Tag Archive for: #GlaucomaSurgery

Before we get into dropless glaucoma treatment, let’s begin with the definition and what actually it is all about.

What is Glaucoma?

Glaucoma is the world’s predominant cause of blindness, which affects over 3 million individuals in the United States itself. Sadly, until vision is already impaired or lost,  glaucoma is usually notIced.

Why Dropless Glaucoma Treatment?

Since people suffering from glaucoma are facing so many issues with the glaucoma medication eye drops treatment. Many people share their trouble of remembering their drops on time while others face some issues of allergies such as dry or red irritated eyes and the most common reason for getting tired of huge bills for medications as well always having to go to pharmacy or call in for refills. To overcome all these issues, Dr Marcelin promotes  drop-less ( or minimal medication) approach or treatment for Glaucoma .

Durysta & Glaucoma laser

Many people with open-angle glaucoma do not encounter symptoms they will not be conscious that they have the condition. A major difficulty in the treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT) has been to ensure that patients comply with the prescribed eye drops given for intraocular pressure management (IOP). In fact, 80% of glaucoma patients, either because of complications or inattentiveness, do not use their medication topical drops as advised. That’s why Drop less Glaucoma Treatments, like Durysta & Glaucoma laser and Minimally Invasive Glaucoma Surgery  are all beneficial options.

What is Durysta and how does it work?

For glaucoma patients with open-angle glaucoma or ocular hypertension, Durysta is a micro sustained-release implant. To further alleviate and sustain a stable eye pressure level, Durysta is ican be placed in the eye. This is an in -office procedure

The implant is rod-shaped and inserted into the eye, where the lower angle rests. Via prolonged release of bimatoprost( Lumigan) over several months, it decreases eye pressure. The orientation at the angle of the anterior chamber causes the tissues of the trabecular meshwork and the uveoscleral routes to be positioned nearest to them. This is optimal since this spot can supply the bimatoprost non-stop over several months.

Is Durysta safe?

Durysta has recently gained FDA clearance and is a milestone in the treatment of open-angle glaucoma or ocular hypertension. For those people who have trouble taking regularly prescribed eye drops for glaucoma, Durysta would be a game-changer because it liberates patients from needing to administer drops entirely.

What is Glaucoma Laser?

The sort of laser surgery will rely on how serious it is and the type of glaucoma. Lasers emit a concentrated beam of light that will cause a very slight burn or opening in your eye tissue depending on the intensity of the light beam.

The eye is numb during laser surgery so there is minimal to no discomfort. The eye specialist then holds the eye with a special lens. The laser beam is focused on the target areas inside the eye.

The most common laser procedures to treat glaucoma are as follows.

1. a) Laser Trabeculoplasty

Laser Trabeculoplasty ( ALT, SLT, MLT) is the treatment for the patients of open-angle glaucoma treatment (POAG). The laser beam expands the eye’s fluid pathways, helping them function together for the drainage system.

Half the fluid channels are generally treated first. The other fluid channels may be handled at another time in a different session, if appropriate. This method avoids over-correction and decreases the risk any pain after the surgery.  In up to 75% of patients studied, Trabeculoplasty has successfully reduced eye pressure.

1. b) Selective Laser Trabeculoplasty

SLT is the treatment for the patients of open-angle glaucoma treatment (POAG). A laser which works at very low levels is used by SLT. It selectively treats individual cells, leaving untouched untreated portions of the trabecular meshwork; SLT can be repeated safely when needed. And those who have been treated unsuccessfully with ALT or pressure-lowering drops, SLT can be an option.

1. c) Laser Peripheral Iridotomy

LPI is the treatment for the patients of narrow angles and narrow-angle glaucoma. When in the eye, the angle between the iris and the cornea is too wide, narrow-angle glaucoma can  exists. This fluid drainage can be blocked by the iris, raising inner eye pressure intermittently or can shut down all together causing an Acute Angle Closure Attack and causing sudden accuse painful loss of vision. A tiny opening in the iris is created by LPI, which helps the fluid reach the channels ( angles) easier and flow through the drainage channels

1. d) Minimally Invasive Glaucoma Surgery

 Over the past 5-10 years there has been a revolution in glaucoma surgery, specifically Micro-Invasive Glaucoma Surgery, commonly called MIGS.

MIGS can be thought of in a few broad categories, either enhancing fluid outflow using the eye’s inherent drainage system (GATT, Kahook Dual Blade Goniotomy, Trabectome, iStent), shunting fluid to the outside of the eye (XEN Gel Stent) or decreasing production of fluid within the eye (ECP). Some types of MIGS procedures are FDA approved to be performed only in conjunction with cataract surgery (iStent) whereas other MIGS procedures are approved to be performed independent of cataract surgery (GATT, goniotomy, Trabectome, XEN Gel Stent, and ECP).

While MIGS procedures will not replace or eliminate traditional glaucoma surgery, they have greatly decreased the number of patients who require these more invasive surgeries, which can be wrought with complications,  to control their IOP. Due to their better safety profile than other major glaucoma surgery , MIGS procedures have allowed us to have a lower threshold for a surgical intervention with the goal of providing better IOP control while decreasing a patient’s glaucoma medication burden.

1. e) Laser Cyclophotocoagulation

This is an alternate to microsurgery filtering that is generally used later in the care algorithm. It is possible to get several different kinds of lasers to hamper the capacity of the ciliary body to make fluid and therefore lower the pressure of the eye. In order to completely control glaucoma, the procedure will need to be repeated.

1. f) Trabeculectomy

Your ophthalmologist may evaluate that Major glaucoma surgery should be done if treatment with eye drops, tablets, or laser surgery does not reduce intraocular pressure to a healthy level. A Trabeculectomy involves making a new drain in the eye is one way of reducing eye pressure in an eye with glaucoma.

1. g) Tube Shunt Surgery

Patients with signficant uncontrollable glaucoma, unsuccessful trabeculectomy, or susceptibility to forming scar tissue may be referred for treatment. To allow drainage, a small, flexible tube (a shunt) with a silicone pouch is placed into the tissues of the eye.

Is the dropless treatment right for me?

For people who would prefer to manage their eye pressure without the use of eye drops, dropless glaucoma therapy can be a suitable option for various reasons: patient comfort, trouble recognising or instilling eye drops, eye drop prices, eye drop allergies such as red or dry irritable eyes, or suboptimal eye pressure when using eye drops. You will find out more about these solutions from your glaucoma specialist .

What do we do?

At Hudson Ophthalmology, Dr Kerline Marcelin MD is a board certified ophthalmologist with additional fellowship training in glaucoma diseases and treatments. She also is a Clinical Assistant Professor of Ophthalmology in glaucoma at the New York Eye & Ear Infirmary since 2000. professionals specialised in the treatment of glaucoma are dedicated to combating this debilitating condition by using medications, lasers or surgeries and as appropriate.

If traditional glaucoma drugs are not successful or accepted, there may be rge the potential to provide several dropless alternatives, such as Durysta Implant (an innovative experimental glaucoma treatment) and other laser therapies including Selective Laser Trabeculoplasty (SLT), Argon Laser Trabeculoplasty (ALT), Laser Peripheral Iridotomy (LPI), YAG Laser Cyclophotocoagulation, Trabeculectomy or Tube Shunt Surgery, helping you fight glaucoma and prevent irreversible blindness.

After a comprehensive review of your individual condition, Dr. Kerline Marcelin  will decide which form of therapy is appropriate for you.