Signs you have glaucoma, and what to do about it

Posted at 10:03 AM, Dec 15, 2016
and last updated 2016-12-15 11:03:21-05

“Doctor, I can’t afford these drops!” 

“Doctor, I can’t remember to take these drops everyday!” 

“These drops irritate my eyes!”

These are some of the many common complaints we hear from our patients being treated for glaucoma.

The lowering and stabilization of intraocular pressure is the only proven treatment for glaucoma. Several large studies have shown that eye pressure is a major risk factor for the development of glaucoma. 

Glaucoma is often treated with the use of eye drops several times per day, sometimes in combination with pills. It is unfortunately hard for many of our patients to stay on these meds for life since cost, forgetfulness and side effects often decrease compliance.

What is Glaucoma?

Glaucoma is a group of eye diseases causing optic nerve damage. The optic nerve (back of the eye) carries images (like a cable) from the retina, which is the specialized light sensing tissue, to the brain so we can see. In glaucoma, eye pressure plays a role in damaging the delicate nerve fibers of the optic nerve.  

When a significant number of nerve fibers are damaged, blind spots develop in the field of vision. Once nerve damage and visual loss occur, it is permanent. Therefore the goal of all glaucoma treatment is to lower eye pressure to prevent or reduce damage to the optic nerve.

It is estimated that 3 million Americans have glaucoma, but only about half of them know they have it. Glaucoma is a leading cause of blindness for people older than 60. But blindness from glaucoma can often be prevented with early treatment.

When glaucoma develops, there aren’t always early symptoms, and the disease progresses slowly. In this way, glaucoma can steal a person’s sight very gradually.

Fortunately, early detection and treatment (with glaucoma eyedrops, glaucoma surgery or both) can help preserve vision.

Several published studies suggest that medical compliance among glaucoma patients is poor, and between 20 percent and 66 percent of patients do not use their medication as prescribed. The prevalence of noncompliance may vary depending on the patient’s age, systemic and economic conditions, level of education, understanding of glaucomatous progression, motivation and confidence in his doctor.

The complexity of the therapeutic regimen also plays an important role in compliance. Historically, traditional glaucoma surgeries (trabeculectomy and glaucoma tube surgery) have been reserved for those patients with advanced disease since these procedures carry a risk of post-operative complications. 

A patient with early glaucoma would likely not be a candidate for these surgeries due to the risk of surgery. Unfortunately for patients who had mild to moderate glaucoma damage, they were sentenced to a life of daily drops , added cost and side effects.



Glaucoma surgery has entered a renaissance period

As technology has progressed, less invasive techniques have emerged that have improved the safety profile for glaucoma surgery. This has opened more surgical options for patients interested in effective glaucoma management, which does not rely solely on the continuous use of prescription medications.

In recent years, emerging technologies for minimally invasive glaucoma surgery have set the stage for revolutionary approaches that target patients with mild to moderate glaucoma.  Because of the increased safety associated with MIGS procedures, as well as their efficacy in mild to moderate glaucoma and ease of surgical application, more and more surgeons are incorporating these techniques.

These new procedures, such as the iStent®, Cypass, canaloplasty, goniotomy and XEN, allow for the use of microinvasive techniques that avoid disruption of the surface tissue of the eye and minimize post operative complications.  

The iStent® is the world’s smallest medical implant known to be implanted in the human body. The first MIGS device approved by the FDA, today iStent® has been implanted in more than 200,000 eyes around the world, with more and more imolanted every day.

These technologies now provide an opportunity to help reduce the drop burden for glaucoma patients who would have normally have been told to “deal with drops.”  

There has been a significant improvement in the quality of life of a patient who has these procedures.