Wiles Eye Center is well-known as a leader in modern treatment strategies for glaucoma. Our eye care professionals’ successes attract numerous patients from around the Midwest who seek modern glaucoma treatment. Combining advanced techniques with state-of-the-art technologies, Wiles Eye Center’s experienced team provides superior eye care for our glaucoma patients.
Quick Facts about Glaucoma
- One of the most common causes of vision loss and blindness in the world
- It is estimated that more than 3 million Americans have it
- A disease of the optic nerve, which is a bundle of nerve fibers that carry information about the images we see to the brain
- Damages these nerve fibers, which can lead to peripheral vision loss first and eventually blindness (in uncontrolled cases)
- Early detection and treatment can protect against vision loss and blindness
- Not curable, but can be managed with medication and/or laser or traditional surgery
What Causes Glaucoma?
The eye constantly produces clear fluid called aqueous humor that circulates inside the eye, giving it a round shape and facilitating the ability to see clearly. As new aqueous humor is produced, fluid drains out of the eye through an area called the anterior chamber or drainage angle, located where the iris (the colored portion of the eye) meets the sclera (the white of the eye).
Normally, there is a delicate equilibrium between the amount of fluid produced and the amount of fluid that drains from the eye. But if fluid fails to drain properly, this balance is thrown off, and the pressure inside the eye can rise. This increase in intraocular pressure (IOP) can threaten to damage the optic nerve. Reducing IOP to the target level is the key element in glaucoma treatment. Each patient’s target IOP is the unique level at which optic nerve damage is not likely to occur.
Because there is no cure for glaucoma, regular eye exams are important, as early detection is necessary to slow the progression of the disease. If not detected early enough and if left untreated, glaucoma can cause severe vision loss and, ultimately, blindness.
Risk Factors for Glaucoma
Although glaucoma can affect people of all ages and backgrounds, certain individuals are at a higher risk of getting the disease. Risk factors for glaucoma include:
- Being over age 60
- Having a family history of glaucoma
- Having high intraocular pressure
- Being black, Asian or Hispanic
- Being nearsighted
- Having diabetes, high blood pressure or other chronic health problems
- Having a history of an eye injury or certain types of eye surgery
- Having a history of long-term use of corticosteroid medications
The Types of Glaucoma
Although many kinds of glaucoma exist, there are two primary forms of this disease:
Primary open-angle glaucoma (POAG) is the most common form of glaucoma. In POAG, fluid drains slower than usual through the drainage angle. (Imagine fluid passing through a clogged drain.) Intraocular pressure rises slowly, gradually pressing on and damaging the optic nerve and impairing vision. Once the optic nerve has been damaged and vision has been lost, it is impossible to recover. Thus, regular examination and testing is important to detect POAG.
On the other hand, angle-closure glaucoma is associated with a physically obstructed drainage angle. This blockage may be partial or complete, but it can cause a swift spike in IOP. Partial obstruction usually has no symptoms; however, acute angle-closure glaucoma, or complete obstruction, may develop quickly and demand urgent medical attention, as permanent vision loss can occur within hours.
Glaucoma Symptoms
With primary open-angle glaucoma, intraocular pressure rises slowly, so most people notice no pain or symptoms until the disease has advanced considerably and their vision is impaired.
Angle-closure glaucoma causes a faster spike in intraocular pressure, and the symptoms are much more noticeable. People with angle-closure glaucoma may experience nausea, vomiting, halos and eye pain. Prompt treatment is needed to reduce the elevated pressure.
Glaucoma Tests
Regular eye exams are important to detect glaucoma. Although most glaucoma cases arise in patients over the age of 60, a significant number of people are affected at earlier stages. Known as “the silent thief of sight,” glaucoma’s first symptom can be the irreversible loss of vision. The team at Wiles Eye Center uses sophisticated technology to identify glaucoma at its earliest stages. Annual visits are recommended for patients 60 years old and over. Regular exams are encouraged for younger patients found to be at higher risk based on their family history or examination findings.
During an eye exam, the doctor inspects the internal structures of the eye, including the drainage angle and the optic nerve, to look for abnormalities or damage. Intraocular pressure is measured, and peripheral vision may be tested. Photos or computer measurements may be taken if needed.
Our Approach to Glaucoma Treatment
Treatments offered to our St. Joseph and Kansas City glaucoma patients include medicated eye drops to reduce the amount of fluid in the eye or improve the outflow of fluid from the eye. But some of our patients find the daily use of eye drops inconvenient, or experience side effects from the medicine.
We also offer virtually painless laser procedures, such as selective laser trabeculoplasty (SLT), and more advanced techniques to lower pressure in the eye. In many cases, we are able to control glaucoma for patients without the need to use eye drop medications on a daily basis.
Glaucoma Surgery
Wiles Eye Center also offers minimally invasive glaucoma surgery (MIGS), which was developed to increase fluid filtration from the eye to reduce intraocular pressure. MIGS procedures use microscopic-sized instruments and tiny incisions, which are less likely to disrupt the eye’s tissues than more invasive surgical techniques. These procedures also minimize or virtually eliminate some of the complications associated with traditional surgery.
Among the most successful MIGS procedures we offer is iStent, which involves implanting a small device in the eye to create a bypass between the front of the eye and natural drainage pathway to increase fluid flow. With the iStent, many patients are able to reduce or even eliminate their need for glaucoma medication.
Another MIGS procedure, canaloplasty, uses a microcatheter to enlarge the drainage canal and relieve intraocular pressure in the eye. Canaloplasty is particularly useful for patients with open angle glaucoma and those who wear contact lenses. Wiles Eye Center also offers Cypass micro-stent surgery and Xen Gel stent, both of which use tiny implants placed just below the surface of the eye to lower eye pressure. Like the iStent, Cypass micro-stent surgery and Xen Gel have the ability to reduce or eliminate a patient’s need for glaucoma medications.
Wiles Eye Center is among a select group of eye care centers providing the latest techniques in glaucoma management, including the revolutionary “Trabectome” procedure. In fact, Wiles Eye Center’s founder Dr. Stephen Wiles is a certified Trabectome trainer. In this procedure, glaucoma-affected tissue is removed in a matter of minutes to allow better pressure control and thus preservation of sight.
Durysta Implantable Glaucoma Treatment
Wiles Eye Center is always ahead of the curve in pursuit of new medications and treatments for glaucoma. We now offer Durysta, the first FDA-approved implantable medicine for open-angle glaucoma. With this revolutionary drug delivery system, a tiny, rod-shaped implant is inserted into the eye one time. (For perspective, the rod is smaller than the “I” in “LIBERTY” on a dime.) The implant slowly and steadily delivers bimatoprost, a highly effective medication to lower intraocular pressure, for several months. Durysta is easily implanted during a minimally invasive in-office procedure that only takes a few minutes. Over time, the implant gradually dissolves and is eventually absorbed by the body.
Durysta enables patients to manage their eye pressure without the inconvenience and cost associated with daily glaucoma eye drops. In our experience, we have found that some patients have trouble remembering to take eye drops on a regular basis, or they struggle to physically administer the drops because of dexterity problems or related medical issues. Other patients experience uncomfortable side effects from traditional eye drops. Although side effects can occur with Durysta, they are less frequent than with traditional eye drops. Thanks to Durysta, patients now have an alternative solution to lower intraocular pressure and stave off glaucoma-induced damage.
Glaucoma Prevention
Although there is no way to completely eliminate the likelihood of developing glaucoma, there are a few things patients can do to reduce the risk.
First, patients should not smoke. Smoking has been linked to several eye diseases, including glaucoma and cataracts.
Also, patients should follow a healthy, active lifestyle. This means exercising for at least 30 minutes three times a week, and trying to maintain a healthy weight. Eating a balanced diet full of healthy, fresh foods is recommended. Any pre-existing medical conditions like diabetes should be managed with medication and follow-up with a primary doctor.
Finally, comprehensive eye examinations are key, as they allow eye doctors the opportunity to catch signs of problems in their early stages, when they are more easily treatable.
Frequently Asked Questions About Glaucoma
What is the optic nerve’s job?
Located at the back of the eye, the optic nerve is actually part of the central nervous system. The retina — the layer of light-sensitive tissue lining the back of the eye — senses incoming light and creates electrical impulses. The optic nerve’s job is to transmit those impulses to the brain, which interprets them into the images that we see.
Can I get glaucoma if my intraocular pressure is normal?
Yes. In normal-tension glaucoma, the optic nerve suffers damage even though intraocular pressure is normal. Doctors are not absolutely sure what causes normal-tension glaucoma, but some believe blood flow problems are a contributing factor.
If my intraocular pressure is high, will I definitely get glaucoma?
It is possible to have high intraocular pressure without optic nerve damage. If that is the case, you should have your eyes checked regularly, as high eye pressure is a risk factor for glaucoma.
What precautions should I take if I have a family history of glaucoma?
If you have a family history of glaucoma, you are at an increased risk of the disease and must be especially proactive about your eye health. The best thing you can do is have yearly eye exams with a trusted ophthalmologist who can identify signs of the disease before irreversible damage occurs. In between exams, watch for any symptoms or declines in your vision and let your doctor know if you notice anything. When caught early, glaucoma can be managed with medications, laser or traditional surgery.
What is the ideal eye pressure?
There is no one-size-fits-all ideal eye pressure that is good for everyone. What is normal for you may be high for someone else, or vice versa. Furthermore, fluctuations in eye pressure are normal. Your target pressure is determined by your eye doctor based on your personal health history and the results of your eye exam and testing.
Is surgery necessary to treat glaucoma?
No, it is not always necessary to operate on an eye with glaucoma. Many cases of glaucoma can be managed with the use of prescribed medications and close monitoring. Another option is laser treatment, such as selective laser trabeculoplasty, to lower eye pressure.
If I have lost vision to glaucoma, can it be recovered?
Currently, treatments for glaucoma aim to preserve remaining vision, not restore vision that has already been lost. Once the cells that make up the optic nerve are injured and die, they cannot regenerate. However, research is underway to look for ways to replace these lost cells and restore vision.
Contact Wiles Eye Center Today
The team at Wiles Eye Center is committed to preserving the vision of all of our glaucoma patients. Contact Wiles Eye Center today to speak with an eye care professional and schedule your appointment.