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What is Glaucoma?

Glaucoma is often called the silent thief of sight because this degenerative eye disease slowly steals your vision and can lead to blindness. In the beginning stages of the disease there are typically no outward symptoms. Without regular eye exams, you will not realize this silent disease is damaging your vision.

Glaucoma is often caused by a build-up of fluid pressure in the eyes due to an overproduction of fluid or when the drainage system of the eye becomes blocked. This pressure can damage your optic nerve and cause an irreversible loss of vision. The optic nerve connects your eye to your brain and carries visual information to your brain for processing. Your peripheral vision—side vision—is lost first. If glaucoma remains untreated, vision loss creeps in toward the center, first causing tunnel vision, and then, eventually, blindness.

Glaucoma Risk Factors

You are at higher risk for developing glaucoma in the following situations

  • High intraocular pressure (IOP)
  • Family history of glaucoma
  • Abnormal optic nerve anatomy
  • Over the age of 40
  • African, Hispanic, or Asian descent
  • High myopia (nearsightedness)

Even if you don’t have any of these risk factors, you should still have regular eye exams.

What Are the Types of Glaucoma Diseases?

Open-Angle Glaucoma is the most common type of glaucoma. It occurs when ocular fluid cannot pass through the eye’s filtration system (trabecular meshwork) to the drainage canals. Many people do not notice early symptoms because glaucoma attacks the peripheral vision before it affects central vision. Over time, peripheral vision is slowly diminished and eventually may lead to full blindness if not treated. Annual eye exams can help alert you to changes in vision and should be scheduled regularly.

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Closed-Angle Glaucoma occurs suddenly when the eye’s fluid cannot drain and causes a rapid increase in eye pressure. A person may experience pain and sudden impairment of vision. Acute CAG requires emergency medical treatment. Permanent vision loss can happen in a short period of time with this condition. If you experience severe pain and nausea, blurry vision, and redness in the eyes you should seek immediate treatment to avoid severe vision loss.

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Congenital Glaucoma

Congenital Glaucoma is a condition in which children are born with a defect in the eye’s angle. This defect interferes with fluid drainage and causes elevated pressure.

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Secondary Glaucomas

Secondary Glaucomas can occur as a result of other diseases or treatments, such as:

  • High blood pressure
  • Diabetes
  • Complications of cataract surgery
  • Steroid treatments
  • Uveitis (inflammation of the middle layer of the eye)
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Low Tension Glaucoma occurs when patients with normal eye pressure experience damage to the optic nerve or peripheral vision loss.

Glaucoma Treatment Options

If glaucoma is detected early enough, the progress of the disease can be halted with medical and surgical treatment options. Pacific Eye Institute offers different types of treatment options, depending on your unique condition.

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Glaucoma Eye Drop Treatments

Prescription eye drops for glaucoma help maintain a healthy pressure in your eye and are an important part of the treatment routine for many people with glaucoma. Be sure your doctor knows about any other drugs you may be taking (including over-the-counter items like vitamins, aspirin and herbal supplements) and about any allergies you may have. As with any medication, these eye drops have side effects which are tolerable for most patients. Sometimes, due to the general health of a patient, some types of eye drops cannot be given.

Surgical Treatments

In Selective Laser Trabeculoplasty (SLT), laser energy is delivered to the drainage system of the eye, known as the trabecular meshwork. This treatment is extremely safe and well-tolerated by patients. The SLT technique is very gentle and studies show that it does not damage the tissue of the drainage system. This glaucoma treatment takes only minutes to apply and there is usually no discomfort felt by patients. Following the laser treatment, patients usually continue taking any existing glaucoma drops. After several weeks, a follow up appointment at Pacific Eye Institute will be required to evaluate intraocular pressure. We will then determine how successful the procedure has been.

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MIGS (Minimally Invasive Glaucoma Surgery) is an innovative, less invasive treatment option for patients with mild to a moderate glaucoma. MIGS is a great option for patients who are looking for a lower risk surgical option to reduce eye pressure. MIGS uses microscopic devices and tiny incisions to reduce intraocoular pressure (IOP) and slow the progression of glaucoma. MIGS may allow glaucoma patients to reduce their dependence on eye drops.

One type of MIGS is a micro-stent, which work by:

  • Lowering internal eye pressure by increasing the outflow of fluid
  • Allowing fluid to access the drainage channel, or bypass a blocked channel

The physicians at Pacific Eye Institute are proud to offer the iStent®  device and the The Hydrus® Microstent

  • Both devices have been proven safe and are designed for people with glaucoma who also have a cataract
  • Either can be placed into the eye during cataract surgery
  • The devices are exceptionally small, and won’t be seen or felt after the procedure is over.
  • The devices improve your eye’s natural fluid outflow to safely lower eye pressure by creating a permanent opening in the trabecular meshwork.
  • Both work continuously to control eye pressure and prevent damage to the optic nerve.
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Endoscopic CycloPhotoCoagulation (ECP) is a laser procedure performed at the same time or after cataract surgery. ECP has proven itself highly effective in reducing or eliminating the need to continue using glaucoma medications in the majority of patients who receive this treatment.

The ECP laser, particularly when combined with cataract surgery, is a minimally invasive and effective intervention for lowering intraocular pressure and controlling glaucoma. The recovery after the laser is typically rapid, like a person’s recovery after standard cataract surgery.

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The surgeons at Pacific Eye Institute are proud to offer Micropulse Transscleral Cyclophotocoagulation (MP-TSCPC) for the treatment of glaucoma. This relatively new laser surgery can help control glaucoma in patients who already have eye damage caused by glaucoma and when medication and other surgeries have been unsuccessful at controlling glaucoma. To learn more about this innovative treatment, please schedule an appointment with one of our glaucoma experts.

During the procedure, our surgeons will laser the secretory epithelium of the ciliary body to reduce aqueous humor secretion with the goal of lowering intraocular pressure (IOP).

The procedure is performed with the Iridex Cyclo G6 Laser
The procedure is performed with the Iridex Cyclo G6 Laser

Patients with open-angle glaucoma may be candidates for angle surgery, which includes canaloplasty and goniotomy. Put simply, viscocanalostomy and canaloplasty are surgical procedures offering an alternative to trabeculectomy. Your Pacific Eye Institute Surgeon will work to enlarge your eye’s drainage system (Schlemm’s canal) to allow increased fluid flow out of the anterior chamber. In both procedures, the goal is to restore the eye’s natural drainage system and provide sustained reduction of intraocular pressure.

A tube shunt is a surgical procedure used to drain excess fluid when medications and laser procedures are no longer an option. In this surgery, a small tube is inserted into the eye to create an alternative passageway for excess fluid to drain into a reservoir behind the eye, reducing the pressure in the eye.

The implant procedure is typically an outpatient surgery, done under local anesthesia. This solution is extremely effective in treating glaucoma. It consistently reduces pressure, is long lasting, and offers a quick recovery time.

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When treatment with medication or less invasive laser surgery does not lower intraocular pressure, your glaucoma specialist my need to perform a trabeculectomy. During a trabeculectomy, your Pacific Eye Institute Surgeon will create an alternate channel through which fluid inside the eye can exit. The eye pressure is reduced because fluid, which was once blocked, can now drain through the new opening into a reservoir (bleb) underneath the conjunctiva where it is then absorbed by the body.

During the weeks following surgery, eye drops must be used to prevent inflammation and infection. Frequent follow-up visits are necessary, so that our team can follow your progress and determine if any further treatment is required.

XEN Gel StentAn Alternative to Trabeculectomy
An innovative device known as the XEN Gel Stent is able to perform a similar function with quicker recovery and a less invasive approach.  We are pleased to offer this innovative technique at Pacific Eye Institute if your eye requires such treatment.

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To learn more about glaucoma treatments in the Inland Empire, contact Pacific Eye Institute today to schedule an eye exam.

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