Delaware Glaucoma Specialist
What You Need to Know About Glaucoma
Whether you are seeking an initial evaluation or advanced surgical solution, Eye Consultants is the Delaware Glaucoma Specialist who can provide you with the expertise and treatment needed to manage the disease of glaucoma. Through proper treatment and continued evaluations, the vast majority of patients diagnosed with glaucoma retain excellent vision and optic nerve function.
Three million people in the US have glaucoma, and 50% of them don’t know it.
Glaucoma by the Numbers
What is Glaucoma?
Glaucoma is a group of related disorders that ultimately affect the optic nerve, causing peripheral vision loss. One symptom of this condition is elevated eye pressure, however it can only be detected by an examination. Glaucoma is often called the “sneak thief” of sight, as many patients are unaware they have the disease. Currently, the best treatment revolves around lowering eye pressure. This can be done in a number of ways from topical eye drops to more complex surgeries. As a glaucoma specialist, Dr. Dealy is trained to manage complex and severe cases of glaucoma, diagnose the condition and provide treatment with surgery or lasers. As new and novel procedures and devices become available, Dr. Dealy is committed to providing these services as they become FDA approved.
In order to prevent permanent vision loss, glaucoma needs to be diagnosed early and treated appropriately to prevent blindness.
Glaucoma specialists have specific training for treating glaucoma both medically and surgically, and most often focus on cases too difficult for the general ophthalmologist to control. Glaucoma can result from other ocular conditions like diabetes and ocular vascular disease, or arise after other complex surgeries like corneal transplants or retinal detachment surgeries. Dr. Dealy works with other ophthalmic sub-specialists to provide focused and dedicated treatment to control and manage glaucoma.
What is Angle Closure Glaucoma?
This type of glaucoma is also known as acute glaucoma or narrow angle glaucoma. It is much more rare and is very different from open-angle glaucoma in that the eye pressure usually rises very quickly. It can cause a significant amount of pain and some individuals may seek emergency room care.
This happens when the drainage canals get blocked or covered over, like a sink with something covering the drain.
A simple test, called gonioscopy, can be used to see if your angle is normal and wide or abnormal and narrow.
Symptoms of angle-closure glaucoma may include headaches, eye pain, nausea, halos around lights at night, and very blurred vision.
Treatment/Laser Peripheral Iridotomy
Treatment of angle-closure glaucoma usually involves either laser or conventional surgery to remove a small portion of the bunched-up outer edge of the iris. Surgery helps unblock the drainage canals so that the extra fluid can drain. Most patients will undergo the laser procedure, a Laser Peripheral Iridotomy, in the office. Many times this is done as a preventative measure, so that the patient will not experience angle-closure glaucoma in the future.
Glaucoma Treatment Options
The most important part of any treatment plan is consistent management and attention to any problems that may arise. We work with our patients to make sure they understand how adherence to their treatment plan and regular testing all help to prevent the progression of glaucoma.
Medical Management of Glaucoma
If caught early, glaucoma can often be managed with medication only and no need for surgery. Medical treatment for glaucoma commonly involves the use of daily eye drops–of which there are many different brands and types. Eye pressure monitoring appointments as well as evaluations of your optic nerve function (the Visual Field test) and diagnostic testing to assess your optic nerve structure will be done periodically to assess for treatment success.
Surgical Management of Glaucoma
The goal of all glaucoma surgery is to lower eye pressure to prevent or reduce damage to the optic nerve.
Selective Laser Trabeculoplasty (SLT)
SLT is an in-office laser procedure that is used to provide eye pressure control. Recent studies have shown that it is as effective as topical daily eye drops at controlling your eye pressure, especially when used in the early stages of the disease.
Implantation of Durysta™
This treatment option is a small biodegradable implant that delivers a constant dose of Bimatoprost. It is one of the newer procedures that we can offer to provide eye pressure control without the need for daily topical eye drop instillation. Not all patients are candidates for these procedures.
MIGS (Minimally Invasive Glaucoma Surgery)
Standard glaucoma surgeries — the trabeculectomy or tube shunt procedure—are major surgeries. While they are very effective at lowering eye pressure and preventing progression of glaucoma, they have a long list of potential complications.
The MIGS group of operations have been developed in recent years to reduce some of the complications.
MIGS procedures work by using microscopic-sized equipment and tiny incisions. While they reduce the incidence of complications, some degree of effectiveness is also traded for an increase in safety.
The MIGS group of operations are divided into several categories:
– Miniaturized versions of trabeculectomy (XEN® Gel Stent)
– Trabecular bypass operations (iStent® and Hydrus®)
– Totally internal or suprachoroidal shunts
– Milder, gentler versions of laser photocoagulation
– Angle based surgeries: Kahook Dual Blade®/OMNI® Surgical System
Trabeculectomy
Trabeculectomy is the most commonly performed surgery for uncontrolled or worsening glaucoma. Dr. Dealy performs these procedures weekly for patients whose glaucoma has progressed and is no longer controlled with less aggressive forms of treatment. A trabeculectomy is called a “filtering” surgery, as it creates a fistula between the inside and outside of your eye, allowing the release of the fluid and causes a reduction in eye pressure.
Glaucoma Drainage Device Surgery
Another way to control eye pressure this procedure involves the implantation of a special device that is able to help drain the aqueous fluid from the anterior chamber of the eye. The most commonly used shunts are the Ahmed Valve ™ and the Baerveldt Glaucoma Drainage Implant ™ .
Newer, smaller devices have made a huge impact on glaucoma care in the last 10 years. These small devices or procedures are usually combined with cataract surgery in an attempt to lower eye pressure and hopefully reduce the medication burden. The iStent®, Hydrus®, Kahook Dual Blade®, and EX-PRESS® Shunt are all surgical devices and procedures designed to lower eye pressure.
Diode Laser Cyclophotocoagulation
This laser procedure is performed in the outpatient surgery center due to the need for anesthesia. Laser energy is applied to the circumference of the eye, causing local inflammation and destruction to the ciliary body—the structure that produces fluid. This causes a reduction in eye pressure.
Glaucoma Surgery FAQs
Is there pain during the procedure?
In most cases, there is no pain involved. The surgery is usually done with a local anesthetic and relaxing medications. Often a limited type of anesthesia, called intravenous (I.V.) sedation, is used.
In addition, an injection is given around or behind the eye to prevent eye movement. This injection is not painful when I.V. sedation is used first. The patient will be relaxed and drowsy and will not experience any pain during surgery.
What is the success rate?
Many of the studies regarding the success of glaucoma surgery document follow-up for a one year period. In those reports, it shows that in older patients, glaucoma filtering surgery is successful in about 70-90% of cases, for at least one year.
Occasionally, the surgically-created drainage hole begins to close and the pressure rises again. This happens because the body tries to heal the new opening in the eye, as if the opening were an injury. This rapid healing occurs most often in younger people, because they have a stronger healing system. Anti-wound healing drugs, such as mitomycin-C and 5-FU, help slow down the healing of the opening. If needed, glaucoma filtering surgery can be done a number of times in the same eye.
Where is the surgery done?
Usually, glaucoma surgery is an outpatient procedure, requiring no overnight hospital stay. Eye Consultants uses the Limestone Surgery Center and the Outpatient Surgery Center in Wilmington Hospital. Patients are scheduled for post operative appointments one day after the surgery and one week after the surgery. Glaucoma surgical patients require continued monitoring, and sometimes return to the office several times in a 2-3 month period.
What is the recovery time?
For at least one week after surgery, patients are advised to keep water out of the eye in the case of swimming or using hot tubs. Showering is not a problem. Most daily activities can be done, however, it is important to avoid driving if your vision is too blurry, and any heavy lifting. The most important thing to do is follow the schedule of post operative eye drops.
Each case is different, so check with your doctor for specific advice.
What will my eye look like after surgery?
The eye will be red and irritated shortly after surgery, and there may be increased eye tearing or watering. The inner eye fluid flows through the surgically-created hole and forms a small blister-like bump called a bleb. The bleb, usually located on the upper surface of the eye, is covered by the eyelid, and is usually not visible.
What will my vision be like after surgery?
There may be some vision changes, such as blurred vision, for about six weeks after the surgery. After that time, vision will usually return to the same level it was before surgery.
In a few cases, the vision may be worse due to very low pressure. Cataracts or wrinkle in the macula area of the eye may develop.
After surgery, you may need to change your contact lenses or glasses. Gas permeable or soft contact lenses may be worn. However, the bleb may cause fitting problems, and special care will be needed to avoid infection of the bleb. Contact lens users should discuss these problems with their eye doctor following surgery.
Schedule Your Appointment with a Delaware Glaucoma Specialist
Let’s halt your vision loss! Prevention is the key in glaucoma treatments and we’re ready to develop your personal treatment plan to keep you from losing ground while keeping things as simple and cost-effective as possible.