Glaucoma Treatment
El glaucoma is the set of eye disorders that cause damage to the optic nerve and severely and significantly compromise the patient's vision. In most cases, glaucoma is associated with an increase in intraocular pressure (IOP) levels, but it can also be caused by other conditions such as diabetes or stroke.
The treatment of glaucoma varies according to the evolutionary stage of the disease. In the early stages we apply a medication up to more invasive treatments such as operating room treatments. For this reason most patients start using glaucoma eye drops, but it is usual for the treatment to go through undergoing a drainage surgery when the disease progresses.
Glaucoma Treatment
El glaucoma is the set of eye disorders that cause damage to the optic nerve and severely and significantly compromise the patient's vision. In most cases, glaucoma is associated with an increase in intraocular pressure (IOP) levels, but it can also be caused by other conditions such as diabetes or stroke.
The treatment of glaucoma varies according to the evolutionary stage of the disease. In the early stages we apply a medication up to more invasive treatments such as operating room treatments. For this reason most patients start using glaucoma eye drops, but it is usual for the treatment to go through undergoing a drainage surgery when the disease progresses.
How is glaucoma diagnosed?
Before addressing the treatment of glaucoma, it is necessary to make a good diagnosis of it. Glaucoma is known as the silent enemy of vision, because, in most cases, it does not usually cause symptoms in its initial phase. For this reason, most of the patients with glaucoma are diagnosed during a routine check-up with the ophthalmologist.
To diagnose glaucoma we can perform different diagnostic tests with the aim of comprehensively examine the eyes. The eye exam may include the following studies:
- Tonometry to measure intraocular pressure.
- Analyze the optic nerve and rule out or detect lesions.
- c testampor visual to detect those areas where vision has been lost.
- Pachymetry to measure the thickness of the cornea.
- Gonioscopy to examine the drainage angle or iridocorneal angle.
Can glaucoma be cured?
Glaucoma is a disorder that has no cure, it is a degenerative illness with which the patient must learn to live the rest of his life. However, the sooner the diagnosis is made and the patient begins to receive glaucoma treatment, the better we can control the progression of this disease, delay damage to the optic nerve and loss of vision.
It is also important to note that the damage caused by glaucoma in the optic nerve and vision is irreversible. There are many occasions when patients go to the ophthalmologist worried about a visual decrease, and it turns out that it is an undiagnosed glaucoma. In these cases there is no treatment that allows us to restore the patient's visual acuity.
What treatments are there for glaucoma?
The goal of glaucoma treatment is monitor intraocular pressure levels to prevent optic nerve damage and vision loss. Glaucoma is treated on a scale, that is, treatment can vary as the disease progresses.
Glaucoma treatment options include:
- Medical treatments through the use of drops or drugs.
- Glaucoma treatments with laser.
- Transmission surgical glaucoma.
Medical-pharmacological treatment
Among the medical treatment options for glaucoma we find those that are intended for the instillation of drops and others that are focused on the prescription of tablets.
Eye drops
In the initial phase of glaucoma we usually prescribe eye drops to the patient to decrease elevated IOP levels, as they act on the ocular structure by reducing the production of aqueous humor and, therefore, improve drainage problems.
Among the most prescribed eye drops for glaucoma we find:
- Prostaglandins.
- Beta blockers.
- Alpha-adrenergic agonists.
- Carbonic anhydrase inhibitors.
- Miotic or cholinergic agents.
- Rho-kinase inhibitor.
Some glaucoma drops are absorbed into the bloodstream and can cause side effects.
Oral medications
When eye drops are not effective in lowering intraocular pressure, we will prescribe oral medications for glaucoma. It is usually prescribed a carbonic anhydrase inhibitor. Oral glaucoma drugs can cause tingling in the fingers and toes, upset stomach, depression, and kidney stone formation.
Glaucoma laser treatment
Laser treatments for glaucoma are performed in consultation and we use different techniques depending on the type of glaucoma presented by the patient.
Selective laser trabeculoplasty (SLT)
Trabeculoplasty with laser technology is recommended for patients with open angle glaucoma and consists of applying the laser to open the channels of the trabecular meshwork that are obstructed.
Iridotomy
Laser iridotomy is indicated in patients suffering from angle-closure glaucoma. We use the laser to open a small hole in the iris of the eye through which the aqueous humor can flow.
Treatment with surgery
Fortunately, there are different surgical options to treat patients with glaucoma and improve their quality of life. The techniques explained below help to improve the aqueous humor drainage system and lower intraocular pressure levels. Among the techniques glaucoma surgery most common we find:
Trabeculectomy
La trabeculectomy is a filtering surgery for the treatment of glaucoma. This surgical technique consists of making a small opening in the sclera, the white part of the eye, to remove part of the trabecular meshwork and create a ampfiltration pot in the conjunctiva. This bubble is hidden in the eyelid and serves to filter the aqueous humor.
Deep non-perforating sclerectomy
Another filtering surgical technique that represents an alternative to trabeculectomy is non-perforating deep sclerectomy (NPSS). The main difference between both surgical options is that non-penetrating deep sclerectomy prevents the opening of the anterior chamber and, consequently, the risks that this entails.
One of the main advantages of this surgical option is that we obtain a greater control on hypotension (excessive drop in pressure), choroidal detachment and the formation of a macular edema.
This surgical technique can be performed with Válvula (Esnoper clip) or without valve implantation.
With drain valve
Depending on the patient's case, the placement of a drain valve or an anterior chamber (intracameral) drainage tube. Among the most implanted valves we find the Ahmed and of Baerveldt.
This surgical technique is performed in complex cases such as diabetic patientsWhen other surgeries have failed or when it is necessary to combine the surgical treatment of glaucoma with a cornea transplant.
Minimally invasive glaucoma surgery
Over the last few years, techniques for minimally invasive glaucoma surgery (MIGS). This technique offers more stable intraocular pressure levels over time, shorter surgical time, less trauma and faster recovery, positioning itself as one of the safer techniques that exist.
This surgical option is especially indicated in patients whose intraocular pressure is not very high, which allows us to better adjust the IOP. Additionally, it offers excellent results when glaucoma surgery has to be combined with cataract surgery.
How to prevent glaucoma?
To prevent glaucoma, the best we can do is attend an eye exam annually, especially if you have a family history of this disease. As we mentioned before, glaucoma is a silent disorder, and the only way to detect it early and prevent vision loss is by attending regular medical check-ups.
Both young people and adults should attend routine eye exams, however, from the age of 40 it is especially important examine the eyes to rule out glaucoma. Patients with risk factors should attend an ophthalmological consultation every year from the age of 35.
