Glaucoma Treatments
Micro Invasive Glaucoma Surgery (MIGS) - Istent
IStent is not only the smallest medical implant known to be implanted in the human body–it also started a revolution in glaucoma treatment and surgery as the first Micro Invasive Glaucoma Surgery (MIGS) device approved by the FDA. In a U.S. pivotal trial, IStent was shown to be effective in decreasing IOP, with an excellent safety profile, few complications, and fast recovery time.
Today, IStent has been implanted in over 100,000 eyes around the world. A more recent study published by the Journal of Cataract and Refractive Surgery shows that even three years after the iStent procedure, 79% of patients had IOP ≤ 16 mmHg, 86% were able to reduce the number of glaucoma medications taken, and 74% were medication free. The procedure is covered by Medicare and most private insurance plans, and we believe patients are going to be very excited about the opportunity to receive cataract surgery and glaucoma treatment therapy at the same time.
Laser Peripheral Iridotomy (LPI)
Narrow-angle glaucoma (also known as angle-closure glaucoma) occurs when the angle between the iris and the cornea in the eye is too small. This causes the iris to block fluid drainage, increasing inner eye pressure. LPI makes a small hole in the iris, allowing it to fall back from the fluid channel and helping the fluid drain.
Common Types of Glaucoma
Primary Open Angle:
In open-angle glaucoma, the drain of the eye is normal in configuration, but becomes impermeable over time, causing an increase in intraocular pressure (IOP) and subsequent damage to the optic nerve. It is the most common type of glaucoma. Most people have no symptoms and no early warning signs. If open-angle glaucoma is not diagnosed and treated, it can cause a gradual loss of vision. This type of glaucoma typically develops slowly and sometimes without noticeable loss of sight. It often responds well to medication, if caught early and properly treated.
Angle Closure:
This type of glaucoma is also known as acute glaucoma or narrow angle glaucoma. It is much rarer and is very different from open-angle glaucoma in that the eye pressure usually rises very quickly. This happens when the drainage canals get blocked acutely. Symptoms of angle-closure glaucoma may include headaches, eye pain, nausea, rainbows around lights at night, and very blurred vision.
Low-Tension or Normal-Tension
With this type of glaucoma, damage occurs to the optic nerve without eye pressure exceeding the normal range. In general, a "normal" pressure range is less than 20 mm Hg. The causes of LTG are still unknown. For some reason, the optic nerve is susceptible to damage from eye pressure, which for most people is in the normal range. Approximately 10-15% of all glaucoma are of the low-pressure variety.
Secondary Glaucoma
This type refers to cases in which another ocular or systemic disease causes or contributes to increased eye pressure, resulting in optic nerve damage and vision loss. Secondary glaucoma can occur as the result of an eye injury, inflammation, tumor, or in advanced cases of cataract or diabetes. It can also be caused by certain drugs such as steroids. This form of glaucoma may be mild or severe.
Glaucoma Suspect
This describes a person with one or more risk factors that may ultimately lead to glaucoma, but this individual does not have definite optic nerve damage or visual field loss. The goal of identifying and treating patients who are glaucoma suspects is to preserve visual function by monitoring them for the earliest signs of damage.
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Selective Laser Trabeculoplasty (SLT)
Selective Laser Trabeculoplasty (SLT) is a clinically proven glaucoma treatment that can help to lower the intraocular pressure (IOP). The SLT laser targets pigmented tissue cells within the drainage system of the eye with short, gentle bursts of light. The lowest possible laser energy is applied to cause the most minimal tissue response.
Due to this there is little to no permanent visible change to the target tissue. These bursts of laser energy stimulate a natural healing response within the eye. As a result, the pores through which fluid must exit the eye become larger, causing a greater outflow of fluid, which in turn lowers the eye pressure. SLT glaucoma treatments are performed in the office through the same apparatus the doctor uses to examine patients.
After the eye is numbed with drops approximately 100 laser pulses are applied through a special mirrored lens. The procedure is not painful, but some patients report a slight pinch, soreness or burning sensation. Any discomfort is mild and usually tolerated without any difficulty. While the treatment itself takes only a few minutes, the overall process takes approximately two hours due to preparatory and follow up measures that ensure the patient’s eyes are safe.
Typically, only one eye is treated at a time. The patient will continue all of their eye drops and will be given a prescription for an eye drop to be used only in the case that there is some discomfort after the procedure. The majority of patients do not feel there is a need for this medication.
Side effects after SLT laser treatments are rare. Below is a list of potential side effects:
- The most common side effects are mild and include soreness, redness and blurring of vision. These are usually very short-lived and can be treated easily and effectively with an eye drop.
- Elevated Eye Pressure – In some cases the eye pressure can increase after the procedure. This increase in eye pressure is usually temporary and may be treated with additional eye drops or oral medications. Very rarely this increase in eye pressure can persist and require more invasive surgical procedures to be performed.
- Peripheral Anterior Synechiae – adhesion of the iris to the cornea.
- Inflammation & Swelling – In rare cases, SLT can lead to persistent inflammation within the eye. This is a potentially serious complication which can lead to other problems in the eye.
It should be stressed that aside from the mild side effects described in the first bullet point all of these are very rare. In the unlikely case that these complications develop the appropriate treatment will be administered. For all medical procedures, the postoperative results vary among individuals. There is the potential for SLT to not have any effect on the eye pressure. On the other hand, the effect can be marked and last for multiple years.
Glaucoma drops may or may not be needed after the procedure depending on the individual circumstances. It is important to be continually monitored for glaucoma, so follow-up appointments are critical. If needed, SLT can be safely repeated in the future depending on results of previous applications.
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