Glaucoma

Symptoms

Open-angle glaucoma signs and symptoms include:

  • Gradual loss of peripheral vision, usually in both eyes
  • Tunnel vision in the advanced stages

Closed-angle glaucoma signs and symptoms include:

  • Severe eye pain
  • Nausea and vomiting (accompanying the severe eye pain)
  • Sudden onset of visual disturbance, often in low light
  • Blurred vision
  • Halos around lights
  • Reddening of the eye

Causes

In open-angle glaucoma, the drainage channels in the angle (called the trabecular meshwork) are partially blocked, causing the aqueous humor to drain out of the eye too slowly. The exact cause of open-angle glaucoma remains unknown.

Closed-angle glaucoma occurs when the iris protrudes forward to narrow or block the drainage angle formed by the cornea and the iris. As a result, aqueous fluid can no longer reach the trabecular meshwork at the angle, so the eye pressure spikes suddenly.

Sometimes, glaucoma can be traced to a known cause, such as eye injury, inflammation, tumor, advanced cataract or diabetes.

Risk Factors

  • Intraocular pressure
  • Age
  • Ethnic background
  • Family history
  • Medical conditions
  • Certain medications

Detection

Early detection is key in preventing vision loss. A comprehensive eye examination by one of the physicians in our office in Northern NJ will help determine if there are possible signs of glaucoma. Measurement of intraocular pressure (IOP) is an important first step in detecting glaucoma. Further testing may include the use of computerized visual field testing (peripheral vision test) and digital optic nerve imaging with advanced equipment here in our Westwood office.

Treatment

Fortunately, glaucoma is highly treatable in most cases. Medication, lasers and surgery are all used to treat this condition. Our doctors are highly skilled in the following treatments for glaucoma.

Selective Laser Trabeculoplasty (SLT)

Using a gentle laser beam, the drainage areas are treated to help increase the drainage of aqueous humor from the eye in patients with open angle glaucoma. Our eye specialists can perform this 10-15 minute procedure in our office here in Bergen County. This painless procedure can be performed as an alternative to medications or in addition to medications. Studies have shown laser trabeculoplasty to effectively lower eye pressure in many patients. SLT may reduce the need and trouble associated with taking eye drops. Another benefit of SLT is that it can potentially be repeated if the effect wears off after a certain period of time.

What Can I Expect Regarding SLT?
When you arrive at our Westwood office, a technician will place eye drops in your eye to prepare you for the treatment. Once the procedure is completed, you will need to have the eye pressure checked an hour or so afterwards. No postoperative drops or medications are typically needed, however artificial tears can be used if the eye is slightly irritated. Over-the-counter pain medications can be taken if necessary. There are no restrictions on activities after the laser treatment. Please continue any glaucoma medications that you have been taking unless otherwise instructed. An appointment will be made to check the pressure in the following weeks. It may take up to eight weeks to get maximum effect from the laser treatment. Complications are minimal but may include inflammation and temporary increase in IOP.

Laser Iridotomy (LI)

In order to treat closed or narrow angle glaucoma, a laser is used to create a small opening in the iris to allow the aqueous fluid to reach the trabecular meshwork. Once the iridotomy is created, the likelihood of developing a glaucoma attack is very low. This brief and painless procedure is performed in our modern Northern NJ office.

Patient Information Regarding LI:
When you arrive at our Westwood office, a technician will place eye drops in your eye to prepare you for the treatment. Once the procedure is completed, you will need to have the eye pressure checked an hour or so afterwards. No postoperative drops or medications are typically needed, however artificial tears can be used if the eye is slightly irritated. Over-the-counter pain medications can be taken if necessary. There are no restrictions on activities after the laser treatment. In rare instances, the iridotomy may take more than one visit to complete. Complications are minimal but may include inflammation, temporary increase in IOP, abnormal streaks of light and minimal bleeding.

 

 

Microinvasive Glaucoma Surgery (MIGS):

Eye surgery, along with other surgical specialties, has undergone revolutionary advances resulting in smaller incisions, faster healing and fewer complications.  Glaucoma surgical treatment is now enjoying technological advances that are helping our surgeons achieve better pressure control to preserve vision in our patients.

iStent®

The iStent is a revolutionary device that increases the eye’s ability to drain aqueous humor. This device is FDA approved to be implanted in conjunction with cataract surgery in patients with mild to moderate glaucoma. Despite its small size (the iStent® is the smallest implanted medical device in the world), it effectively starts lowering eye pressure immediately after implantation. Surgeons from Westwood Ophthalmology Associates implanted the first iStents® in Northern NJ and are some of the most experienced iStent® surgeons in the state.

Many patients with glaucoma are taking eye drops that can be expensive, difficult to administer or have unwanted side effects. The iStent® effectively reduces IOP in open angle glaucoma and possibly reduces the need for medications. In a U.S. clinical study, 68% of patients receiving the iStent® were able to control their pressure under 21 mmHg WITHOUT the use of medications. If you or someone you know has glaucoma and cataracts and want to see if the iStent® can help lower IOP, call our office to set up a consultation with one of our surgeons.

 

Westwood Ophthalmology was also chosen to participate in several postmarket FDA studies because of our extensive experience with the iStent®

 

XEN® Gel Stent

Designed for advanced or severe glaucoma, the XEN® gel stent can aggressively lower intraocular pressure (IOP) with less risk of complications when compared to traditional trabeculectomy surgery.  The

XEN® stent is a small tube about the length of an eyelash that creates a small channel for fluid to drain out of the eye and lower eye pressure.  Most patients are able to achieve IOPs in the low teens while reducing the number of their medications.  Unlike the iStent, the XEN® stent can be performed alone or in conjunction with cataract surgery.  If you have advanced glaucoma and are taking multiple medications, the XEN® stent may be appropriate for you.  A consultation with one of our surgeons in our Westwood, New Jersey office can determine if you are a candidate.


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