Glaucoma

Understanding Glaucoma

An excellent outcome depends on prompt detection of glaucoma. Once you lose vision due to this condition, you cannot get it back.

The optic nerve consists of more than one million nerve fibers. These fibers send signals from your retina (light-sensitive tissue at the back of the eye) to the part of the brain that interprets them. Most damage done by glaucoma to the optic nerve consists of high fluid pressure in the eye (ocular hypertension). Types of glaucoma include:

• Open-angle glaucoma. In this condition, a clear fluid that normally flows in and out of the eye does not flow out of the eye properly. In this most common form of glaucoma, symptoms such as blank spots in your vision develop so slowly that you may not notice them at first.
• Angle-closure glaucoma. In this type of glaucoma, the iris (colored disk at the front of the eye) blocks drainage, causing a sudden rise in pressure within the eye. This condition can cause you pain and demands emergency care.
• Normal-tension glaucoma. You can have progressive damage to the optic nerve even when you have normal eye pressure for unknown reasons.
• Congenital glaucoma. This rare condition appears in infants and toddlers. Prompt treatment often allows children to avoid vision problems.

Regular eye examinations help early detection of glaucoma.

What are Treatment Options for Glaucoma?

IU Health ophthalmologists treat glaucoma with the goal of preventing vision loss and accounting for your needs, concerns and preferences. Most people who have glaucoma can maintain their eyesight with proper therapy despite the lack of a cure for the condition. Follow your glaucoma treatment plan carefully to keep the condition from progressing.

IU Health uses the most advanced approaches and equipment to address glaucoma. The Eugene and Marilyn Glick Eye Institute, part of the Department of Ophthalmology at the Indiana University School of Medicine, gives us access to the latest advancements for managing glaucoma. IU Health also leads in glaucoma research, operating the Glaucoma Research and Diagnostic Center. At this center, we investigate what causes the disease and how we can treat it more effectively treated.

Your doctors provide a variety of treatment options for glaucoma depending on the stage of your disease and your specific needs. Options include:

Medicine

A variety of medicines are available, in eye drop or pill form, to manage glaucoma. These drugs lower the pressure in your eyes by either reducing the amount of fluid they produce or helping the fluid to drain. Eye drops provide the most common treatment for glaucoma. In many cases you will need nothing else, although you might require more than one type of drop.

Many kinds of eye drops require you to administer them two or more times per day. If eye drops alone do not control high eye pressure, we also prescribe pills, such as carbonic anhydrase inhibitors. We use oral medicines less often than drops because they can cause side effects such as numbness in the hands and feet, nausea and frequent urination.

Because high eye pressure does not usually cause symptoms, you may forget to take your eye drops or pills. No matter what drug therapy you and your doctor choose, you must take your medicine as prescribed.

Laser Trabeculoplasty

This outpatient procedure uses a laser to alter the eye’s drainage system and help fluid to flow more efficiently. You remain awake during this painless treatment and might see flashes of bright red or green light. This treatment typically takes between 10 and 15 minutes.

You can go back to normal activities soon after the procedure, but you may need eye drops to control soreness or inflammation as you heal. You may need to continue taking your regular glaucoma medicine indefinitely after surgery.

We generally treat only one eye at a time. If you have glaucoma in both eyes, we schedule a second procedure for a few days or weeks later. You might need a repeat procedure or other treatment after a few years because the effects of laser trabeculoplasty sometimes diminish with time.

Conventional Surgery

For open-angle and angle-closure glaucoma, we commonly suggest glaucoma filtration surgery. We may recommend this surgery when other treatment methods have not worked. In this operation, we cut a tiny flap into the white part of the eye (sclera).

We then make a reservoir (filtration bleb) into which fluid can drain. Finally, we close the incision with stitches. You will likely remain awake during this outpatient operation, but you will receive local anesthetic so that you do not feel pain. You can usually go home soon after the hour-long procedure. However, you need to avoid certain activities, such as heavy lifting, for two or more weeks after glaucoma filtration surgery.

You will wear a patch to protect your eye for one day after the procedure. You also need to use eye drops for a few weeks to control inflammation and prevent infection. You may have blurry vision for several days after the operation. If you need surgery in both eyes, we schedule a second procedure for a few weeks after the first procedure.

Aqueous Shunt Surgery

Another conventional operation for glaucoma includes aqueous shunt surgery. It involves placing a device known as a shunt or implant to allow the aqueous fluid to drain properly. This approach helps when the eye has scar tissue from previous operations.

Surgery takes one to two hours, and you can typically go home the same day. We see you the next morning to check the results and examine you several more times over the following six weeks. You will likely also receive topical antibiotics and steroids during these weeks.