Glaucoma is a group of eye conditions that damages the optic nerve. The optic nerve is responsible for transmitting visual information from the eye to the brain. Normally, the damage to the optic nerve is brought about by increased pressure in the eye called intraocular pressure.
Glaucoma is usually treated with medication to reduce the intraocular pressure. In severe cases, surgery may be necessary to address the condition.
Here are some advances in technology and surgical techniques that appear promising in treating glaucoma:
Micropulse Laser Trabeculoplasty
Micropulse laser trabeculoplasty or MLT is used to lower intraocular pressure in patients with glaucoma. Its effects are similar to those provided by argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). What sets it apart is that is uses lesser energy and inflammation compared to other procedures.
The MLT uses a specific diode laser, the IQ 810, Iridex, which has a much longer pulse length than the SLT. The laser energy is delivered in short microbursts over an extended period of time, i.e. milliseconds as opposed to nanoseconds for SLT. Thus, the temperature rises slowly. The micropulse will help minimize the spikes in eye pressure which can sometimes occur after you undergo a laser procedure.
The canaloplasty is another option for treating open angle glaucoma. It is performed to restore the drainage system in your eyes in order to reduce intraocular pressure. This procedure was granted clearance by the United States Food and Drug Administration (FDA) in September 2008.
• A small incision is made in the eye.
• The canaloplasty microcatheter is inserted in the eye’s drainage system canal.
• Your doctor will use the microcatheter to circle the canal and enlarge it to help drain aqueous fluid.
• The microcatheter is removed. A suture is placed within the canal to keep it open.
Trabectome surgery is a minimally invasive out-patient procedure that is used to treat patients with open angle glaucoma. It is designed to improve fluid drainage from the eyes to balance intraocular pressure. It was granted an FDA clearance in 2004.
• A small incision is made on the eye. It does not require leaving a permanent hole in the eye wall, the creation of an external filtering bleb or an implant.
• Pulse from an electrosurgical hand piece is used to open access to the eye’s drainage system.
Ex-Press Mini Shunt
The Ex-Press Mini Shunt is a very small stainless steel device that is used to augment conventional trabeculectomy surgery. This device that has been used since 2002 helps standardize the operation. It may also help reduce the risk of the eye pressure getting too low immediately after a surgery is performed. It allows the precise control of the amount of fluid allowed to flow out of the eye, necessary to maintain a healthy level of intraocular pressure. It may be used after a standard trabeculectomy has failed to improve the chances of a successful outcome.
Note, however, that these alternative options are still undergoing evaluation and trial. Should you wish to explore these alternatives, consult your optometrist to determine if they will be effective in curing your glaucoma.
Currently it is still the gold standard to try and control glaucoma using up to three different eye drops. If these are failing it makes sense then to proceed to surgery.