Glaucoma

What is Glaucoma?

Glaucoma is an eye disease which causes damage to your eye’s optic nerve. Your optic nerve is an essential part of good vision, and the damage caused by Glaucoma can lead to irreversible vision loss and blindness. The damage caused by Glaucoma is typically caused by the build-up of high pressure in your eye.

Different Types of Glaucoma:

Glaucoma is actually a group of conditions and there are different types of Glaucoma.

Chronic Open-angle Glaucoma

Chronic Glaucoma is caused when your eye’s anterior chamber fills up with too much fluid (called aqueous). Typically, the build-up is caused because drainage channels (called trabecular meshwork) have become blocked. This imbalance in the production and drainage of fluid causes a high build-up of pressure, which damages your optic nerve.

Open-Angle Glaucoma is the most common form of Glaucoma. The symptoms and vision loss are gradual and generally unnoticeable.

Angle Closure Glaucoma

Angle-Closure Glaucoma is a less common form of Glaucoma. It is caused when your eye’s drainage become blocked mechanically and the build-up of fluid can cause a very rapid build-up of pressure.

Angle-Closure Glaucoma can develop much more quickly and because of this, the signs are generally more noticeable than open-angle. Noticeable symptoms include severe pain, loss of vision, blurred vision, and nausea. If you experience any of these symptoms, it is crucial that patients seek help as soon as possible.  Angle-closure glaucoma is more common in women, farsighted individuals, and those of Asian and Hispanic ethnicity.  If diagnosed early enough, it can be preventively treated with a special laser called Laser Peripheral Iridotomy which can help prevent the more severe symptoms listed above from ever happening.  This is one of the reasons annual eye exams by a competent eye doctor are recommended.  The test of choice for diagnosis is Gonioscopy.

Glaucoma Symptoms

Unfortunately, many Glaucoma sufferers do not express any early symptoms or warning signs like pain. Regular visits to your eye doctor are the best way to detect and diagnose Glaucoma early. Early detection is key to preventing long-term vision damage or blindness.  We recommend yearly eye exams for those over the age of 40. If your family has a history of eye diseases or if you have certain health issues like Diabetes you should consult with your eye doctor as you may need to go more often.

Glaucoma Prevention and Treatment

During your routine eye exams, your doctor will assess your intraocular pressure and optic nerve for signs of elevated eye pressure or damage. Although it is not always possible to prevent glaucoma, regular eye exams allow for early detection and treatments that avoid vision loss.  In addition to eye drop medications that are available for glaucoma, there are multiple surgical options for lowering eye pressure.

Selective Laser Trabeculoplasty (SLT)

SLT is one of the safest and a very effective treatment for open-angle glaucoma.  This is a pain-free 10-minute procedure that can lower eye pressure up to 30%.  It can be used as a standalone treatment for glaucoma, to reduce a patient’s dependence on drops, or as an addition to drop therapy.  In many cases, SLT can be performed instead of or as a replacement for drops.  This in turn helps reduce the medication regimen burden for the patient.  Good candidates for SLT may include:

  • Highly active individuals who don’t want to be burdened by drops
  • Patients who are allergic or intolerant to drops or want to avoid their side effects
  • Patients with arthritis who have trouble administering eye drops
  • Patients for whom eye drops have not been effective or are inadequate to control eye pressure
  • Patients highly dependent on contact lenses for whom taking the contacts out to use drops creates an undue burden

Trabeculectomy

Traditional Trabeculectomy is a very detailed surgical procedure where an intricate opening is created through the sclera (white part of the eye) to allow fluid to drain between the surface layers of the eye and bypass the natural drain of the eye.  This procedure carries more risk and is reserved for cases of glaucoma that are not responsive to less invasive treatments.

Glaucoma Tube Shunt Surgery

These procedures allow for a surgical device attached to a tube to be inserted in the eye under the surface layer (conjunctiva) of the eye in order to drain fluid from the eye.  They carry less risk than Trabeculectomy but also do not lower eye pressure as much.  Our glaucoma specialist can determine what is the best treatment plan for your glaucoma needs based on your unique situation.

Minimally Invasive Glaucoma Surgery (MIGS)

These surgeries include Trabeculotomy and the Xen, Cypass, and iStent implants for the treatment of glaucoma.  These procedures represent the latest technological advances in the field of glaucoma.  They function by bypassing the natural drainage system of the eye in one way or another.  The benefit of these surgeries is they are less invasive than traditional glaucoma surgeries (such as Trabeculectomy or Tube Shunt Surgery) and have a much better safety profile.

Sensimed Triggerfish Smart Contact Lens

Triggerfish (TF) is the first US-approved Smart Contact Lens and is targeted to improve Glaucoma Management. It is a soft, disposable silicone contact lens with an embedded micro-sensor that captures circumferential changes near the corneoscleral junction. It essentially measures ocular volume change over a 24 hour period.

Ocular volume change is associated with the eye’s ability to handle increases and fluctuations in pressure as they are related to tissue elasticity. Studies conducted by Gustavo De Moraes MD, PhD (Columbia University) and others have shown the readout of the 24-hour TF curve to be highly correlated to glaucoma progression. It measures objective readings at times when accurate IOP measurements are not possible (during sleep etc). In fact, these studies have implied the TF readout to be better correlated with glaucoma progression over a two year follow up period than in-clinic eye pressure readings.

Currently, the potential indicated benefits of the Trigggerfish Contact Lens include:

    • Identifying glaucoma patients at highest risk of progression (risk stratification within disease)
    • Identifying glaucoma suspects at highest risk for progression to glaucoma (normal vs. diseased eyes)
    • Confirming a diagnosis of Normal Tension Glaucoma
    • Monitoring effectiveness of current glaucoma therapy
    • Better management of glaucoma based on risk stratification and road map provided by Triggerfish

How it works

This lens is applied just like a contact lens, the data is wirelessly transmitted from the lens to the antenna that is applied adhesively around the eye, the data is then transmitted from the antenna through a wire to a recorder that the patient wears, and the data is downloaded at the 24 hour mark to our specially set-up computer system for analysis.

Patients maintain their regular routine (with the exception of minimizing exercise and not bathing) during the 24 hour recording period, capturing the most sensitive overnight ocular changes that have thus far been elusive to study.

Watch this short video on the technology below:

Which Glaucoma Procedure is Right for You?

Only your glaucoma specialist can determine if you are a good candidate for any of these procedures.  At Dougherty Laser Vision, we are proud to offer the most extensive options and technological advances available in the field of glaucoma.  In line with our mission statement, our glaucoma team, led by Dr. Houman Vosoghi, is at the forefront when it comes to incorporating the most advanced surgical options for your ophthalmologic care. Please call or schedule a consultation to learn more about Glaucoma treatment at Dougherty Laser Vision.