Glaucoma

What is Glaucoma?

Glaucoma is a term used to describe different eye diseases that result in damage to the optic nerve with resultant vision loss. Most forms of glaucoma are associated with elevated pressure of the eye, however, this may not always be the case. Typically, eye pressure rises due to an imbalance of fluid production inside the eye (aqueous fluid) and inadequate removal through natural drainage systems. Different forms of glaucoma are differentiated by whether the fluid drainage pathway inside the eye is open (open-angle) or blocked (angle-closure). Internal diseases of the eye, prior trauma, or medications can affect the drainage systems of the eye. Glaucoma detection begins with an eye exam with your doctor; ancillary testing such as peripheral visual field and picture tests may aid in the diagnosis. 

The goal of glaucoma treatment is to preserve vision and prevent further loss by lowering eye pressure to safer levels. Target eye pressure is individual for each patient based on the severity of glaucoma, life expectancy, and associated risk factors with treatments. Target pressure levels may be adjusted over time according to the course of disease. Preserving vision requires long-term commitment and teamwork between you and your doctor. 

Treatments

Prescription eye drops are a common treatment for glaucoma. Many different types of eye drops exist, and they have different mechanisms of action. Glaucoma drops may lower the pressure either by reducing the production of fluid inside the eye, or by improving the drainage of fluid through the natural drainage pathways. Glaucoma drops are to be taken at a minimum of once per day as prescribed by your doctor.

Selective laser trabeculoplasty (SLT) is a long-standing, established treatment for reduction of intraocular pressure. This is an office-based, minimally invasive procedure with rare side effect profile. SLT acts by enhancing remodeling of the natural drain inside the eye and improving aqueous outflow, thereby lowering eye pressure.  SLT is increasingly used by ophthalmologist given its low side effect profile, and there is increasing evidence that early SLT may be better initial treatment for some forms of glaucoma. SLT is offered through Arlington Eye Physicians with newer, safer, micropulse technology.

Laser iridotomy is an office-based procedure used for treating patients with angle-closure. Using a special type of laser, a tiny hole is created through the iris to allow opening of the angle and improvement of aqueous outflow. Laser iridotomy is sometimes done as an emergency procedure in an attack of angle-closure, but more often it is performed as a preventive measure against worsening of angle-closure.

Glaucoma surgery is usually undertaken when glaucoma is not adequately controlled with medical and laser therapy. Microinvasive glaucoma surgery (MIGS) is a newer class of glaucoma surgery with less side effect profile than conventional glaucoma surgery. These surgeries are performed in the operating room and work by opening or stenting the natural drainage pathway. Some utilize FDA approved devices, which are the smallest medical devices implanted in the body. Dr. Osmanovic and Dr. Dikopf offer various MIGS surgeries that target different parts of the outflow pathways. 

Conventional glaucoma surgeries create a new drainage pathway for the eye and are performed in the operating room. These surgeries include trabeculectomy, tube shunt surgery, or the XEN® gel stent.  Trabeculectomy surgery creates a drainage path under a small flap in the eye wall. The fluid from inside the eye passes through this pathway and accumulates in a filtration bleb where it is absorbed into surrounding blood vessels. A filtration bleb looks like a small blister on the white part of the eye underneath the upper eyelid. To prevent scarring, antifibrotic medications may be used during and after surgery. A glaucoma tube shunt is a small device that is secured onto the eye wall and enters the front part of the eye. The fluid is directed through the tube from the inside the eye to a reservoir outside which is then absorbed into surrounding blood vessels. The reservoir is located far back on the eye is not easily noticeable. Some tubes start working right away, and some are secured with sutures that slowly dissolve and delay opening. Each type of tube is advantageous in different types of glaucoma, and Dr. Dikopf and Osmanovic offer both types of tubes.  XEN® gel stent is a newer type of conventional glaucoma surgery which utilizes a micro stent, approximately the size of eyelash. Similar to tube shunts, part of the stent is inside the eye and part is on the surface of the eye, allowing a new drainage pathway. XEN® gel stent may allow quicker recovery. 

Our Doctors

Dr. Smajo Osmanovic and Dr. Mark Dikopf completed a year-long internship in general internal medicine followed by three additional years of ophthalmology residency training at the University of Illinois. They were then selected to complete an additional year-long glaucoma fellowship at the University of Illinois. This fellowship focused on medical, laser and surgical treatment of glaucoma and is accredited through the Association of University Professors of Ophthalmology.