Glaucoma Treatment

Glaucoma is a progressive eye condition characterized by increased intraocular pressure that can damage the optic nerve, leading to vision loss if left untreated. This condition typically develops when the eye's drainage system becomes less efficient, causing a buildup of fluid and pressure within the eye. The exact cause of this impaired drainage can vary but often results from a combination of genetic predisposition, age, and other underlying medical conditions. Early detection and management are crucial in preserving your vision, and our skilled optometrists are dedicated to providing comprehensive glaucoma treatments tailored to your unique needs. Don't let glaucoma threaten your eyesight – schedule a thorough eye examination with us today to ensure the health of your eyes.
 

What is the Goal of Glaucoma Treatment?

Before we dive into the new options, it’s important to understand the goal of any glaucoma treatment. At present, glaucoma is not curable. However, treatment can significantly slow the progression of the disease. Glaucoma damages your eye's optic nerve. Extra fluid builds up in the front part of your eye (cornea), which increases the pressure in your eye. Reducing this pressure is the primary objective of any glaucoma treatment. This is often referred to as intraocular pressure or IOP.

Standard Glaucoma Tests

During a comprehensive eye exam, your eye doctor will always check for glaucoma, regardless of the risk level. This provides a baseline for comparison as you age. There are two tests: tonometry and ophthalmoscopy.
 

Tonometry

Tonometry measures the pressure within your eye. Your eye doctor will give you drops to numb your eyes. Then he/she will use a device called a tonometer, which applies a small amount of pressure with a warm puff of air.

Eye pressure is unique to each person, so it’s not always a reliable indicator of glaucoma. It’s simply another piece of information to help your eye doctor assess your eyes. The range for normal pressure is 12-22 mm Hg (“mm Hg” in millimeters of mercury, a scale for recording eye pressure). Most glaucoma cases are diagnosed with pressure over 20mm Hg. However, some people can have glaucoma at pressures between 12 -22mm Hg.
 

Optical Coherence Tomography 

Optical Coherence Tomography uses light waves to take cross-section images of your retina, which is the area of light-sensitive cells at the back of your eye that is responsible for receiving light and transmitting it into messages that are sent up to the brain. The technology behind OCT enables your eye doctor to see each of the different layers that make up the retina. By being able to see these and measure them, they can obtain a much clearer picture of the overall health and condition of your eyes.

Visual Field 

Visual field testing is one of the most effective diagnostic treatments in the detection of glaucoma. This is because when patients are affected by glaucoma, it is usually the peripheral vision that is affected by their condition first. However, it can also be used to detect central or peripheral retinal diseases, eyelid conditions such as drooping, optic nerve damage, and conditions that affect the visual pathways from the optic nerve to the area of the brain where this information is processed into vision.

Supplemental Glaucoma Tests

Perimetry

Perimetry is a visual field test. It creates a map of your complete field of vision. During this test, you’ll look straight ahead and then indicate when a moving light passes your peripheral (or side) vision. Try to relax and respond as accurately as possible. To ensure accuracy, your doctor may repeat the test to see if the results are the same the next time. If you’ve been diagnosed with glaucoma, a visual field test is usually recommended at least once per year to assess changes to your vision.
 

Gonioscopy

This diagnostic exam helps determine the angle of your iris and cornea. First, you’ll receive eye drops to numb the eye. A hand-held contact lens is gently placed on the eye. A mirror on the contact lens shows the doctor if the angle is closed and blocked (a possible sign of angle-closure or acute glaucoma) or wide and open (a possible sign of open-angle, chronic glaucoma).
 

Pachymetry

Last, your eye doctor may want to use pachymetry as another way to confirm a diagnosis. Pachymetry measures the thickness of your cornea, the clear window at the front of the eye. A probe called a pachymeter is gently placed on your cornea to measure its thickness. Pachymetry can help clarify your diagnosis because corneal thickness has the potential to influence eye pressure readings.

What are the Standard Glaucoma Treatments?

Eye drops for glaucoma treatment seem like an easy option but there are several challenges that can reduce its effectiveness. It can be difficult to get all the medicine in the eye, especially for older adults with less of a steady hand. In addition, since it must be applied daily, individuals may forget. Since the drops have no perceivable benefit because early stages of glaucoma have no symptoms, patients might make it a lower priority which is understandable since it may also have unpleasant side effects like burning, red eyes.

Beyond eye drops, laser surgery is a less invasive option. The laser opens clogged tubes and drains fluid. It can take a few weeks to see the full results. If laser surgery or drugs don’t relieve your eye pressure, you may need a more traditional operation. You would have to go into the hospital and will need a few weeks to heal and recover. Although usually effective, glaucoma surgery can make you more likely to get cataracts later on. It can also cause eye pain or redness, infection, inflammation, or bleeding in your eye.

What are Recent Advances in Glaucoma Treatment?

Alternatives or Improvements to Eye Drops
The Glaucoma Research Foundation reported several new developments on the horizon. These technologies focus on reducing patient error in applying eye drops which would make the medication more effective and improve the quality of life for the patient. Here are some of the products underway:

• A polymer, like a contact lens, would contain the drug; it would sit under the eyelid and release the medication over several months

• Microneedles would inject medication into a specific spot to be most effective

• Implantable extended-release devices using engineered highly precise microparticles and nanoparticles

• Polymer-based intraocular delivery technologies that would allow customizable sustained release

• Drops that allow the medication to get into the eye more easily

• Tear duct plugs that release medication

In addition, people with glaucoma who take more than one eye drop per day are beginning to see those medications available as a single, combined eye drop. New products include Cosopt (timolol and dorzolamide), Combigan (timolol and brimonidine) and Simbrinza (brinzolamide and brimonidine).
 

Minimally Invasive Glaucoma Surgery

Minimally Invasive Glaucoma Surgery (MIGS) procedures are small cuts or micro-incisions through the cornea that cause the least amount of trauma to the surrounding tissues. Doctors implant a tiny device to allow fluid to drain from the eye, reducing internal pressure. Some devices (iStent) are implanted during cataract surgery. Cataract surgery alone lowers pressure, but the combination of both is more effective and can lower the need for medication.

These new techniques minimize tissue scarring, allowing for the possibility of traditional glaucoma surgery in the future if needed. They also give doctors the opportunity to treat patients earlier and more safely than older surgeries.
 

Monitoring Eye Pressure

An easy, accurate way to measure eye pressure is critical to monitoring the progress of glaucoma and adjusting treatment as needed. For patients that require more frequent testing of their eye pressure, there’s now an at-home tonometer called iCare HOME. There’s no puff of air and no eye drops. The patient can easily share the information with their eye doctor.

If you have a glaucoma diagnosis, you can feel confident that your glaucoma treatment options are only going to improve in the years ahead. Although the disease is not curable, it is very manageable with the right treatment.