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We’ll Help You Choose the Best Procedure
There are many types of glaucoma surgery and each must be tailored to the person and circumstance.
Examples of glaucoma surgeries include:
- trabeculectomy (the “gold-standard” of glaucoma procedures)
- valved and non-valved tubes
Dr Slade trained with some of the foremost thought leaders in glaucoma and will know what procedure will be best for you. He has excellent results performing a “Utah” trabeculectomy.
Dr Slade in St George UT Specializes in Glaucoma Surgery
If you or someone you know has been living with glaucoma, or has recently been diagnosed with it, then you may have discussed with your eye care physician the various different types of preventative measures you can take or the possibility of having glaucoma surgery. To slow or even stop the progression of glaucoma, it’s important to understand the options available out there to help you. If you would like to make an appointment at the St. George Eye Center, Dr Slade in St George, UT, can discuss with you a plan for managing glaucoma, and explain the benefits for different options so that you may better understand the surgical and non-surgical protocols involved.
Before you come for your appointment, feel free to review the information below. We have put together a thorough overview of glaucoma in general, as well as a list of its common treatment procedures and the surgeries used to help effectively manage this condition.
What is Glaucoma?
Glaucoma is a very debilitating disease of the eye, which causes severe damage to the optic nerve. Over time, if left untreated, it can cause permanent and irreversible blindness. In fact, glaucoma is a major leading cause of blindness among adults today, falling second just behind cataracts. Whereas everyone is at risk for contracting glaucoma, it tends to follow the rules of genetics. For example, certain ethnic groups are at a much higher risk than others maybe, as well as those who may have a family history of hypertension. Age can also play a major factor in the progression of glaucoma as well, considering it is more commonly seen among those aged 60, and older. Many times, a person may have glaucoma without even knowing it, because symptoms do not typically begin to arise until well after it has had some time to mature and develop. This is one of the reasons that physicians, strongly urges people to see their eye care physician on a regular basis as they age.
What are Some of the Symptoms and Signs of Glaucoma?
As mentioned above, symptoms of glaucoma typically do not start to show up until after the disease has had some time to progress and evolve. That said, there are some notable signs that should be taken into account, and reported to your eye care physician as soon as possible should you begin to experience any of them. A few of the more common notable signs include the following:
- double vision
- light sensitivity
- change of iris color
- visible “dark spots” in sight
- difficulty adjusting to dark rooms
- red, swollen or crust laden eyelids
- pains in and around the eyes
- excessive tear production or watery eyes
- blurred vision or difficulty focusing on objects
Although it is very rare, please keep in mind that there are other, more serious indications of glaucoma, as well. And in cases such as this, they should always be considered of emergency status, prompting for an immediate examination. Do not hesitate to go to the nearest emergency room if any of these situations occur:
- sudden onset of blurred vision
- sudden vision loss in one or both eyes
- flashes of light or black spotting in sight
- light or bright objects omitting a “rainbow” type halo appearance around them.
Common Tests Used to Diagnose Glaucoma
During the process of glaucoma diagnosis, your eye care physician will perform a complete series of eye tests to rule out any other potential problems or issues. Each individual test serves a specific purpose, assisting your doctor to better determine the overall health and condition of your eyes. Below is a list of the more commonly used tests that are performed in the diagnosis of glaucoma:
- Tonometry– This test is started by numbing the eyes with a special drop. Once the eyes are numb, a tiny amount of pressure is applied to each eye with a small tool called a tonometer. It is used to measure the pressure of each inner eye. Usually, a high reading can be an indication of glaucoma, although this is not a definitive indicator – this is because normal readings can occasionally appear in some patients that do have glaucoma. Eye pressure is often relative to each individual patient, causing the need for a few other additional tests to make an accurate diagnosis.
- Ophthalmoscopy– This procedure requires a dilation of the pupils, which is done by using another special eye drop. By dilating the pupils, this allows your doctor to further examine the optic nerves of both eyes to check for any other potential damages. Your eye care physician will use a device called an ophthalmoscope (or funduscope) to light and magnify the optic nerves, checking for any changes or abnormalities to the shape and color of them.
- Perimetry– This test is sort of like a visual exercise completed by the patient. It is performed by the physician using a small light to test your field of peripheral vision. You will then focus by looking straight ahead while your doctor moves a small light in and around your outside vision, testing for the responsiveness of your eyes. Try not to be too concerned if you do not see the light right away, as this is always considered normal. Instead just try to relax, and respond naturally to the light responses while the test is being performed.
- Gonioscopy– Gonioscopy is a procedure that is performed by gently placing a hand held lens device directly onto the eye. Once again, this is a test that requires the numbing drops to be applied to the eyes prior performing. During the process, the doctor will determine the angles of the iris and cornea. What they are mainly looking for are any indications of angle-closure, or open-angle glaucoma. In other words, are the iris’ and corneas closed and/or blocked? Or are they wide open? This test will help your eye care physician to better determine just that.
- Pachymetry– With this simple test, your eye care physician will check to see the overall thickness of your cornea, which is the thin, clear layer surrounding the front part of the eyes. This procedure is performed by using a pachymeter device, a unique tool designed to probe and measure the overall thickness of the cornea. Since corneal thickness can affect the results of an eye pressure reading, this test is essential in the complete diagnosis of glaucoma, allowing for your doctor to recommend a treatment plan that will work the very best for you.
Glaucoma can prove to be a very challenging disease to diagnose at times, which is why it requires a complete and thorough set of evaluation tests prior to a definitive diagnosis. You also want to see a doctor that has years of experience. Protecting your sight is top priority. The results of your tests will help your eye care physician to better determine, and create a custom treatment plan for your specific and unique eye care needs. Not every condition is the same, therefore not every treatment plan will be the same, either. At any point should you discover that you have been diagnosed with glaucoma, it is important to make sure that you discuss with your eye care physician what subtle eyesight changes you should be watching out for. You need to understand any of the potential risks involved, know how to best care for the condition, identify the signs that mean you should contact a doctor immediately, and take the time to explore the treatment options and procedures that are available with an experienced physician.
Glaucoma Surgery Treatments and Procedures
When it comes to treating glaucoma, Dr Slade in St George UT, can help you understand the different options you have to choose from. Some options may be more suited to your condition, while others may not. Your eye care physician will recommend the best choices for you based off of the current stages of your disease, and your overall health in general. Listed below are a few of the more commonly practiced glaucoma surgery treatment plans and procedures that many patients are having done today.
What is it?
A trabeculectomy is a surgical procedure that reduces the buildup of intraocular eye pressure (IOP) that occurs behind the eye. It is primarily the most common type of operation performed in the treatment of glaucoma, and is normally done as an outpatient procedure. General anesthesia is usually not necessary, as a combination of local anesthetics are all that is needed to numb the eye. However, a mild sedative can be used in addition to help ease the nerves of the patient. It is typically performed in less than an hour, and most patients are able to return home the very same day. In some cases, blurry vision can occur for up to two weeks or longer following the operation, but each situation may vary depending on the current status of the condition.
How is it done?
Once the topical local anesthetic has been applied to the eye, your physician or eye care surgeon will create a small incision or hole in the wall of the eye, just directly above the iris. This small hole enables for a more free flowing or draining of the eye fluid, also known as aqueous humour. The small hole is covered by a flap or a “trap door,” which serves as a protective layering. It is held in place by non-dissolvable sutures that are removed later on. When the aqueous fluid begins to flow through the trap door, it will collect into a small draining reservoir called a bleb that lies just below the outer layer of the eye, and underneath the eyelid.
Am I a candidate?
A glaucoma surgery like trabeculectomy can be done on most people, even on those that may have existing cataracts. It is generally quite a safe procedure with very minor risks involved. Most patients who have procedure experiencee an overall high success and satisfaction rate, helping to preserve their vision for many years to come.
Tube Shunts (Valved and Non-valved Tubes)
What are they?
Tube shunt surgery is another procedure that focuses on allowing for better drainage of the aqueous fluid from behind the eye, preventing the buildup of intraocular eye pressure. However, this operation is slightly different than that of a trabeculectomy, as it involves the placement or installation of a small, soft tube into the eye. The tube shunt is made of a silicone or polypropylene material, and attached to one end of it is a small pouch which is designed to assist in the draining process. In a sense, it almost has the appearance of a tiny computer mouse. Typically, tube shunt procedures are performed in addition to a trabeculectomy because the initial procedure has not performed as expected, or the eye needs additional assistance with the draining process. This surgery is also usually done with a local anesthetic, although it is not necessarily uncommon to be done with a general anesthetic, either. This is typically done as an outpatient procedure, and the risks involved are very minimal.
How do they work?
The small tube shunt (or stent) operates by placing it in the front part of the eye, allowing for the drainage of aqueous fluid to come out from behind the eye. It collects into the small silicone pouch, which rests on the surface of the eyeball, and is covered by the eyelid. Once the fluid begins to flow more freely, it can be collected and absorbed through the eye veins, where it can be transported away from the eye cavity.
Am I a candidate?
If you have had a trabeculectomy procedure done already and it does not seem to be working effectively, or if you have previously had an injury to the conjunctiva of the eye, then you may be a perfect candidate for a tube shunt surgical procedure. However, there are a few factors that your eye care physician will take into consideration before recommending it to you. For example, which type of tube shunt is going to be the best option for the condition you currently have? There are two likely possibilities: valved, and non-valved.
- Valved Tube Shunts– Also known as an Ahmed glaucoma valve, the valved tube shunt is the most commonly used of the two. It’s functionality allows the flow of fluid in one direction, limiting the degree of how low the pressure is able to drop. In a recent clinical study, there were fewer complications in the early stages after the initial application with a valved tube shunt, as opposed to those that are non-valved. Alternatively, intraocular pressure was slightly higher than that of a non-valved tube. Additionally, continued use of medicated eye drops are also required to be part of a daily use after this procedure.
- Non-Valved Tube Shunts– A non-valved tube shunt is also known as a Baerveldt or Molteno shunt. Typically, in order for these types of tube shunt to work to their fullest potential, some scarring must take place first before that can happen. For example, before the tube can fully open all the way, any absorbable sutures that were placed by the surgeon must completely dissolve. This can take a bit longer for the desired effect to start working, leaving room for more initial complications. That said, once the initial waiting period has passed, the overall failure rate was lower than that of the valved tube shunt, requiring less application of medicated drops after a few years time.
What is it?
Canaloplasty is a more advanced restorative treatment in which the process increases or expands the natural drainage system of the eye. It is a proven and safe surgery, and is different in the sense that it does not require a hole to be applied to the eye in order to allow for the drainage of the aqueous fluid. Therefore, there is no need for a reservoir or “bleb.” It has much fewer complications than that of other glaucoma surgeries, and it requires a lot less follow-up visits with you eye care physician once complete. It’s also considered much less intrusive than other glaucoma treatments, and recovery time is much shorter, as well.
How is it done?
Canaloplasty is generally performed as an outpatient procedure with a localized anesthetic and sedative for the overall comfort and relaxation of the patient. Your eye care surgeon will begin by making a tiny incision in the eye, allowing for placement of a microcatheter into the drainage canal. This is also known as a Schlemm’s canal. From this step, a dilation solution is injected into the Schlemm’s canal, enhancing the flow of aqueous fluid. The system circles around the outer edge of the iris, widening the canal so that the aqueous fluid may begin to drain normally again. Once this process is complete, your surgeon will remove the microcatheter, and set an absorbable suture in place to keep the draining system open. After the surgery is finished, it is normal to experience some minor irritation under the eyelids, as the sutures have not fully absorbed yet. It is also not uncommon to notice a bit of bleeding as well, but this is usually an indication that the process was successful, as these are typical signs that the outflow of aqueous fluid has been restored.
Am I a candidate?
Once again, this advanced treatment is suitable for the majority of patients living with open-angle glaucoma. However, it is considered to be more beneficial for those who have had difficulties administering their required medications to the eye, or for those that may have experienced unsuccessful treatments or other surgeries in the past. Also, some patients may be more reluctant to elect a trabeculectomy procedure for their situation; therefore, a canaloplasty procedure may be the most advisable option for them.
What is it?
Trabectome is a newer procedure, although it has been practiced successfully in eye clinics around the world for over ten years now. Often performed in unison with the removal of any existing cataracts, it has also proven to be quite effective in significantly lowering eye pressure, and restoring blurry vision caused by cataracts. This procedure is considered minimally-invasive, which allows the patient to return home the very same day. In fact, the entire process normally takes anywhere from 5 to 15 minutes to complete. Some patients are even able to gain clear visibility the following day. However, recovery time may vary depending on the severity or progression of each existing condition.
How is it done?
First, the eye care physician will numb the eyes with a local anesthetic. IV or other oral sedatives may also be offered as an option for the comfort of the patient, as well. With the use of a specialized Trabectome tool or device, any existing strainer-like tissues (also known as trabecular meshwork) that have become built up in the Schlemm’s canal or drainage system, will be removed. This will allow more free-flow of the aqueous fluid. Additionally, this is also done through the same incision which is made for the removal process of any cataracts. You will most likely be scheduled for a follow up appointment the next day in order to check for swelling, inflammation, or any signs of potential infection. On average, this practice can lower intraocular eye pressure by up to 30%.
Am I a candidate?
As with the majority of all glaucoma surgeries, most patients are worthy candidates for this particular procedure. However, continued usage of glaucoma eye drops is advised following this glaucoma surgery, including antibiotic drops, steroid drops, and wetting drops. People who have a more active lifestyle that includes a rigorous sports routine or repetitive heavy lifting, should plan to avoid such activities for at least a week or longer. Another important factor to take into consideration is that occasionally, additional subsequent surgeries may be necessary as well, to further prevent the progression of glaucoma down the road.
Glaucoma is often referred to as the “silent thief” because it slowly and quietly damages the eyes, causing irreparable harm resulting in permanent vision loss. However, with today’s advancements and technologies in the medical field, miracles can be performed allowing one to preserve their eye health for many years to come. If you would like more information about glaucoma surgery and treatment options, please feel free to contact the office of Dr Slade in St George UT. We look forward to meeting you and helping you with a plan to protect your eyesight for life!