Leader Heights Eye Center, 309 Leader Heights Road, York, PA 17402 • Phone: (717) 747-5430


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Glaucoma Treatments



 

 

Drops

Most glaucoma patients need or choose drops. There are five major classes of them, and each one lowers the pressure by a different means than the others. If you are on drops, it is very important that you take them consistently. If you haven’t been taking the drops as you should, tell the doctor – we will work out a treatment plan that you can do.

Selective Laser Trabeculoplasty

Selective laser trabeculoplasty (SLT) is a laser surgical procedure used to lower intraocular pressure (IOP) of patients with open-angle glaucoma. SLT is used to treat the eye’s drainage system, known as the trabecular meshwork – the mesh-like drain that surrounds the iris. Treating this area of the eye’s natural drainage system improves the flow of fluid out of the eye, helping to lower the pressure. 

The laser used in SLT is very low-powered. It treats specific cells selectively, leaving untreated portions of the trabecular meshwork intact. It causes no demonstrable damage to the eye’s drain, unlike the older argon laser. For this reason SLT, unlike other types of laser surgery, may be safely repeated. 

SLT is typically performed in the ophthalmologist’s (Eye M.D.’s) office or an outpatient surgery center. The procedure usually takes about five minutes. First, anesthetic drops are placed in your eye. The laser machine looks similar to the examination microscope that your doctor uses to look at your eyes at each office visit. 

You will experience a flash of light with each laser application. Most people are comfortable and do not experience any significant pain during the surgery, although some may feel a little pressure.

Most people will need to have their pressure checked soon after the laser treatment since there is a small risk of increasing IOP right after the procedure, almost always temporary. If this does occur, you may require medications to lower the pressure, which will be administered in the office. Very rarely, the pressure in the eye increases to a high level and does not come down. If this happens, you may require a surgery in the operating room to lower the pressure. 

Most people notice some blurring of their vision after the laser treatment. This typically clears within a few hours. The chance of your vision becoming permanently affected by this laser procedure is extremely small. 

Most patients can resume normal daily activities the day of laser surgery. You may need to use eye drops after the procedure to help the eye heal properly. 

It will take several weeks to determine how much SLT lowered your eye pressure. You may require additional laser, drops or glaucoma drainage surgery to lower the pressure if it is not sufficiently lower after the first laser treatment. 

In some, the laser is recommended as first-line therapy in order to avoid using drops. In others, it is used to make the drops the patient takes work better. In still others, SLT is used to avoid adding drops to the current drop regimen. 

When your glaucoma is first diagnosed, you may be given the option of treatment with drops or laser. The advantage to a laser is that, if it works, you can avoid taking drops for the rest of your life, avoiding the expense, effort and possible side effects of drops. SLT works about 75% of the time, on average. If it does not, drops will work just as well as if you never had the laser. 

While some people may experience side effects from medications or surgery, the risks associated with these side effects should be balanced against the greater risk of leaving glaucoma untreated and losing your vision. 

Peripheral Iridotomy 

If your ophthalmologist (Eye M.D.) or optometrist suspects that you have “narrow” or “closed” angles, this means that the drainage channel of your eye is blocked or nearly blocked by the iris, the colored part of your eye. This can cause elevated intraocular pressure and subsequent vision loss. This is called angle-closure glaucoma. 

An attack of acute angle-closure glaucoma is marked by sudden onset of very high eye pressure and complete blockage of the drainage channel in the eye. Symptoms include pain, red eye, and decreased vision. Here, the laser is done as an emergency procedure. The eye pressure can also rise gradually (chronic angle closure glaucoma)--you would have no symptoms at all. Most often, peripheral iridotomies are done when your eye doctor discovers the iris to be touching or dangerously close to the eye’s drain.

To treat angle-closure glaucoma, your ophthalmologist will perform a peripheral iridotomy (PI), creating a hole in the iris (the colored part of the eye) using a laser. This opening is typically so small that it cannot be seen with the naked eye. The opening in the iris allows fluid to flow from behind the iris through the opening, allowing the iris to fall back into a more normal position, opening the drain. 

This laser treatment is performed in the ophthalmologist’s office. The treatment will not improve your vision, but it can help prevent vision loss from angle-closure glaucoma. Side effects of the treatment are unusual and include a temporary rise in intraocular pressure and inflammation. Sometimes, light can come through the hole and cause glare. If this occurs and it does not go away on its own, it can be eliminated by various means.
Decreased or lost vision

Non-laser surgery

Surgery in the operating room is usually tried only after laser and drops have proven to not lower the pressure adequately. The commonest one is a trabeculectomy, in which a new drain is created. With a seton an artificial drain is placed in the eye. Much talked about nowadays is MIGS, minimally-invasive glaucoma surgery. These involve surgery on the eye’s drain directly and are usually done at the time of cataract surgery. Most of these are in evolution and they don’t lower the pressure as well as a trabeculectomy or seton. Still, MIGS can be appropriate for some people.

 

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