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Glaucoma Surgery

Glaucoma and Glaucoma Surgery

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What is Glaucoma?

Glaucoma is a disease that damages the optic nerve. The optic nerve is made of more than 1 million nerve cells called neurons. These neurons deliver the signals to the brain that are interpreted as images and give us the gift of sight.

Glaucoma causes the neurons of the optic nerve to slowly die off. For each neuron that is killed, we lose a small portion of our vision. These subtle changes in your vision are difficult to notice, and a relatively large amount of damage must take place before you are able to tell that you are losing your vision. Glaucoma has been called the sneakthief of vision or silent stealer of sight because of it’s slow and subtle impact on vision. This process is often associated with elevated pressure within the eye, however there are many factors that can contribute to the development of glaucoma


Glaucoma is the second most common cause of irreversible blindness in the United States in patients over 40 years old. Vision lost to glaucoma cannot be restored but further vision loss can be prevented. Many patients diagnosed early and treated properly never develop a perceptible loss of vision.

Currently all treatments for glaucoma aim to lower the pressure of the fluid within the front portion of the eye called the aqueous humor. The aqueous humor is produced inside the eye. The most commonly used treatments are prescription eye drops that decrease fluid production within the eye or increase the flow of fluid out of the eye. In some cases patients may have an inadequate response to the eye drops and require laser treatments and/or surgery to control their glaucoma.

Risk factors for the development of glaucoma include:

  • Increasing age

  • Family history of Glaucoma

  • African, Asian, or Hispanic Ancestry

  • Past ocular trauma

  • Steroid use

  • Conditions that affect blood flow such as diabetes, migraines, and low blood pressure

Since glaucoma is most often asymptomatic, the American Academy of Ophthalmology recommends a screening eye exam around age 40 for healthy adults, when the earliest signs of the disease may begin to appear. For healthy adults over 65, the academy recommends complete eye exams every 1 to 2 years.

Proper management of glaucoma requires vigilance on the part of the patient and physician. In addition to monitoring of IOP, several tests are scheduled periodically to detect development or progression of the condition. These tests include photographs of the optic nerve to compare year to year, Automated Visual Field Testing to subjectively monitor the impact the condition is having on your vision, and Ocular Coherence Tomography (OCT) scans of the retina and optic nerve to measure the nerve fibers that are affected by glaucoma. With this information, your doctor can make the best choice on how to manage your glaucoma.

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Selective Laser Trabeculoplasty (SLT)

SLT is a laser procedure that is indicated to treat open angle glaucoma. The procedure can be used as an initial therapy or as additional treatment to reduce independence on IOP lowering drops. Laser energy is applied with a laser that focuses energy to selected tissues. In SLT the laser is focused on to the drainage tissue in the eye called the trabecular meshwork.

The laser energy initiates a chemical and biological change in the tissue that allows for better fluid drainage. This procedure can lower intraocular pressure (IOP) up to 30% when used as initial therapy. These results tend to be less in patients that are currently taking IOP lowering eye drops. Effects of the treatment can last on average 1-5 years, or longer. When the effect wears off, the procedure can be repeated.

Laser Peripheral Iridotomy (LPI)

An LPI is designed to treat or prevent glaucoma due to angle closure. The anatomical “angle” is the space between the iris and the cornea that leads to the drainage tissue of the eye called the trabecular meshwork.

Risk factors for Narrow Angles

  • Shorter eye

  • Farsightedness

  • Developing Cataract

Angle closure may also occur as a result of inflammatory conditions, such as uveitis, or vascular conditions, such as diabetes, that can lead to “secondary angle closure” over time. If you are diagnosed with narrow angles you are at risk for developing acute angle closure, a medical eye emergency. An acute angle closure event can lead to a dramatic spike in IOP. This IOP spike can cause the cornea to swell and become cloudy, the eye may become very red, and your vision will be decreased. The increased pressure is also quite painful and can become severe enough to cause nausea and vomiting. An angle closure event left untreated will cause swift, irreversible damage to your optic nerve and cause significant vision loss or even total blindness.

An LPI utilizes a laser to place a small hole in the peripheral edge of the iris to allow for fluid exchange between the front portion and the back portion of the eye. This helps to prevent the pressure from building up in the eye.

iStent inject®

The iStent inject® is the smallest medical device known to be implanted in the human body. It is made of two tiny stents that are designed to restore your eye’s natural ability to drain fluid out of the eye to reduce intraocular pressure. Designed for cataract patients with glaucoma, iStent inject® can be implanted by Dr. Routh at the time of cataract surgery. The device is intended to reduce or eliminate your dependence on eye drops to control glaucoma. You won’t see or feel the iStent inject® stents after they are inserted, but they are designed to effectively manage your eye pressure. Proven to be safe and effective in clinical trials, iStent inject® has been implanted in the eyes of patients around the world, with more patients benefiting from the procedure every day

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