New developments in the treatment of glaucoma provide even more options for managing and living with this eye disease. Here are some of the latest treatment options to be aware of and consider.
Just about everyone knows that glaucoma is an eye disease, but very few know what it actually does to the eyes and vision. It is called the silent thief of sight for two reasons:
• First, it is without visual symptoms until it is very far advanced.
• Second, it is, in the vast majority of cases, painless.
Signs of risk for glaucoma are easily detected by an eye doctor during a routine exam. In the past, many doctors and patients were under the assumption that most glaucoma cases had to have high eye pressures. We now know that up to 30% of glaucoma patients have eye pressures in the normal range, so other factors are involved in the damage. A simple “glaucoma pressure check” or screening is not nearly enough to rule out the disease.
While increased intraocular pressure (IOP) is not the definition of glaucoma, the treatment at this time is solely based on lowering the pressure. That can be achieved by the use of topical drops, laser or surgical procedures. The majority of glaucoma sufferers can be controlled with drops alone.
The management of glaucoma has come quite a long way in the last 20 years. Before that, we had the choice of one drop that gave patients headaches, red eyes, night blindness and the increased risk of retinal detachment – or another drop that lowered heart rate and energy and caused depression and impotence. They were prescribed two to four times a day. Understandably, patients rarely used them as they should.
We now have three kinds of once-a-day drops to choose from, along with a number of twice-a-day drop choices for additive therapies as needed. The negative side effects with these new drugs are much reduced, though the drops are not without the occasional allergic reaction. Some of the side effects are increased lash length and darkening – not all bad. The other good news is that they are very effective and can delay or completely eliminate the need for laser or surgical intervention – even in some of the more difficult cases.
Many pharmaceutical companies are also doing research on implantable or sustained release, drug-eluting devices for the eye or inner eyelid surface that may eliminate the need for drops in the future.
Glaucoma procedures and surgery
Just as in drop therapy, many improvements have been made in the surgical treatment of glaucoma in the last few decades. Lasers have proven to be a good addition to topical drop therapy and, in a few cases, can reduce or eliminate the need for drops.
The most common glaucoma laser procedure is SLT, or Selective Laser Trabeculoplasty. SLT gently opens drainage passages in the front of the eye to increase fluid outflow, thereby reducing pressure and stress on the optic nerve.
Another laser procedure, trans-scleral micropulse cyclophotocoagulation uses energy to target and eliminate some of the fluid producing cells behind the iris and lowers the pressure in that manner. This treatment is a bit more involved but in many cases can lower the pressure more than SLT.
MIGS, or Minimally Invasive Glaucoma Surgery, is a catch-all term for a variety of new non-laser surgical procedures done in the front of the eye to lower pressure.
MIGS are without the increased risk and complication rate of more involved “open eye” filtering or shunt/drainage device implantation surgeries. MIGS has garnered quite a bit of interest from investors, doctors and patients, but we have yet to see any long-term study results. However, MIGS will probably soon play a significant role in the future of glaucoma management.
When was your last comprehensive eye exam? Early detection of eye disease is crucial for effective treatment options. If you’d like to schedule an exam or discuss treatment possibilities with the specialists at Accent Vision, please contact us. Your vision is precious!