At Montgomery Eye Center, our Naples, Florida ophthalmologists have experience treating thousands of people with glaucoma. From early intervention to more complicated cases, we have the skills and facility to ensure the best in glaucoma care.
What Is Glaucoma?
Glaucoma is a relatively common eye disease which is a leading cause of blindness, especially when not diagnosed early and treated regularly. Glaucoma is known as the “sneak thief of sight” because extensive and irreparable damage can be done to a person’s vision before they notice any symptoms. Often glaucoma causes no pain and changes occur so slowly and subtly that they are barely noticeable.
Glaucoma is a group of eye diseases that results in optic nerve damage. The optic nerve transmits images seen by the eye to the brain and acts as the connection between the brain and the visual system. It is composed of many independent nerve fibers that are bundled together like an electric cable containing numerous wires. When pressure inside the eye (intraocular pressure) rises above normal levels, it begins to damage these delicate nerve fibers and prevents them from sending images to the brain effectively. Typically, peripheral vision is affected first and is rarely noticeable. Because of this slow damaging effect, glaucoma is known as the “silent thief of sight.”
Without intervention by an ophthalmologist, glaucoma continues to cause vision loss and in advanced cases can cause total blindness. With early treatment, it is possible to slow or stop the disease process. Although there are many forms of this disease, the most common of the multitude are explained below.
Intraocular pressure increases when the clear liquid, called the aqueous humor, which normally flows in and out of the eye, cannot drain properly. Treatment for glaucoma focuses on lowering intraocular pressure to a level that is unlikely to cause further optic nerve damage. This is known as the “target pressure” or “goal pressure.” The target pressure varies from person to person, and may change during the course of your treatment.
Types of Glaucoma
There are different types of glaucoma. The most common form is primary open-angle glaucoma, when the aqueous humor that normally circulates in the front portion of the eye is blocked from flowing out of the eye through a tiny drainage system. This results in an increased IOP. Most people who develop primary open-angle glaucoma notice no symptoms until their vision is impaired.
Primary Open-Angle Glaucoma
Primary Open-Angle Glaucoma is the most common form of the disease and occurs when fluid inside the eye does not flow and drain properly. This fluid, called aqueous humor, circulates around different structures in the front of the eye to support eye shape and provide nutrients. When it is blocked from exiting the eye, intraocular pressure rises above normal levels and damages the optic nerve in the back of the eye. The goal of treatment is to reduce eye pressure and stop damage to the optic nerve.
In Angle-Closure Glaucoma
In Angle-Closure Glaucoma, a sudden pressure increase inside the eye can cause sudden optic nerve damage and vision loss in a matter of hours. This occurs when the iris (the colored part of the eye) moves out of place and completely blocks intraocular fluid from leaving the eye. The resultant build up of aqeous humor dramatically increases eye pressure, causing eye pain, halos around lights, nausea, and vomiting. This rare case is classified as a medical emergency and immediate intraocular pressure reduction is brought about by medications, surgical intervention, or a combination of the treatments.
Normal Tension Glaucoma
Normal Tension Glaucoma is a condition characterized by an eye with normal intraocular pressure that exhibits signs of glaucoma. This variation of primary open-angle glaucoma is not well understood, but is still benefited by traditional treatment. Like other forms of glaucoma, the goal of treatment is to lower the eye pressure.
Risk factors for glaucoma include an elevated intraocular pressure, a family history of glaucoma, an African-American ethnic background, advanced age, or particular optic nerve conditions. Regular eye exams with your ophthalmologist are extremely important if you are at risk for developing glaucoma.
- Advanced Age
- Elevated Intraocular Pressure (IOP)
- Family history of glaucoma
- African/Hispanic Ancestry
- Farsightedness or Nearsightedness
- Systemic health problems (diabetes, hypertension, migraines)
How is Glaucoma Treated?
There is no cure for glaucoma—damage to nerve cells and fibers cannot be reversed. However, glaucoma can be controlled, which is why early intervention is so important.
In the vast majority of cases, eye drops or laser treatment will sufficiently control the IOP to prevent further loss of vision. However, they can lose their effectiveness over time or cause unpleasant side effects. In these cases surgical intervention may be required. Laser treatment is a simple, painless operation to open up the drainage within the eye, and is performed in our office.
In some instances when all other options have been exhausted, surgery may be performed to create a new drainage system in the eye. Our operating rooms and equipment are state-of-the-art, and our ophthalmologists highly skilled in the most advanced surgical procedures.
Our Techniques and Technology
Glaucoma treatment typically begins with prescription eye drop therapy. Eye medications are chosen by your doctor to control glaucoma progression by lowering the eye’s intraocular pressure. Glaucoma drops typically work by either reducing the amount of fluid produced inside the eye or by increasing the amount of fluid that leaves the eye. Because there are many different types of these medications, it is important that an ophthalmologist trained and experienced in glaucoma therapy prescribes the drop most suited to your ocular and systemic health.
Selective Laser Trabeculoplasty (SLT) is a highly successful technique used to treat open-angle glaucoma. During this short procedure, laser energy is directed toward a part of the eye responsible for draining fluid inside the eye. By expanding this drainage channel, pressure inside the eye is lowered and the disease process is controlled. Often, the SLT procedure allows patients to discontinue glaucoma medications while still maintaining an appropriate eye pressure. This procedure is covered by Medicare and most other medical insurances.
Laser Peripheral Iridotomy (LPI) uses laser energy to create a small drainage channel in the iris (the colored part of the eye). This new channel allows the fluid inside the eye to flow more easily, and can effectively reduce the intraocular pressure. Like SLT, patients that have had an LPI performed are more likely to maintain a normal pressure without the need for glaucoma medications or eye drops. When indicated, this procedure is covered by Medicare and most other insurances.
Surgical Treatment is used in advanced stages of glaucoma when other techniques have failed to prevent optic nerve damage. Microsurgical instruments are used to create new drainage channels and pathways for the eye to lower pressure. There are several types of surgical interventions to lower eye pressure including Shunt procedures, iStent, and Trabeculectomy. In each of these procedures, advanced technology and surgical precision is used to provide the best possible surgical outcome.