Glaucoma Treatment in San Diego
Also Serving Oceanside
What Is Glaucoma?
Glaucoma is an eye disease characterized by damage to the optic nerve and loss of peripheral vision. The majority of the time glaucoma is related to elevated intraocular pressure (IOP). However, in some cases pressure inside the eye is not elevated; this is called normal tension glaucoma. Glaucoma is one of the leading causes of blindness for patients between the ages of 18 and 65 and often goes undiagnosed because the symptoms are undetectable until the advanced stages. There are two major categories of glaucoma: open-angle glaucoma and closed-angle glaucoma (often called narrow-angle glaucoma).
Symptoms: Often, there are no symptoms associated with early or moderate open-angle glaucoma or open-angle glaucoma might be as subtle as light sensitivity. In the early to middle stages of open-angle glaucoma, the symptoms are unnoticeable and can only be detected through a visual field examination, by bumping into things or by missing objects in your field of vision. In the latter stages of the disease the visual field examination will reveal holes (scatoma) and the patient may notice areas of missing vision. Open-angle glaucoma in the early to mid-stages affects only the peripheral vision; therefore, it often goes undetected. This is why repetitive pressure checks, visual field examinations and OCT testing are imperative for all glaucoma patients.
Causes: Glaucoma is a result of excessive pressure building up inside of the eye and/or damage to the optic nerve either from overproduction of fluid or blockage of fluid outflow. Sometimes, there is a buildup of pigment or other substances present in the eye that blocks or impedes the fluid outflow.
Diagnosis: Open-angle glaucoma is diagnosed when the eye pressure is measured during an examination, evaluation of the health of your optic nerve through Ocular Coherent Tomography (OCT) testing and analysis and visual field analysis (or testing of your peripheral vision).
Treatment: Drug therapy usually comes in the form of eye drops. There are four main families of drugs that are commonly prescribed to lower eye pressure. This treatment is tailored to each individual based on how well it is tolerated and how effective it is. Stabilizing the eye pressure may take time while you find the right combination of drugs to use.
Laser treatment for open-angle glaucoma is called selective laser trabeculoplasty (SLT). The exact mechanism is still unknown but is thought to be immune mediated. After SLT treatment, the treated eye may drop three to six points and the untreated eye may drop a point or two. Effectiveness varies between patients. Some patients are quite responsive; others are not. SLT therapy is not permanent and may need to be repeated.
The classic form of glaucoma surgery is to create an artificial way to drain fluid from the inside of the eye to outside the eye. The oldest and still the most common form of surgical intervention is called a trabeculectomy, which makes a hole in the eye allowing fluid to drain from the eye, which results in lower eye pressure. Sometimes a trabeculectomy is performed with devices that prevent scarring, called shunts or tube shunts.
Tube shunts are becoming more popular due to a better long-term success rate than a trabeculectomy alone. This is especially true for those with any prior eye surgery, children or complicated cases.
Canaloplasty, a newer surgical method, is similar to angioplasty in the heart in that a micro-catheter is used to dilate Schlemm’s Canal and a small suture is used to stent the canal open. Unlike a trabeculectomy, canaloplasty does not create a full thickness hole in the eye. This results in fewer complications, i.e., less chance of infection, risk of pressure dropping too low (hypotony), etc. Canaloplasty is a safer way to reduce your dependence on medications.
Closed, Acute and Narrow-angle Glaucoma
Description: Closed-, acute- and narrow-angle glaucoma can result in blindness within 24 hours if not treated appropriately or in time. This form of glaucoma results from closure of the angle, which can be caused by the natural aging of the eyes and some medications. It is most often found with individuals that are highly farsighted. In narrow angle glaucoma, the eye pressure rapidly rises, which creates very obvious symptoms including severe eye pain, severe headache, decreased vision, seeing halos around lights, vomiting and extreme pain. If you have been told you have narrow angles by your ophthalmologist, it is important to read all medication labels and avoid any medications that warn, “Do not take if you have glaucoma.”
Diagnosis: When experiencing these symptoms, it is important to receive emergency treatment from an ophthalmologist. The ophthalmologist will measure your eye pressure and perform a pupillary and slit-lamp exam with a gonioscopy. An ultrasound bio-microscopy can also be used to diagnose narrow angle glaucoma. Treatment for narrow angle glaucoma is usually permanent and includes laser iridotomy, surgical iridotomy or cataract surgery. In most cases, a simple hole is made in the peripheral iris with the laser. This relatively painless procedure usually takes five to 10 minutes and is performed in the physician’s office. A laser iridotomy can close following the procedure, which is why annual exams are important so retreatment can be undergone if needed. In rare cases where the laser is ineffective, a surgical iridotomy can be performed. In both instances, the hole will permit the fluid to bypass the pupil, opening the angle and relieving the spike in intraocular pressure. Another method for preventing or relieving angle closure is cataract surgery, which opens the angle.
Frequently Asked Questions about Glaucoma
Is glaucoma preventable?
Although there are no known ways of preventing glaucoma, there are ways to prevent vision loss and blindness from the disease.
Regular eye exams are critical to identify signs of the disease in its earliest stages and prevent it from advancing. During a comprehensive eye exam, special tests are performed to measure inner eye pressure and the shape and color of the optic nerve, and examine other factors that could indicate glaucoma.
Generally, individuals under the age of 40 should have eye exams every two to four years to check for signs of glaucoma. Individuals between the ages of 40 and 54 should have eye exams every one to three years; individuals between the ages of 55 and 64 every one to two years; and individuals over the age of 65 every six months to a year.
Individuals at a heightened risk of developing glaucoma — such as people of African descent, people with diabetes and anyone with a family history of glaucoma — should have eye exams every one to two years after the age of 35.
To reduce the risk of developing glaucoma, it’s a good idea to follow other healthy lifestyle habits such as not smoking, eating a balanced diet and maintaining a stable weight.
And although exercise cannot entirely prevent glaucoma, studies have shown that regular exercise may lower intraocular pressure. Walking, jogging or practicing yoga three or more times a week can have positive effects on the health of the eyes.
Is glaucoma surgery covered by insurance?
Insurance coverage may vary by provider.
In certain cases, Medicare covers treatment options for glaucoma including medications, surgery or a combination of both.
If I have glaucoma, can I get LASIK?
In some instances, patients with glaucoma can undergo LASIK. However, some of the steps in the traditional LASIK procedure may briefly elevate intraocular pressure. For that reason, an alternative laser vision correction surgery such as PRK or LASEK may be more suitable.
Will cataract surgery affect my glaucoma?
It might have unpredictable effects. In some cases, cataract surgery can actually lower intraocular pressure. For certain people, this may either reduce or completely eliminate the need for medications to manage the glaucoma.
However, it is important to closely monitor intraocular pressure after cataract surgery. Patients may require additional follow-up visits or close monitoring to better manage their glaucoma.
Can glaucoma come back after glaucoma surgery?
Glaucoma surgery cannot cure glaucoma. Rather, the goal of treatment is to lower intraocular pressure to protect the optic nerve from additional damage and preserve vision.
Usually this is accomplished by creating a new opening in the eye so the buildup of fluid can properly drain. Sometimes the opening can narrow, intraocular pressure can spike and symptoms can return. Depending on the specific circumstances of the case and procedure, a second procedure may be required.
Will my vision be fully restored after glaucoma surgery?
No, glaucoma surgery does not restore sight that has been lost from the disease. However, our team can help you make the most of the vision you still have, whether by using special devices or services for low vision.
Contact San Diego Eye Care Center
To schedule a consultation for glaucoma treatment in San Diego & Oceanside, please contact our office at (760) 757-1144.