Glaucoma is a term used to describe a group of conditions in which the eye pressure is high, leading to damage to the optic nerve (the nerve that connects our eye to the brain). This can lead to permanent damage to the field of vision, which in severe cases can cause tunnel vision and blindness. Even in less severe forms, glaucoma can interfere with independent living and can affect our ability to drive.
Prevention is the key. Regular eye exams with your optician, particularly if there is a family history of glaucoma, can detect the condition early with a prompt referral to your eye specialist.
Fortunately, we now have many very sensitive tests that can diagnose the condition well before it causes any perceptible damage to your vision. These include Visual Field tests and Optical Coherence Tomography scans. Both of these are done in clinic and only take a few minutes with no discomfort.
Once the diagnosis is confirmed, the key is to lower the eye pressure in order to preserve vision. I am pleased to be able to offer the very latest treatment options which include:
- Eye drops: There are a wide variety of eye drops which can be used to lower the eye pressure. They are usually taken once or twice a day but do need to be instilled regularly for the rest of your life.
- Lasers:
- Selective Laser Trabeculoplasty: This is a simple and painless laser treatment that only takes a few minutes to perform and you can go home the same day. It can be done either to supplement the effect of eye drops or to replace them completely. I will be able to tell you at your consultation how this can help you best.
- Laser Peripheral Iridotomy: In a particular type of glaucoma (narrow angle glaucoma), I can create a very small channel in the iris using a special laser. This can not only help lower the pressure, but can also prevent future attacks of very high pressure (called acute angle closure glaucoma).
- Cyclodiode: If the eye pressure is not being controlled despite best efforts with all other treatment options, this laser can be performed to stop production of fluid in the eye (this is done by a part of the eye called the ciliary body).
- Surgery: I am trained in all the latest surgical techniques for the treatment of glaucoma. These include:
- Cataract Surgery: For some, simply removing a developing cataract can not only lead to improvement in vision but can also lower the eye pressure.
- Cataract Surgery with iStent inject implantation: At the time of cataract surgery I can also implant a very tiny titanium stent into the eye which helps to drain fluid out of the eye thus lowering the pressure. This is part of an exciting new type of surgery called minimally invasive glaucoma surgery (MIGS) and I am privileged to be one of the first surgeons in Plymouth to introduce and perform this procedure.
- Cataract Surgery with goniosynechiolysis: Sometimes an iStent cannot be safely placed as the drainage angle of the eye is narrow. In such circumstances the drainage area can be opened up with goniosynechiolysis.
- Trabeculectomy with antimetabolite injection: This involves creating a flap on the surface of the eye which allows fluid to drain out. A special anti-scarring medication is used to ensure success.
- Aqueous Shunt Devices: These devices comprise of a soft footplate connected to a plastic tube. The tube is inserted into the eye whilst the footplate is secured to the surface of the eye and drains fluid out. Performing both a trabeculectomy or aqueous shunt device insertion is reserved for cases that are not responding to suitable treatments as listed above.
Good support can make all the difference in living a fulfilling life despite glaucoma. The International Glaucoma Association (IGA) is an excellent resource for this.