Treatment Options for Glaucoma
The doctors at Eye Centers of Racine & Kenosha are experts in Glaucoma diagnosis and treatment. We are among the first practices nationally that test the latest technologies for better glaucoma management. Listed below are some of the treatment options now available. The MIGS devices in particular have been making great progress in the success with treating glaucoma.
Glaucoma Eye Drops
Prescription eye drops for glaucoma help maintain the pressure in your eye at a healthy level and are an important part of the treatment routine for many people. 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.
Like any medication, these eye drops have side effects which can be tolerated by many patients. However, due to the general health of the patient, some types of eye drops can not be given. To minimize this side effect you should decrease the amount of eye drops that is absorbed to your blood stream by pressing on the corner or medial side of your eye near the nose after you apply the eye drops, so you can decrease the amount of drug that pass through the nasolacrimal ducts in which it can pass to your blood stream.
Selective Laser Trabeculoplasty (SLT)
In this treatment, laser energy is delivered to the drainage system of the eye, the trabecular meshwork. This treatment is extremely safe and is well-tolerated by patients. The SLT technique is very gentle, and studies show that it does not damage the tissue of the drainage system. The treatment takes only minutes to apply, and there is usually no discomfort felt by the patient. Following the laser treatment, many patients can decrease or stop their existing glaucoma drops. After several weeks one returns to measure the intraocular pressure and to assess the success of the procedure.
Glaucoma Surgery
If intraocular pressure cannot be controlled with oral or topical medications, an ophthalmologist may recommend glaucoma surgery.
Trabeculectomy
Trabeculectomy is a surgical procedure performed by an ophthalmologist that is used to lower eye pressure. By trying to lower the eye pressure, damage can be halted from further pressure increases. Damage already caused by glaucoma is not reversible. The trabeculectomy procedure involves the surgeon creating a tiny passageway from the inside to the outside of your eye. This helps fluid drain better from the areas it is presently not draining. The trabeculectomy procedure can lower the pressure in your eye and help prevent more damage to the optic nerve.
We can use a device known as a shunt or tube shunt to lower intraocular pressure. The Ex-PRESS mini shunt is a relatively new device, available in the USA since 2002. Over 12,000 implantations have been performed worldwide. During this procedure, the glaucoma eye doctor diverts the fluid through an extremely small tube to the outside of the eye. You neither cut sclera, nor the iris.
Although the device is as small as a grain of rice, it acts just like a heart stent, keeping a pathway open so blood (or in this instance, fluid) can successfully go around the blockage. The Ex-PRESS provides precise control of the amount of fluid that is allowed to flow out, helping the eye maintain a healthy level of internal pressure. The Ex-PRESS mini glaucoma shunt provides effective long term control of intraocular pressure, with a success rate of about 94%.
Shunts
We can use a device known as a shunt or tube shunt to lower intraocular pressure. There are a number of glaucoma drainage devices that the Eye Center uses to help reduce the pressure, including the Ahmed, Baerveldt, Molteno, and Clear Path tube shunt. Each of these shunts has specific advantages that we tailor to the individual patient. Tube shunts can be valuable when patients do not have healthy tissues and are not good candidates for trabeculectomy surgery.
MIGS (Micro-Incisional Glaucoma Surgery)
MIGS can be thought of in a few broad categories, either enhancing fluid outflow using the eye’s inherent drainage system, shunting fluid to the outside of the eye, or decreasing production of fluid within the eye. Some types of MIGS procedures are FDA-approved to be performed only in conjunction with cataract surgery whereas other MIGS procedures are approved to be performed independent of cataract surgery.
The goal of utilizing these new MIGS procedures is to improve safety while tailoring the surgery to the individual patient’s disease stage and lifestyle needs. MIGS has greatly decreased the number of patients who require more invasive traditional glaucoma surgeries to control their IOP.
Moreover, since the safety and efficiency of MIGS procedures is very high, our decision threshold about when to perform a MIGS procedure is lower than with traditional glaucoma surgery. Our goal is to provide better eye pressure control while decreasing the burden of taking drops.
iStent
What is iStent?
iStent is a tiny stent that creates a permanent tunnel for fluid drainage. It helps to relieve pressure in the eye and treat glaucoma-related vision loss. The stent is implanted during cataract surgery. Many people with glaucoma also suffer from cataracts. Because cataract surgery is a stitch-less procedure, the stent is implanted without any cuts or incisions.
iStent is the first MIGS device that improves your eye’s natural fluid outflow to safely lower eye pressure by creating a permanent opening in the trabecular meshwork.
Proven safe and effective, the iStent Trabecular Micro-Bypass:
- is safely implanted during cataract surgery
- spares important eye tissue that is often damaged by traditional surgeries
- does not limit treatment options that could help maintain your vision in the future
Hydrus
The Hydrus Microstent is a revolutionary new therapy used during cataract surgery to help manage glaucoma. It has been proven in global clinical trials to lower eye pressure, which resulted in a reduction of glaucoma medicine and, in some patients, eliminated the need for medication.
Roughly the size of an eyelash, the highly flexible Hydrus Microstent is placed by a surgeon during cataract surgery using microscopic incisions. This less invasive approach allows for fewer complications and faster healing times than traditional glaucoma surgery.
The XEN® Gel Stent
The XEN® Gel Stent is a surgical implant designed to lower high eye pressure in open-angle glaucoma patients where previous surgical treatment has failed and/or medications alone were insufficient (also known as refractory glaucoma).
iTrack viscodilation
The iTrack™ surgical system is used to perform ABIC™ which is also known as Canaloplasty. This procedure leaves no device in the eye and helps to rejuvenate the natural drainage system.
The OMNI™ Glaucoma Treatment System
The OMNI™ Glaucoma Treatment System is the only device that combines two well-established micro-invasive glaucoma surgery (MIGS) procedures into one using a single device and single clear corneal incision.
With dual mechanisms of action targeting the trabecular meshwork and collector channels, OMNI™ is designed to address the entire natural trabeculocanalicular outflow pathway to reduce intraocular pressure in adult patients with open-angle glaucoma.
Kahook Goniotomy
The Kahook Dual Blade® (KDB) is a high-tech, single-use ophthalmic blade that is used to treat glaucoma, typically performed at the time of cataract surgery. The outpatient procedure is quick and painless, with the post-operative recovery quicker than most other glaucoma treatment options. With a low risk of leaks or infections, the KDB is an excellent and safe option to treat your glaucoma.
What is the Procedure?
The Kahook Dual Blade® is intricately designed to allow surgeons to release intraocular pressure (IOP) by making tiny incisions in the trabecular meshwork and the wall of the Canal of Schlemm. It is inserted in the eye through a clear corneal micro incision. The groundbreaking, micro-engineered steel body is specifically designed to produce targeted, fine-tuned incisions for an effective glaucoma treatment.
