Glaucoma

Glaucoma Diagnosis And Treatment

Dr. Burns provide Glaucoma treatment in Louisville Kentucky.

What is Glaucoma?

Glaucoma is a group of eye diseases that gradually damage the optic nerve, eventually robbing a person of vision. In order to prevent blindness, early detect is crucial. People afflicted with glaucoma often have no noticeable early symptoms, and by the time they notice a change in their vision, it may be too late to save their sight. Glaucoma is not curable, but it can be controlled. It was once thought that intraocular pressure (IOP) was the primary cause of optic nerve damage, but it has since been found that other risk factors can play a role in vision loss, even when people have normal IOP. This is one of the reasons why Dr. Burns uses a state of the art Optical Coherence Tonography (OCT) for early glaucoma detection and diagnosis.

How does glaucoma affect my vision?

Aqueous humor is a clear fluid that fills the front of your eye. It is important in helping to keep the eye healthy. Also, the aqueous fluid provides pressure to maintain the shape of the eye, like the air in a balloon. This pressure is called intraocular pressure or IOP.

In a healthy eye, the aqueous fluid flows in and out of the natural drainage system. With most types of glaucoma, this system does not work properly. The fluid inside the eye cannot drain. As a result, the pressure or IOP inside the eye increases. This pressure affects the optic nerve, resulting in vision loss.

Diagnosis of Glaucoma: OCT Analyzer

Rather than measure intraocular pressure, the OCT  analyzer uses a laser to quickly and painlessly measure the thickness of the optic nerve fibers on the retinal surface, just before they come together to form the optic nerve. The OCT produces a color-coded picture of the nerve fiber layer, which allows Dr. Burns to diagnose glaucoma at the earliest possible stages.

David A.
“Dr. Burns gave excellent service to my wife. This is a practice that is professionally run, friendly and patient-centered. My wife had glaucoma and advanced cataracts in both eyes which had been misdiagnosed by other eye doctors. When we first visited Dr. Burns practice, my wife had lost 85 % of her sight in one eye and 50% in the other eye. After the surgeries, we received calls from his practice to check on how she was doing. The post-surgery follow-ups were also professionally handled. The end result was a remarkably improved eyesight with low eye pressures. Dr. Burns came highly recommended by a family member. And we are highly satisfied with the high level of professional care we received. We highly recommend his services to any person in need of eye surgery and treatment.”

Glaucoma Treatment Options

When glaucoma is diagnosed, the patient will be prescribed eye drops to lower the intraocular pressure. Other treatments include oral medications (which are rarely used, partly due to side effects), laser surgery, such as SLT treatment, and filtration surgery.

Selective Laser Trabeculoplasty for Glaucoma

Selective laser trabeculoplasty (SLT), a surgical treatment for elevated intraocular pressure (IOP) in patients with open-angle glaucoma, is an exciting recent development in open-angle glaucoma treatment. Prior to its introduction, oral medications and argon laser trabeculoplasty (ALT) were the primary treatment strategies for open-angle glaucoma.

How it Works

SLT works by using a specific wavelength of light to irradiate and target only the pigment-producing cells in the trabecular meshwork. The trabecular meshwork is the area which drains fluid from the eye. This is the area of the eye which is not working properly in open-angle glaucoma causing the fluid to not drain effectively, thus, resulting in elevated IOP. SLT treatment, unlike ALT treatment, does not cause any thermal damage to surrounding cells in the meshwork, thus causing less damage and scarring to these tissues. When the meshwork is treated with SLT, a biologic response occurs at the cellular level, thus leading to IOP reduction. The meshwork appears to drain fluid more easily than before treatment with SLT. This, in turn, reduces the risk that the glaucoma will progress. One of the advantages of SLT over ALT includes less thermal damage . Therefore, SLT can be repeated several times in the future, whereas ALT typically can only be repeated once. SLT has very few complications, the main one being a transient rise in IOP in the first hour after treatment. Results of SLT are very good to excellent in most patients. Patients who are using just one drop for controlling IOP have an 80% chance of a 4 to 8 point drop in their IOP after SLT treatment. Dr. Burns will discuss with you the best and most effective treatment options for your type of glaucoma. He is happy to provide SLT treatment in his office now in order to make it more convenient for you. Please contact our office today if you are interested in finding out more about SLT treatment for glaucoma.

iStent ™

iStent ™The iStent™ is a tiny medical device that aids in permanently lowering eye pressure after it is implanted in the eye. The iStent allows fluid to escape by bypassing the trabecular meshwork thru the canal thus improving the natural outflow of the eye. This extremely small medical device helps your eyes maintain a healthy pressure level, significantly decreasing the risk of vision loss due to glaucoma.

The iStent™ is for patients who suffer with open-angle glaucoma and also need cataract surgery. If you have elevated eye pressure due to open-angle glaucoma, the iStent™ can help you safely maintain pressure levels without the hassle of a number of different eye drops. It is vital to maintain safe levels of eye pressure if you have glaucoma and this is one of the best ways to prevent vision loss associated with glaucoma.

The iStent™ has been approved by the FDA, and it is the smallest medical device to ever be gain their approval. This device is so small that it is 20,000 times smaller than the intraocular lenses used in cataract surgery. Once it is placed in your eye, you will not be able to see it.

Glaucoma FAQs

Is glaucoma hereditary?

Yes, family history is a significant risk factor for developing glaucoma especially if it is a first-degree relative such as a mother, father or a sibling. There is a significant amount of research going on at the present time to identify patients that have a genetic defect which can lead to the development of glaucoma. Eventually, it is hoped that we will be able to identify individuals that are at risk for developing glaucoma before damage occurs and offer an intervention that can prevent the onset of the disease.
 

How do you prevent glaucoma?

At the current time, we do not know a way to prevent the development of the most common type of glaucoma which is called chronic open angle glaucoma. A less common type of glaucoma known as acute angle-closure glaucoma can be prevented by performing a laser procedure called a laser peripheral iridotomy prior to the onset of this type of glaucoma. Acute angle-closure glaucoma is an emergency once the onset begins and can cause permanent vision loss or blindness if it is not diagnosed and treated in an urgent manner.
 

How do you treat glaucoma?

The most common treatment for chronic open angle glaucoma is the use of eye drops designed to lower the intraocular pressure (pressure inside of the eye). There are many different classes of eye medications that help lower the intraocular pressure and many of the drops can be combined to lower intraocular pressure in patients that have difficult pressures to control. Combination eye medications are also available that contain two different medications in one bottle.

If the pressure is not low enough with drops, open angle glaucoma can be treated with a laser procedure known as a Selective Laser Trabeculoplasty, or SLT. The SLT is a very safe laser procedure that can lower intraocular pressure by 5 to 7 points in over 80% of patients. It can be used to prevent the need of adding more drops to the patient’s treatment regimen or to lower the pressure enough to avoid a more invasive surgical procedure.

If laser and drop treatment are still not lowering the intraocular pressure enough, surgical procedures are the next step. A pressure lowering procedure called a trabeculectomy has been the standard procedure for poorly controlled glaucoma for many years, but newer, less invasive procedures have now been developed that are revolutionizing the treatment of glaucoma. These procedures are known by the terminology Micro Invasive Glaucoma Surgery or MIGS. Several MIGS procedures are now FDA approved and can be performed at the same time as cataract surgery or can be performed as a stand-alone procedure.
 


Is glaucoma painful?

The most common type of glaucoma, chronic open angle glaucoma, typically has no pain or other symptoms associated with the disease. This is problematic as most patients are unaware that they have it unless they get an eye exam. This can go on for many years and the patient may develop severe peripheral or side vision loss without knowing it. Once the vision is lost, it cannot be regained.

The less common type of glaucoma which was mentioned previously, acute angle-closure glaucoma, does have severe pain associated with its onset. Patients will develop severe eye pain along with a severe headache, eye redness, vision loss and even nausea and vomiting because the intraocular pressure can go extremely high in this condition. Most patients with acute angle-closure glaucoma end up going to the emergency room not knowing that an eye problem is causing their symptoms. Unfortunately, this can delay sight-saving treatment as it is an emergency and needs to be treated urgently to avoid severe and permanent vision loss. A routine eye exam can detect patients that are at risk for this type of glaucoma and a laser treatment can prevent the development of this type of glaucoma.
 


Does Dr Burns see/treat glaucoma patients?

Yes. Glaucoma is one of the main diseases that Dr Burns treats. He provides medical treatment for glaucoma meaning eye drops, and also surgical treatment such as laser procedures and microinvasive glaucoma surgery (MIGS).
 

I’m new to the area and was treated for glaucoma by another doctor…do I need to bring my records?

Having your records with you is not required but it is very helpful and appreciated. If you don’t have your records, you can complete a HIPAA release of information form at the time of your visit so we can obtain a copy from your previous physician.
 

What is a visual field test?

A test that measures a patient’s peripheral vision. It is used to diagnose such diseases as glaucoma, strokes, and brain tumors.
 

How long does a visual field test take?

The standard visual field test takes about 20-30 minutes but a screening test takes less time.
 

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