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GLAUCOMA
MODERN TREATMENT
METHODS
ORALOV BEKHRUZ
 Glaucoma is sometimes labeled the “silent thief of sight” because
it results in peripheral vision loss without any warning symptoms.
 However, with early detection and modern treatment methods,
about 90% of people can avoid vision loss due to glaucoma.
What Is Glaucoma?
 The eye has an internal fluid system that is constantly producing
liquid that starts inside the eye, then drains out onto the surface
where it becomes the tear fluid that keeps your eyes from drying out.
 In most types of glaucoma, the drainage ducts of the eye become
clogged or blocked, preventing fluid from draining out of the eye.
 This leads to an increase in pressure in the eye (called the
intraocular pressure) and this pressure damages the optic nerve.
TYPES OF GLAUCOMA
Open angle glaucoma is the most common type of glaucoma. It occurs when an accumulation of
sediment gradually clogs the drainage ducts of the eye:
1.african-americans
2.hispanics
3.persons over age 60
4.steroid users
5.persons with high blood pressure.
6.if you have a family history of glaucoma, you are at elevated risk.
Angle closure glaucoma occurs when the iris blocks the drainage ducts. Because this can
suddenly cut off fluid drainage, causing a dramatic increase in intraocular pressure and rapid
damage to the optic nerve, it is sometimes called acute glaucoma. It requires emergency
attention. It is more common in people who are farsighted, Asian-Americans, and women. Risk
also increases with age.
If you experience:
•eye pain
•halos
•nausea
•vomiting
•vision loss
•you may be having an attack of acute glaucoma and should get emergency care.
 Secondary glaucoma is when clogging of the drainage angle is
caused by something else, such as injury to the eye, eye cancer, cornea
overgrowth, infection, or other causes.
It can have effects similar to either open angle or angle closure
glaucoma.
Risk factors are related to the primary causes.
 Pediatric glaucoma is when children suffer glaucoma. Most
commonly, a child is born with elevated intraocular pressure. This
affects about 1 in 10,000 infants, and seems to be genetic.
 Normal tension glaucoma occurs when the optic nerve suffers
damage without elevated intraocular pressure.
This is more likely in people with a family history of glaucoma,
cardiovascular disease, or Japanese ancestry.
SIGNS AND SYMPTOMS
 Open angle and chronic angle-closure. A visit to an optometrist or
ophthalmologist might show that an individual who has either of the two common
types will have abnormalities in their optic nerve endings and visual field loss.
 Acute angle-closure. Although it is not as common as the other two types, it has a
characteristic sign of the impairment. Most patients reported the occurrence of severe
and chronic eye pain, visual blurring, nausea and vomiting, and headache. The eyes
can also appear reddish and the pupils might be dilated but shows no reaction to light.
In the naked eye, a person with acute-angle closure might look cloudy. Optometrists
and Ophthalmologists often note a decrease in visual clarity, closed drainage angle,
and swelling of the corneal tissue.
 Elevated intraocular pressure (IOP). In cases of glaucoma, the most detected
condition is when there is an increase in the pressure of the fluid of the eyes. This is
due to the build-up of aqueous humor, a natural clear fluid that is secreted in between
the cornea and the eye lens. During the development stages of the disease, a person’s
aqueous humor will not be filtered or drained properly in the trabecular meshwork,
thus a buildup can occur.
 Although there is still no known cure for glaucoma, medical researchers have
definitely made a progress that can help in providing modern treatment methods for
this kind of eye disease. In most cases it can be stopped from progressing or slowed
downed.
 Discovery of myocillin. The discovery of this natural fluid has led
researchers into creating a model-type module that helps in simulating the
occurrence of glaucoma. Through these methods, they are able to study the
molecular mechanisms that take place in the onset of the disease, leading
them to produce oral medicines, topical eye drops, as well as laser therapies
which can delay or prevent the damages of elevated intraocular pressure
among patients.
 Prescription medicines. For several years, a topical treatment method has
also been introduced, namely latanoprost and dorzolamide, as well as the
development of non-invasive treatment method that facilitates the
application of topical medicine to the patients’ eyes.
 OPA-6566. This is another drug that is still being developed by Acucela
and Otsuka Pharmaceutical which aims to lower IOP, and at the same time,
decrease the probability of any unwanted side effects to the system.
Glaucoma treatment has greatly evolved for the past 30 years. From eye drops
to eye surgery, a myriad of treatment options are now available for glaucoma
patients. Though it has been previously a practice of glaucoma specialist since
the 60’s to begin treatment with a wide array of eye medications like :
•Miotics
•Beta-blockers
•Prostaglandin analogs ( pilocarpine, timolol and latanoprost)
As examples respectively, they are now slowly being replaced by sophisticated
procedures like:
•Canaloplasty
•Viscocanalostomy
•Sclerotomy.
The advantage of these modern glaucoma cures is that they are far safer than
and just as good in terms of lowering intraocular pressure as traditional eye
surgery called trabeculectomy. Clinical trials have proven this, with early
surgery saving the patient the inconvenience of applying eye drops each day
and from suffering from their many side effects. Since majority of glaucoma
patients are in their advanced years, it is expected for them to have medical comorbidities like diabetes, hypertension and heart disease. Thus, eye
medications in these cases can do more harm than good
Therapeutic trends show a growing number of glaucoma specialist foregoing medicines
altogether and proceeding to glaucoma treatment surgery. The catch with traditional eye
filtering surgery like trabeculectomy however, is its high rate of post-operative
complications like infection, eye trauma and scarring. Trabeculectomy is often reserved
only for those who have frank angle closure glaucoma- a severe form of glaucoma
wherein patients are at the brink of blindness, and those whose remain to have
uncontrolled eye pressures despite years of medication and laser.
BUT WITH THE ADVENT OF NON-PENETRATING SURGERY USING :
•Artificial drainage devices (ADD)
•Collagen implants ( deep sclerotomy)
•Micro catheter technologies(viscocanalostomy & canaloplasty)
The treatment middle ground may not be far behind. One of the amazing and most
promising among these is canaloplasty, which uses a flexible tube as thin as a human
strand of hair to create an alternate bypass and enlarge the normal fluid channels without
interfering with the rest of the structures of the eye.
Glaucoma Surgery involves either laser treatment or making a cut in the eye to reduce the
intraocular pressure (IOP). The type of surgery your doctor recommends will depend on the
type and severity of your glaucoma and the general health of your eye. Surgery can help
lower pressure when medication is not sufficient, however it cannot reverse vision loss.
Glaucoma surgery is indicated when intraoculare pressure is very high or the optic nerve is
badly damaged and unresponsive to topical medication.
Laser surgery is usually performed in the initial stages of glaucoma and is used to reduce the
number of topical medications needed to control intraocular pressure.
There are several types of glaucoma microsurgery. They can be divided in penetrating and
non-penetrating glaucoma surgery.
LASER PERIPHERAL IRIDOTOMY (LPI)
 Narrow-angle glaucoma occurs when the angle between the iris and the cornea in the eye
is too small.
 This causes the iris to block fluid drainage, increasing inner eye pressure.
 LPI makes a small hole in the iris, allowing it to fall back from the fluid channel and
helping the fluid drain.
ARGON LASER TRABECULOPLASTY (ALT)
 The laser beam opens the fluid channels of the eye, helping the drainage system
work better.
 In many cases, medication will still be needed.Usually, half the fluid channels
are treated first.
 If necessary, the other fluid channels can be treated in a separate session
another time.
 This method prevents over-correction and lowers the risk of increased pressure
following surgery.
 Argon laser trabeculoplasty has successfully lowered eye pressure in up to 75%
of patients treated.
SELECTIVE LASER TRABECULOPLASTY (SLT)
 SLT uses a combination of frequencies that allow the laser to work at very
low levels.
 It treats specific cells "selectively," leaving untreated portions of the
trabecular meshwork intact.
 For this reason, it is believed that SLT, unlike other types of laser surgery,
may be safely repeated many times.
FILTERING MICROSURGERY
When medicines and laser surgeries do not lower eye pressure adequately, doctors
may recommend a procedure called filtering microsurgery.
THERE ARE TWO TYPES OF FILTERING SURGERY:
1.penetrating - the most common type of penetrating surgery is:
TRABECULECTOMY
1.non-penetrating - the most common type of non-penetrating surgery is:
DEEP SCLERECTOMY
 In trabeculectomy, a tiny drainage hole is made in the sclera (the white part of
the eye). The new drainage hole allows fluid to flow out of the eye and helps lower
eye pressure. This prevents or reduces damage to the optic nerve.
 In non-penetrating deep sclerectomy (NPDS), a deep scleral flap is
removed, leading to the formation of an empty scleral space called an
'aqueous decompression space', wherein the aqueous humor will be collected
before its drainage. In order to keep the aqueous decompression space open,
different implant devices have been proposed such as collagen Aquaflow
implants, reticulated hyaluronic acid implants, and the T Flux implant.
FILTRATION DEVICE SURGERY
A glaucoma implant consists of a very small plate with a unique valve system that regulates
your eye pressure.
Attached to the plate is a tube that drains the fluid out of the eye, thus reducing the eye
pressure. The implant is outside the eye but it is covered by the skin of the eye so it cant be seen or
felt.
Implant surgery immediately reduces the pressure in the eye by giving the fluid a means to
drain out more efficiently. Because the glaucoma implant is a valve, it adjusts itself according to
the fluid pressure in the eye. There is a precise control on the amount of fluid that is allowed to
flow through it. This ensures that there is no excessive drainage from the eye, which can be a
serious problem.
Implant surgery is done on an outpatient basis under local anesthesia. The total procedure takes
about one hour.
Postoperatively, you will need to take some medications until your eye is completely healed,
and any pain medication for any discomfort you feel.
Regular follow-up exams will track the pressure changes in your eye and ensure that the
glaucoma implant is working successfully.
This type of surgery in performed in patients with previous glaucoma surgeries and / or poor
conjunctival tissue where filtering microsurgery may not be as successful.
THANK YOU FOR YOUR
KIND ATTENTION !!!