At Montgomery Eye Center, our ophthalmologists have experience treating thousands of people with glaucoma. From early intervention to more complicated cases, we have the skills and facility to ensure the best in glaucoma care.
What Is Glaucoma?
Glaucoma is a relatively common eye disease which is a leading cause of blindness, especially when not diagnosed early and treated regularly. Glaucoma is known as the “sneak thief of sight” because extensive and irreparable damage can be done to a person’s vision before they notice any symptoms. Often glaucoma causes no pain and changes occur so slowly and subtly that they are barely noticeable.
Glaucoma is a condition caused by damage to the optic nerve, which is the part of the eye that transmits the images we see from the eye to the brain. The optic nerve is made up of many nerve fibers, like an electric cable containing numerous wires. When the pressure inside the eye—interocular pressure (IOP)—builds up, it damages the delicate nerve fibers by reducing their blood supply. Gradually the nerves are destroyed and lose their ability to send images to the brain. Side vision is usually affected first.
IOP increases when the clear liquid called the aqueous humor, which normally flows in and out of the eye, cannot drain properly. Treatment for glaucoma focuses on lowering IOP to a level that is unlikely to cause further optic nerve damage. This is known as the “target pressure” or “goal pressure.” The target pressure varies from person to person, and may change during the course of your treatment.
Types of Glaucoma
There are different types of glaucoma. The most common form is primary open-angle glaucoma, when the aqueous humor that normally circulates in the front portion of the eye is blocked from flowing out of the eye through a tiny drainage system. This results in an increased IOP. Most people who develop primary open-angle glaucoma notice no symptoms until their vision is impaired.
In angle-closure glaucoma, the iris—the colored part of the eye—is pushed or pulled out of place and completely closes off the drainage angle. This can often occur abruptly, resulting in a sudden IOP increase, and is known as acute angle-closure glaucoma. It is considered an emergency because optic nerve damage and vision loss can occur within hours of the blockage. Symptoms can include nausea, vomiting, seeing halos around light, and eye pain.
Even people with a “normal” IOP can develop glaucoma and subsequent vision loss, a condition called normal tension glaucoma. As the name suggests, the optic nerve is damaged even though the IOP is considered normal. While normal tension glaucoma is not well understood, we do know that lowering the IOP can slow progression of this condition.
Childhood glaucoma is rare. It can start in infancy, childhood, or adolescence, and blindness can result if left untreated. Like primary open-angle glaucoma, there are few, if any, symptoms in the early stage.
Risk factors for glaucoma include an elevated IOP, a family history of glaucoma, an African-American ethnic background, advanced age, or particular optic nerve conditions. Regular eye exams with your ophthalmologist are extremely important if you are at risk for developing glaucoma.
How Glaucoma Is Treated
There is no cure for glaucoma—damage to nerve cells and fibers cannot be reversed. However, glaucoma can be controlled, which is why early intervention is so important.
In the vast majority of cases, eye drops or laser treatment will sufficiently control the IOP to prevent further loss of vision. However, they can lose their effectiveness over time or cause unpleasant side effects. In these cases surgical intervention may be required. Laser treatment is a simple, painless operation to open up the drainage within the eye, and is performed in our office.
In some instances when all other options have been exhausted, surgery may be performed to create a new drainage system in the eye. Our operating rooms and equipment are state-of-the-art, and our ophthalmologists highly skilled in the most advanced surgical procedures.
Our Techniques and Technology
Selective Laser Trabeculoplasty (SLT) is a clinically proven procedure that has been used with great success to treat open-angle glaucoma. In this procedure, laser energy is directed to the eye’s drainage tissue which results in better drainage of fluid, and a lowering of IOP. Because the type of laser used—often referred to as a “cold laser”—produces less heat energy, it results in minimal scar tissue and pain.
You may experience slight inflammation following the procedure, which is treated with eye drops or an over the counter pain pill. The SLT procedure often, but not always, enables our patients to discontinue ongoing glaucoma medication to maintain a target IOP. You can expect the effect to last between one to five years. SLT may be repeated at this time, or glaucoma medication may be used.
SLT is FDA approved and covered by Medicare and medical insurance.