GLAUCOMA TREATMENT + PROCEDURES
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Glaucoma is one of many chronic conditions we commonly treat in our office. In a basic sense, "glaucoma" refers to a family of ocular diseases in which the fluid pressure inside the eye ("intra-ocular pressure" or "IOP") is too high. This high pressure can crush and damage delicate structures inside the eye, namely the optic nerve. Damage to the optic nerve can result in loss of sight. Vision loss with glaucoma is typically gradual and characteristically starts in the peripheral vision, moving slowly (over years or decades) toward the central vision. For this reason, glaucoma patients rarely have any symptoms until very late in the disease process.
Sight loss from glaucoma cannot be reversed; treatment aims to lower the intra-ocular pressure to prevent further damage. First-line treatment for lowering IOP involves topical eye drops. The majority of glaucoma patients are managed with eye drops alone.
For some glaucoma patients, however, eye drops are either not sufficient to lower the pressure, or they are not tolerated well (medication allergies, etc). For these patients, there are surgical procedures aimed at lowering IOP by allowing fluid outflow from the eye.
Selective Laser Trabeculoplasty (SLT):
SLT is a quick and painless in-office laser procedure that can lower your eye pressure (IOP). As seen above, glaucoma is a condition in which the fluid pressure inside the eye is too high, so one method of lowering the IOP is to increase fluid outflow. The SLT procedure targets the trabecular meshwork, which is the region of the eye between the cornea and the iris and is responsible for allowing the intra-ocular fluid (aqueous humor) to flow out into the episcleral veins. SLT effectively lowers IOP by using laser energy to create drainage holes in the trabecular meshwork, allowing a greater quantity of fluid to leave the eye. SLT is a good option for patients who need more IOP control beyond eye drops, or patients for whom eye drops cannot be tolerated.
Micropulse G6 Laser Cycloablation:
The Micropulse G6 procedure is a more invasive laser procedure than SLT and is performed in the operating room. This procedure lowers IOP by lowering the amount of intra-ocular fluid (aqueous humor), but instead of targeting the trabecular meshwork (like SLT), Dr. Singh uses the G6 laser to target the ciliary body, which is the part of the eye that produces the aqueous humor. This results in less production of intra-ocular fluid and thus lower eye pressure. This procedure is recommended in patients with more advanced glaucoma or those needing a marked decreased in the intraocular pressure, beyond multiple topical drops.
iStent® Trabecular Micro-Bypass: Treating Glaucoma During Cataract Surgery
The iStent Trabecular Micro-Bypass Stent is the world’s smallest medical implant, and can be placed in the eye during a cataract surgery procedure for patients who are diagnosed with open-angle glaucoma. While Dr. Singh is already working in the anterior chamber of the eye to perform the cataract operation and intraocular lens (IOL) placement, he can simultaneously place a small stent in the trabecular meshwork. This iStent creates an open channel through which the aqueous humor fluid can flow out of the anterior chamber, out to the episcleral veins, thus lowering the eye pressure. Most patients with open-angle glaucoma are candidates for the procedure, and an in-office evaluation with one our doctors can confirm candidacy for the iStent implant.