What is Glaucoma?

Glaucoma is actually a group of diseases that damage the optic nerve. The optic nerve is responsible for connecting the back of the eye (retina) to the brain. Glaucoma is usually caused by an increase in the fluid pressure in the eye – either because of overproduction of fluid or when the drainage system of the eye becomes blocked. The higher pressure inside the eye can causedamage to the optic nerve, resulting in permanent vision loss.

Our doctors at Atwal Eye Care provide diagnosis and treatment of glaucoma in Buffalo, NY.

Types of Glaucoma

• Open-angle glaucoma (most common): fluid builds up in the eye due to a blockage in the trabecular meshwork which leads to elevated eye pressure.
• Angle-closure glaucoma: the iris blocks part of the angle of the eye so fluid cannot drain properly. This leads to a sudden increase in eye pressure and is a medical emergency.
• Congenital glaucoma: present at birth, the angle of the eye does not allow for proper drainage of fluid.
• Secondary glaucoma: this develops as a complication of another eye surgery, injury, disease or other eye conditions.

Glaucoma Symptoms 

Glaucoma is often called the silent thief of sight because there are no obvious symptoms with the most common type of the disorder: open-angle glaucoma. Most people do not detect a change in their vision until there has actually been a significant loss of vision. Unfortunately, vision loss from glaucoma is permanent. 

Glaucoma is one of the leading causes of blindness. An estimated 3 million Americans have glaucoma but only half know they have the condition. 

In most cases, glaucoma can be detected during routine eye exams. Special instruments are used to check the fluid pressures in the eye and a magnifying lens is used to examine the drainage channels for proper fluid outflow.

Symptoms of Later Stage Open-Angle Glaucoma

• Mild headache
• Night vision difficulties
• Blind spots in both eyes
• Tunnel vision

Symptoms of Angle-Closure Glaucoma

With angle-closure glaucoma, there will be a sudden increase in eye pressure. This is a medical emergency because it can destroy vision very quickly. Symptoms may include: 

• Blurred vision
• Severe eye pain
• Nausea 
• Halos around lights
• Severe headache

Risk Factors for Glaucoma

Although glaucoma can occur at any age, the risk of developing glaucoma increases dramatically after age 60. Other risk factors for glaucoma include:

• Family history of glaucoma
• Presence of diabetes, heart disease or high blood pressure
• Trauma to the eye
• Certain eye conditions (thin corneas, retinal detachment, etc.)
• Race (African Americans, Hispanics, Asians, Native Alaskans and Japanese are at higher risk)
• Naturally high intraocular pressure

Diagnosis of Glaucoma

In order to detect and diagnose glaucoma, our team may use several tests and techniques:

• Optical Coherence Tomography (OCT), a non-invasive imaging test that uses light waves to take cross-section pictures of the various distinctive layers of the back of your eye (retina).
• Visual field test to measure your peripheral vision – how much your eyes can see from side to side when you focus on one central point. The information gathered can show our team the severity of glaucoma as well as vision loss that has been sustained.
• Corneal hysteresis (CH) measurements to determine the shock-absorbing ability (biomechanical property) of your cornea. If your CH is low, you may be at a higher risk of developing glaucoma.

Glaucoma Treatments 

Although there is no medical cure for glaucoma, the condition can be treated and managed to help slow vision loss and preserve your vision. The earlier your condition is diagnosed the more effective treatment will be. 

Our doctors offer the following glaucoma treatment options to reduce eye pressure: 

• Medicated eye drops 
• Oral medications
• Selective Laser Trabeculoplasty (SLT)
• ® Gel Stents

• Drainage tubes (shunts)
• Laser peripheral iridotomy 
• Trabeculectomy (filtration surgery) 
• Minimally Invasive Glaucoma Surgery (MIGS)
• OMNI™ System
• DURYSTA™

Eye Drops

There are a variety of medicated eye drops that can be prescribed to decrease eye pressure. Your doctor may prescribe drops that increase the outflow of fluid, reduce the production of fluid or drops that achieve both. 

Oral Medications

Oral medication can be a stand-alone option or supplement the medicated eye drops. A commonly prescribed medication is a carbonic anhydrase inhibitor. 

Selective Laser Trabeculoplasty (SLT)

Laser energy is used to clear blocked channels in the trabecular meshwork. Specific cells are treated during the process. The results are not instant; it may take 1-3 months for eye pressure to lower. 

XEN® Gel Stents

The XEN Gel Stent is a small tube that is permanently inserted into the eye, under the conjunctiva of the eye (clear membrane that covers the white of the eye). Once inserted, it becomes soft and flexible, helping to create a drainage channel in the eye and lower eye pressure. 

Drainage Tubes (Shunts)

A flexible tube is inserted into the drainage area of the eye to promote fluid escape. This is typically done after other methods of treatment have been explored. SLTis now offered as a First Line treatment and it can be repeated if necessary. The SLT procedure is performed in-office.

Laser Peripheral Iridotomy 

A laser is used to create a small hole on the outer edge of the iris for fluid release. This can be used as a preventative measure for people with narrow drainage areas in the eye or to treat existing glaucoma. 

Trabeculectomy (Filtration Surgery)

This is also called conventional glaucoma surgery. A small hole is made in the white of the eye to create a new drainage flap for fluid to drain through at a desired rate. 

Minimally Invasive Glaucoma Surgery (MIGS)

We may recommend a MIGS procedure to increase the flow of fluids from your eye, lower your intraocular pressure and protect your optic nerve. There are several different procedures that fall under this category, but all require only tiny incisions and cause less trauma to the eye than other types of surgeries. The MIGS procedure may be done with a microscopic tube inserted into the eye to drain fluid (microtrabeculectomy), placing a tiny stent into the trabecular meshwork, inserting tiny shunts (tubes) into the eye or using laser treatment procedures.  

The right treatment(s) for your eyes will depend on the type of glaucoma you have, the severity of your condition and your overall eye health. If you have glaucoma you will need to be regularly monitored to ensure that your treatment is working. By keeping your eye pressure within a normal range for your unique eyes, we may be able to protect your optic nerve from further damage. 

OMNI™ System

For primary open-angle glaucoma patients, we offer the OMNI™ Glaucoma Treatment System. This system allows our doctors to identify where you might have blockages in your eyes that are preventing fluid from flowing freely and, therefore, increasing your eye pressure. It combines two Minimally Invasive Glaucoma Surgery (MIGS) procedures in one device: canaloplasty and trabeculotomy. 

OMNI treats three areas of common fluid outflow areas with just one device providing openings in the trabecular meshwork, Schlemm’s Canal and collector channels. This treatment can be done during cataract surgery or as a stand-alone procedure. OMNI is an efficient and effective way to help your eye fluid stabilize. 

DURYSTA™

For patients with open angle glaucoma, DURYSTA is an extremely tiny, dissolvable implant that is placed into your eye to continually release medication that can reduce your elevated eye pressure. This FDA-approved option is an alternative to daily eye drops. In fact, just one DURYSTA implant can help lower your eye pressure for up to 15 weeks. 

Side effects can include eye redness, light sensitivity, dry eye, feeling of a foreign object in the eye, pain, blood spot on the eye, blurry vision and other symptoms. If you experience these symptoms or any other vision changes, contact your doctor. 

Remember, vision loss from glaucoma is permanent but can usually be prevented with early detection and treatment. That means that regular eye exams are especially important for people over age 60 or those in other high-risk groups. Call 716-896-8831 or click here to schedule an eye exam.