Glaucoma

Glaucoma is actually a group of eye diseases that lead to damage of the optic nerve, which can then lead to vision loss and possibly blindness. Optic nerve damage usually occurs in the presence of high eye (intraocular) pressure.

There are many types of glaucoma, but the two most common types are open-angle glaucoma and closed angle (angle-closure) glaucoma. 

Open-angle glaucoma, (also called primary open-angle glaucoma and chronic glaucoma) accounts for 90 percent of all glaucoma cases and occurs when the trabecular meshwork becomes blocked and the fluid can’t get to the normal drainage canals. This blockage results in fluid build-up and intraocular pressure. The fluid build-up happens gradually. 

Closed angle glaucoma, (also called acute glaucoma or angle closure glaucoma), accounts for about 9 percent of all glaucoma cases and occurs when the opening between the cornea and iris narrows, such that the fluid cannot get to the trabecular meshwork and normal drainage channels. This narrowing results in fluid build-up and intraocular pressure. The fluid build-up happens very quickly. 

People at highest risk are those with any of the following:

• Age older than 40
• African-American race
• Family members who have (or had) the disease
• Farsightedness or nearsightedness
• Diabetes
• Long-term use of corticosteroid drugs
• Previous eye injury

The most common treatments for glaucoma are eye drops. There are a number of different categories of eye drops, but all are used to either decrease the amount of fluid in the eye or improve its outward flow. Dr. Jong may prescribe a combination of eye drops. 

Laser Surgery

Trabeculoplasty is often used to treat open-angle glaucoma. In argon laser trabeculoplasty (ALT), a high-energy laser is aimed at the trabecular meshwork to open areas in these clogged canals. These openings allow fluid to bypass drainage canals and flow out of the eye. In selective laser trabeculoplasty (SLT) a low-energy laser treats specific cells in the trabecular meshwork. Because it affects only certain cells without causing collateral tissue damage, SLT can potentially be repeated.
  

Laser peripheral iridotomy (LPI) is frequently used to treat closed-angle glaucoma, in which the angle between the iris and the cornea is too small and blocks fluid flow out of the eye. In LPI, a laser creates a small hole in the iris to allow fluid drainage.

Cyclophotocoagulation is usually used to treat more aggressive or advanced open-angle glaucoma that has not responded to other therapies. A laser is directed through the sclera or endoscopically at the eye fluid-producing ciliary body. This helps decrease the production of fluid and lower eye pressure. Multiple treatments are often required.

Currently, laser surgery is the most frequently used procedure to treat glaucoma. It normally lowers eye pressure, but the length of time that pressure remains low depends on many factors, including the age of the patient, the type of glaucoma and other medical conditions that may be present. In many cases, continued medication is necessary, but potentially in lower amounts.