysis is necessary to determine  the severity or presence of glaucoma.

Get Your Glaucoma Treated by Dr Edwin Y. Endo, OD & Associates.

Treatment for glaucoma can come in the form of eye drops, laser surgery, or microsurgery. Eye drops help to reduce the formation of fluid, or helps to increase its drainage. Laser surgery attempts to increase the flow of liquid, or to remove the blockage. Microsurgery is when a trabeulectomy is performed to create a new channel to drain the fluid and reduce intraocular pressure that way.

Although the damage from glaucoma cannot be reversed or restored, early diagnosis can help prevent further damage by reducing eye pressure. By following the treatment plan and keeping up with scheduled eye exams, you can help mitigate and control the damage and effect glaucoma has in your life. Schedule your eye examination today and avoid further eye damage from glaucoma!

 

 

<p direction=" see=" "="" dr="" div="" edwin="" regarding="" glucoma="">Treatment for glaucoma can come in the form of eye drops, laser surgery, or microsurgery. Eye drops (new medications include Vyzulta, Rhopressa, Xelpros, Rocklatan, & popular ones include Lumigan, Travatan Z, Alphagan P, Combigan) help to reduce the formation of fluid, or helps to increase its drainage. Laser surgery attempts to increase the flow of liquid, or to remove the blockage. Microsurgery is when a trabeulectomy is performed to create a new channel to drain the fluid and reduce intraocular pressure that way.

Although the damage from glaucoma cannot be reversed or restored, early diagnosis can help prevent further damage by reducing eye pressure. By following the treatment plan and keeping up with regular eye exams, you can help mitigate and control the damage and effect glaucoma has in your life. Call us today and avoid further eye damage from glaucoma!

Definitions & Additional Information

Glaucoma: An optic neuropathy associated with progressive death of retinal ganglion cells and their axons, and associated visual field loss. The characteristic changes of the optic nerve head that distinguish glaucoma from other optic neuropathies include excavation and undermining of the neural and connective tissues.

Primary open-angle glaucoma (also chronic open-angle glaucoma): Glaucoma in the setting of an eye with a visibly open anterior chamber angle (between the iris and anterior sclera/peripheral cornea) and no other ocular or systemic disorder that might result in glaucoma. 

Secondary open-angle glaucoma: Glaucoma in the setting of an eye with a visibly open anterior chamber angle (between the iris and anterior sclera/peripheral cornea) and some other ocular or systemic disorder that can result in glaucoma. Examples of secondary open-angle glaucomas include pigment dispersion syndrome, pseudoexfoliation syndrome, and steroid-induced glaucoma.

Glaucoma suspect: A nonspecific term describing someone at higher than average risk of having or developing glaucoma. In the case of open-angle glaucoma, this risk may be increased due to elevated intraocular pressure (ocular hypertension), an optic nerve with an appearance consistent with the structural changes caused by glaucoma, a significant family history of the disease, or a racial background known to confer higher rates of glaucoma. It is currently possible to estimate the risk of future glaucoma only in some patients in the ocular hypertensive group.

Treatments for Open-Angle Glaucoma

Medical, laser, and incisional surgical treatments are used to treat glaucoma. The most common currently used medical treatment includes several classes of eye drops, including prostaglandin analogs, beta-adrenergic antagonists, oral and topical carbonic anhydrase inhibitors, and alpha-adrenergic agonists. Laser trabeculoplasty is an office-based procedure that lowers the IOP by increasing the outflow of aqueous humor from the eye. Incisional surgery to lower the IOP comprises procedures that have been performed for decades, such as trabeculectomy and aqueous drainage device surgery, as well as a host of newer procedures, such as nonpenetrating deep sclerectomy, canaloplasty, endoscopic cyclophotocoagulation, and alternative methods of trabecular bypass.

Definitions of Laser and Incisional treatments

Laser trabeculoplasty: A procedure in which laser energy (argon, YAG, diode) is applied to the trabecular meshwork in an effort to reduce the resistance to outflow for aqueous humor. The procedure is performed as part of an office visit and requires topical anesthesia and a mirrored contact lens.

Trabeculectomy: The most commonly performed incisional surgery for lowering intraocular pressure in glaucoma patients. Under local anesthesia, a passageway is created at the limbus (junction between the cornea and sclera) that allows the aqueous humor to flow from the anterior chamber to the space between the sclera and the conjunctiva, thereby lowering the intraocular pressure. The hallmark of a trabeculectomy is the fluid-filled bleb (blister) present on the surface of the eye underneath the upper eyelid.

Trabeculotomy: An incisional surgery procedure generally used to lower intraocular pressure in glaucoma affecting infants and children. A metal probe or a suture is passed into Schlemm’s canal, a structure into which aqueous humor passes as it exits the eye. The probe is used to disrupt tissue that is typically impeding outflow of aqueous humor from the eye, thereby increasing outflow and decreasing the intraocular pressure. Some surgeons also use trabeculotomy in the treatment of glaucoma in adults.

Aqueous drainage devices: Any of a number of plastic implants used in the surgical management of glaucoma with the aim of lowering the intraocular pressure. All devices consist of a tube that is inserted into the eye and a plate connected to the tube that is sewn to the sclera and covered by conjunctiva. Aqueous humor moves through the tube and out of the eye to drain on top of the plate into the space between the plate and the conjunctiva.

Cyclophotocoagulation: A procedure in which laser energy is used to damage the ciliary processes, reducing the amount of aqueous humor that they produce and thereby lowering the intraocular pressure. The procedure can be performed through the sclera (external cyclophotocoagulation) or from the inside of the eye (endocyclophotocoagulation).

Deep sclerectomy: A procedure in which the surgeon makes an opening in the conjunctiva to expose the sclera. The surgeon dissects a partial-thickness flap about 5 mm in width to about one-third depth in the sclera at the limbus. A second flap is dissected below this flap in order to leave a very thin layer of tissue and to expose Schlemm's canal. This underlying flap of scleral tissue is removed, and the surgeon grasps the roof of Schlemm's canal and removes a strip that is about 3 mm in length. Aqueous humor is able to permeate the remaining tissue without a full-thickness hole being necessary. The external flap is then sutured in its original position and the conjunctiva is sewn back in place.

Viscocanalostomy: A surgical procedure that is the same as for deep sclerectomy (see above) but also includes viscoelastic injected into Schlemm's canal in a circumferential fashion in an effort to dilate Schlemm's canal. The external flap is then sutured in its original position and the conjunctiva is sewn back in place.

Canaloplasty: A procedure that begins with a combined deep sclerectomy and viscocanalostomy procedure (see above), after which a microcatheter with an illuminated tip is passed through Schlemm's canal for 360 degrees. A 10-0 Prolene suture is tied to the catheter and threaded around Schlemm's canal for 360 degrees. The two ends of this suture are tied under tension in an effort to expand Schlemm's canal. The external flap is then sutured in its original position and the conjunctiva is put back in place.

Trabectome™: A procedure in which the surgeon makes a 1.7 mm incision through the peripheral cornea and injects viscoelastic into the anterior chamber. The Trabectome device is then introduced into the anterior chamber and, under visualization using direct gonioscopy with an operating microscope, the Trabectome is used to ablate about one quadrant of trabecular tissue. The Trabectome uses low-energy electrical pulses to vaporize the trabecular tissue, and aspiration is used to remove it. The viscoelastic is removed and the corneal wound is sutured closed.

iStent™: A device placed into Schlemm’s canal. The Glaukos Trabecular Micro-Bypass Stent (iStent) is made of nonferromagnetic titanium. One end sits in the anterior chamber and the posterior end sits in Schlemm’s canal, allowing fluid to bypass the trabecular meshwork. The device is inserted under direct visualization (using direct gonioscopy) through a 3 mm temporal clear corneal incision. After viscoelastic is placed in the anterior chamber, the applicator is passed through the incision and the device is anchored into Schlemm’s canal in the nasal angle. Viscoelastic is removed with irrigation and aspiration.

Gold shunt: A device that connects the anterior chamber to the suprachoroidal space. The SOLX™ Gold Shunt is a 24-karat gold rectangle (3.2 x 5.2 mm). There are two plates with grooves in them to allow flow from the higher pressure anterior chamber to the lower pressure suprachoroidal space. The conjunctiva is disinserted at the limbus, and a full-thickness scleral incision is created 2 mm posterior to the limbus. A crescent blade is used at 90 percent scleral depth to direct the anterior portion of the shunt to the anterior chamber and to cut posteriorly 2 to 3 mm to direct the posterior segment into the suprachoroidal space. The scleral incision is closed with 10-0 nylon sutures and the conjunctiva is closed.

Incisional Treatments for Glaucoma

 

Currently Available Methods to Treat Open Angle Glaucoma Series:

  1. Currently Available Methods to Treat Open Angle Glaucoma
  2. Beta-blockers, Selective Alpha Adrenergic Agonist, CAIs
  3. Prostaglandin Analogs, Cholinergic Receptors Agonists, Fixed Combination Agents
  4. Carbonic Anhydrase Inhibitors (CAIs)
  5. Laser Trabeculoplasty
  6. Continuous Wave and Micropulse® Cyclophotocoagulation
  7. Trabeculectomy and Glaucoma Drainage Devices
  8. Ab-Externo Canaloplasty
  9. Ab-Interno Canaloplasty
  10. Trabeculotomy
  11. IStent®, Cypass® Microstent, Xen® 45 Gel Stent, Cataract Surgery
  12. Next-Generation Glaucoma Medications and Surgeries
  13. iStent Supra®, Hydrus™ Microstent, and InnFocus MicroShunt®
  14. Canaloplasty with Stegmann Canal Expander

Selective Laser Trabeculoplasty vs Topical Medication as Initial Glaucoma Treatment

Link 

  • In this study, 167 patients with primary open-angle or exfoliation glaucoma were randomized to receive either selective laser trabeculoplasty (SLT) or topical medication as a first-line treatment. The authors compared the effect of these treatments on quality of life and clinical outcomes and found no differences between groups in terms of glaucoma-specific quality of life.
  • Overall, we did not find evidence that SLT was superior to medication in improving glaucoma-specific QoL. While we found superior IOP reduction in the medication arm, eyelid erythema and conjunctival hyperaemia were more prevalent in these patients compared with the SLT group.

Selective Laser Trabeculoplasty as the Primary Treatment for Open-Angle Glaucoma 

  1. This commentary discusses the use of selective laser trabeculectomy as a first-line treatment for treatment-naïve primary open-angle glaucoma and ocular hypertension in view of the results from LiGHT study. 
  2. Overall, selective laser trabeculectomy appears to be subjectively effective and relatively risky, which may not allow it to be generalizable to all patient populations.

– Raza Shah, MD