Kremer Laser Eye Center - Surgical Procedures

It is of course not possible to answer all questions on a web site. If you are considering medical or surgical treatment for glaucoma, your doctor will answer all of your questions.

• What is Glaucoma?
• How common is Glaucoma?
• Risk factors for Glaucoma
• Types of Glaucoma
• Can blindness from Glaucoma be     prevented?
• Treatment for Glaucoma
• Medical treatment
• Surgical treatment
• Selective Laser Trabeculoplasty
• Argon Laser Trabeculoplasty
• Laser Peripheral Iridotomy
• Trabeculectomy
• Shunt Procedure
• Summary

What is Glaucoma?
Glaucoma (pronounced glaw-coma) is a disease of the eye in which damage occurs to the optic nerve, typically as a result of an elevated pressure within the eye. The optic nerve sends messages from the eye to the brain allowing us to see. Damage to the optic nerve causes progressive loss in peripheral vision and can eventually lead to blindness.

Normally, the eye produces a fluid called aqueous humor which is essential in maintaining the eye's shape and normal function. Eye pressure can be increased due to poor access of the aqueous humor to the drainage system (closed-angle glaucoma) or problems within the drainage system (open-angle glaucoma).

How Common is Glaucoma?
Glaucoma is a very common cause of blindness in adults. It affects over 1% of Americans, and 3% of Americans over the age of 40. Another five to ten million Americans have an elevated eye pressure, the major risk factor for glaucoma. In fact, glaucoma is the number one cause of blindness in African-Americans, and it is the number three cause of blindness in Caucasians.

The problem is that half of the people with glaucoma do not even know they have it, because glaucoma generally takes away vision slowly and without pain. By the time a person notices changes in vision, the glaucoma has already caused permanent damage. This is the reason individuals need to be screened for glaucoma with both a pressure check and an examination of their optic nerves.

Risk Factors for Glaucoma
• Increasing age
• Race (African-American, Latin-American, Caucasian)
• Family history
• Steroid treatment
• History of eye injury
• Diabetes
• Hypertension
• High Nearsightedness or Farsightedness
• Thin cornaeal tissue

Types of Glaucoma
There are many types of glaucoma, but they can generally be divided into two major categories based on the configuration of the drainage angle within the eye.

• Open-Angle Glaucoma: This is the most common type, accounting for about 70% of cases. The drainage area in the eye is open but does not function properly. Pressure generally builds up and vision is lost slowly. There are no symptoms early in the course of the disease.

• Closed-Angle Glaucoma: In this condition, the drainage area of the eye becomes blocked by the iris, and the pressure within the eye can become quite elevated. This disease has a rapid onset and can cause severe eye pain, headaches, blurred vision, halos around lights and even nausea and vomiting. Certain patients with narrow anterior chamber angles may be predisposed to develop this type of glaucoma and may require laser treatment to prevent it.

Can blindness from glaucoma be prevented?
The good news is that we are very capable of treating most individuals with glaucoma, especially if we detect it early. Treatment usually keeps the disease from getting worse. However, sight destroyed by glaucoma cannot be restored. This is why it is so important to be screened for glaucoma with a routine eye examination.

Treatment for Glaucoma
In open-angle glaucoma, initial treatment is provided with either drops or a laser. In closed-angle glaucoma, initial treatment is with a laser.

• Medical Treatment: There are many excellent drops available now to treat glaucoma. Our glaucoma specialist, will discuss the pros and cons of different medications.

• Surgical Treatment: There are also many different surgeries we use to treat glaucoma.

• Selective Laser Trabeculoplasty is a new version of this that allows us to re-treat a patient should the pressure become elevated at some point after laser treatment.

• Argon Laser Trabeculoplasty (ALT) is used in patients with open-angle glaucoma to lower the eye pressure by placing small burns adjacent to the drainage angle.

• A Laser Peripheral Iridotomy (LPI) is performed in patients who have narrow angles, closed-angle glaucoma or pigmentary glaucoma to reestablish the normal drainage angle configuration. In this type of laser, we make a small hole in the iris (the colored part of the eye).

• A Trabeculectomy is performed in patients who have failed drops and laser surgery. Our glaucoma specialist will create a new drain in your eye to reduce the eye pressure.

• A Shunt Procedure, such as a Baerveldt Implant, places a small plastic tube into the eye to relieve the pressure more permanently when other methods have failed.

Summary
Glaucoma is an eye disease, which causes damage to the optic nerve and leads to vision loss. Once the nerve has been damaged, vision loss is generally permanent. Fortunately, we are very capable of treating glaucoma successfully in most patients, especially if it is caught early. We encourage routine evaluations for all individuals over the age of 40 and for those who have any risk factors noted above. Our glaucoma specialist, is more than happy to further evaluate you and treat you as necessary to maintain good vision.