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James B. Wanner, OD
Glaucoma Medical and Surgical Treatments
Maryland Eye Associates
. http://marylandeyeassociates.com

Glaucoma Medical and Surgical Treatments

Glaucoma is the leading cause of irreversible blindness in the world. Fortunately, if it is diagnosed early enough in the disease process it can be treated and the vision can be preserved. Treating glaucoma involves both medical and surgical treatments. Typically, early in the disease process, glaucoma can be managed very well with medications and or laser surgery. Later in the disease process, and in some less common types of glaucomas, intra-ocular surgery is often needed for effective treatment.
All treatments of glaucoma to date are directed at lowering the eye pressure (intra-ocular pressure). By lowering the eye pressure we decrease the damage that occurs to the optic nerve. This helps to preserve the vision. Unfortunately with glaucoma once vision is lost it can not be recovered. So the goal of treating people with glaucoma is to save or preserve the vision that has not yet been lost to glaucoma.
Medical management of glaucoma can be with topical medications (prescription eye drops) or with oral medications.Topical medication is the most common form of treatment for glaucoma. Oral medications can also be used but are used much less frequently than the topical medications. There have been many advances in the topical glaucoma medications over the years. All of the topical and oral medications are aimed at lowering the eye pressure. These medications do this by either decreasing the production of fluid in the eye (aqueous humor), or by increasing the rate of outflow of the fluid from the eye. The rate of production of eye fluid and the rate of outflow of the eye fluid is what gives us our eye pressure. The major categories of topical medications are; prostaglandin analogs, beta blockers, alpha agonists, and carbonic anhydrase inhibitors. Depending on the severity of the glaucoma one or all of these classes of medications may be used. Topical medications are used anywhere from one to four times a day.
Surgical management of glaucoma includes both laser surgeries and intra-ocular surgeries. Laser surgeries include laser trabeculoplasty (selective or argon) as well as peripheral iridotomies and cyclophotocoagulation procedures. The most common type of laser surgery is the laser trabeculoplasty. This laser is used to treat the outflow component of the eye. It is very successful in the majority of patients and often lowers the eye pressure for some period of time similar to using one topical medication. This laser is often part of the treatment plan along with topical medications. Laser peripheral iridotomies are performed on people who have either angle closure glaucoma or are at risk for angle closure glaucoma. This laser procedure creates a hole through the colored part of the eye (iris) and helps to deepen the angle where the fluid from the eye drains out. Cyclophotocoagulation procedures are laser treatments aimed at the muscle in the eye where the eye fluid is made. It is used to damage the muscle so it does not produce as much eye fluid.
Intra-ocular surgery for glaucoma includes many surgery types. The goal of intra-ocular surgery is also to lower the eye pressure. The most common type of surgery is called a trabeculectomy. In this surgery the surgeon creates a new way for the eye fluid to drain from the eye. This is accomplished by creating a flap in the white part of the eye (sclera) and this then connects the inside of the eye to underneath the clear tissue of the eye (conjunctiva). This leaves what looks like a bubble on the top part of the eye that is called a “bleb.” The next most common surgery is called a tube shunt surgery. In this surgery a device called a glaucoma tube shunt is used to lower the eye pressure. The glaucoma tube shunt is composed of a plate and a tube. The plate of the device is sutured to the wall of the eye, underneath the clear tissue, and the tube is then placed inside the eye. The eye fluid then can drain through the tube to the plate and then underneath the clear tissue. Other glaucoma surgeries exist but are performed less often.
Advances in medications and surgical procedures for glaucoma management have dramatically altered the natural history of this devastating disease. Many treatment options exist today which did not in the not to distant past. We look forward to future advances in the treatment of this potentially blinding disease.

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