Glaucoma

Selective Laser Trabeculoplasty

This procedure for glaucoma is very successful in reducing intraocular pressure. The laser used is a type of modified Nd:Yag laser that is frequency doubled to produce light in the visible range but without producing a thermal effect. The treatment takes about 10 minutes and is highly successful at reducing eye pressure in patients with glaucoma.

iStent® Trabecular Micro-Bypass: Add an Exciting New Glaucoma Technology to Your Cataract Surgery.

Technology has always played an important role in eye care. Today, almost every aspect of vision is connected to a product or procedure that wasn’t available even ten short years ago. Cataract surgery is a good example of how innovations can make a difference. Every aspect of it utilizes recently developed technology that will help us improve your vision.

Today, this includes managing your mild-to-moderate open-angle glaucoma: because now we are able to add another step to your cataract surgery that allows you to treat your open-angle glaucoma in a completely new way. This is important because once diagnosed, you and most patients like you will spend the rest of your lives putting one, two or even three different kinds of drops in every day. Unfortunately, all of these drops will not only be inconvenient, but potentially very expensive. The iStent Trabecular Micro-Bypass Stent is designed to reduce your eye pressure and you can have it done at the same time you have cataract surgery.

The world’s tiniest medical device—iStent—is 20,000 times smaller than the intraocular lenses (IOL) used in your cataract surgery. But the size of iStent is only part of its story. By increasing the eye’s ability to drain fluid, this technology is designed to reduce the pressure in your eye.

iStent works like the stents used to prevent heart attacks and strokes. When blood vessels get clogged, a stent creates access to the vessel flow. While a highly innovative technology, how iStent works is elegantly simple:

• If you have glaucoma, over time the eye’s natural drainage system becomes clogged
• iStent creates a permanent opening through the blockage to improve the eye’s natural outflow
• Restoring this mechanism lowers and controls pressure within the eye

iStent: managing glaucoma while treating your cataracts

iStent is implanted during your cataract surgery procedure. Once implanted, iStent will begin working to safely and effectively manage pressure. What’s more, patients who receive iStent may experience a reduction in glaucoma medications; but this will be at the discretion of your physician.

Trabeculectomy

All glaucoma surgeries, and there are many variations on the basic theme, attempt to reduce eye pressure by providing an escape for the fluid that is produced inside the eye. Trabeculectomy is a local anesthetic, outpatient procedure that creates an artificial opening into the front chamber of the eye such that fluid escapes and percolates underneath the very surface skin of the eye, the conjunctiva. This causes ballooning up of the conjunctiva into what is called a bleb, or bubble that acts as a reservoir to accumulate escaped fluid and hold it there until it is reabsorbed into the bloodstream.

This operation is successful at reducing the eye pressure more than 85% of the time. Sometimes it is still necessary to use glaucoma drops after surgery, but often it is not. Many times in the immediate post operative period, the laser is used to cut sutures on the surface of the eye, beneath the conjunctiva, to allow for better drainage of fluid. This way, a certain amount of control is possible in titrating the effect of surgery.

Scarring is the usual cause when trabeculectomies fail. We know that in cases where an eye has had previous surgery, there is a greater chance of failure associated with it. Often, intraoperatively, a medication is used on the surface of the eye to reduce the tendency for scar tissue formation. This has been shown in studies to increase the success rate with trabeculectomy so is almost always used in cases where scar tissue is expected to be an issue.

While trabeculectomy is considered a relative low risk procedure, there are certainly risks, as with any surgery. The risks are balanced against the risk of blindness from glaucoma. Frequently taking the risk of surgery is preferable to any of the other alternatives. Surgery is almost never contemplated in cases where the pressure can be adequately controlled on topical medication.