Glaucoma

Glaucoma is a general term for many conditions that cause progressive damage to the optic nerve resulting in loss of vision. Usually, the eye pressure is elevated, causing direct or indirect optic nerve damage. The pressure is high because the fluid, or aqueous, produced by the eye is blocked from getting to the drain, or trabecular meshwork, or the drain itself is clogged.

If the circulation to the optic nerve is poor, then even “normal” pressures may compromise blood flow, causing loss of vision. If a patient shows evidence of optic nerve injury on examination and/or shows an elevated intraocular pressure, then perimetry, or a visual field examination, is performed. Perimetry involves utilizing a computer program to measure hundreds of spots in your side (peripheral) vision within 4 minutes. If a visual field loss is detected, one of the following treatments will be recommended:

• Topical medications (drops)
• Laser surgery
• Systemic medications (tablets or capsules)
• Viscocanalostomy or trabeculectomy

Our goal is to halt progression of the disease with the least amount of medical or surgical intervention, allowing the patient to maintain useful vision throughout his or her lifetime.

Glaucoma Surgery

If drops fail to control your glaucoma or if you are considering potential alternatives to using drops, there are surgical options to reduce your intraocular pressure. Surgery can facilitate the outflow of fluid (aqueous) or reduce its production. The following laser and/or micro-surgical procedures are used to treat glaucoma.

Laser Peripheral Iridotomy (LPI): laser procedure that enables the creation of a “by-pass” opening in the iris to allow fluid to get to the drain in the eye, or the trabecular meshwork.

Selective Laser Trabeculoplasy (SLT): laser treatment applied directly to the eye drain, or trabecular meshwork, to help fluid pass more easily

Iridoplasty: laser procedure that pulls the peripheral iris away from the eye drain

Endocyclophotocoagulation (ECP): a tiny diode laser is used to directly treat the ciliary processes (fluid producing tissue), which reduces fluid production and lowers intraocular pressure

Trabeculectomy and viscocanalostomy: micro-surgical procedures that facilitate drainage by creating new pathwasys for the fluid, or aqueous, to escape from the eye.

Glaucoma Co-Management

There are two keys to optimizing success of therapy for glaucoma patients:

• Patient compliance with use of medications (instructions are followed)
• Follow-up exams

With co-management, most of your local follow-up care will be provided by your local Doctor of Optometry. Your local optometrist reinforces the need for and proper use of medications, augments the data base through serial pressure checks and side vision exams, and relays the information back to Commonwealth Eye Surgery. We then evaluate trends and determine treatment effectiveness for each patient in collaboration with your local optometrist, recommending changes in your care as necessary.

If follow-up is convenient, patients keep appointments and comply with instructions more readily. This allows for earlier detection of any disease progression, which results in the preservation of vision and, ultimately, a happier patient.