The most common form of glaucoma is called primary open-angle glaucoma occurring in approximately 90% of patients with glaucoma.  This type of glaucoma occurs when the drainage system of the eye called the trabecular meshwork gradually becomes less efficient at draining fluid.  As this happens, your eye pressure, called the intraocular pressure (IOP) rises.  The raised eye pressure leads to damage of the optic nerve.  Open-angle glaucoma develops gradually and without any symptoms.  Unfortunately, this can go undetected for years while it  slowly causes vision loss. 

Damage to the optic nerve can occur at different eye pressures among different people.  Your ophthalmologist establishes a target eye pressure for you that he or she predicts will protect your optic nerve from further damage.

If Symptoms do occur as the disease progresses, you may notice:

• A gradual loss of peripheral vision in one or both of your eyes
• Tunnel vision in the later stages of the disease  

Some patients who develop glaucoma may not have high eye pressure readings, which is called normal-tension or low-tension glaucoma.  Their eye pressure readings are normal, but the optic nerve damage and peripheral vision loss occurs just as in open-angle glaucoma. People with normal-tension glaucoma will have the same symptoms as open-angle glaucoma, and typically receive the same methods of treatment.

A less common form of glaucoma is closed-angle also referred to as narrow-angle or angle-closure glaucoma.  This form of glaucoma occurs in less than 10% of glaucoma patients.

Closed-angle glaucoma occurs when the drainage angle of the eye becomes blocked.  Unlike open-angle glaucoma, eye pressure in angle-closure rises rapidly.  The pressure rises because the iris (the colored part of the eye) partially or completely blocks off the drainage angle.  People of Asian descent and those with hyperopia (farsightedness) tend to be more at risk for developing this form of glaucoma.  If the drainage angle becomes completely blocked, eye pressure rises quickly resulting in a closed-angle attack.

Symptoms of an attack include:

• Severe eye or brow pain
• Redness of the eye
• Decreased or blurred vision
• Seeing colored rainbows or halos
• Headache
• Nausea
• Vomiting

A closed-angle attack is a medical emergency and must be treated immediately.  Unfortunately, people at risk for developing closed-angle glaucoma often have few or no symptoms before the attack.  People at risk for closed-angle should avoid over-the-counter decongestants and other medications where the packaging states not to use these products if you have glaucoma.

Secondary glaucoma results from another eye condition or disease.  For example, someone who has sustained an eye injury, or someone who is on long-term steroid therapy can develop glaucoma.

Ocular hypertension is a condition where someone has a higher eye pressure than normal, but does not have other signs of glaucoma, such as optic nerve damage or peripheral vision loss when tested.  Individuals with ocular hypertension are at higher risk for developing glaucoma later relative to those with lower, or average eye pressure.  Just like people with glaucoma, people with ocular hypertension need to be closely monitored by an ophthalmologist to ensure they receive appropriate treatment.

• Family history of glaucoma
• Age over 40
• African American or Hispanic heritage
• Ocular hypertension
• Farsighted or nearsighted

The key to preventing vision loss or blindness is early detection.  Having full annual eye examination with dilation is highly recommended to look for signs of glaucoma.  Although once vision loss occurs it can not be recovered, we have many treatment options to stop further damage.

Glaucoma eye drops are the most common way to treat glaucoma.  These medications lower your eye pressure by slowing the production of aqueous humor or by improving the flow through the drainage angle.  These eye drops must be taken everyday.  Just like any other medication, it is important to take your eye drops regularly as prescribed by your ophthalmologist. 

Selective Laser Trabeculoplasty (SLT) is often used to treat open angle glaucoma.  During SLT surgery, a low level of energy targets specific cells in the drainage channels using a very short application of light.  This treatment is very safe, and is often used as a first line treatment even before glaucoma eye drops if a patient is a candidate.  The laser can also be repeated in the future if the intraocular pressure rises.

Laser iridotomy is recommended for treating people with closed-angle glaucoma and those with very narrow drainage angles.  A laser creates a small hole about the size of a pinhead through the top part of the iris to improve the flow of aqueous fluid to the drainage angle. 

There has been a revolution in glaucoma surgery called Micro-Invasive Glaucoma Surgery, also known as MIGS.  MIGS can be thought of as enhancing fluid outflow through the eye's natural drainage system.  There are many MIGS devices and procedures we can use.  During cataract surgery, one of these devices or procedures will be employed.

MIGS devices and procedures:

iStent inject

Hydrus stent

Kahook Dual Blade

Omni Glaucoma Treatment System

iStent Inject® Trabecular Micro-Bypass

iStent inject® creates two patent bypass pathways through the trabecular meshwork- the main source of resistance for aqueous outflow-resulting in multi-directional flow through Schlemm’s canal. And it is the smallest medical device known to be implanted in the human body.  Together, these unique advantages are designed to provide exceptional results in a truly micro-invasive  approach. 

Hydrus® Microstent

This tiny implant, by Ivantis, is roughly the size of an eyelash and is designed to enhance fluid outflow in multiple ways to help achieve predictable outcomes.  Hydrus Mircrostent is placed in Schlemm’s canal, a part of the drainage system of the eye.  Fluid then flows through the Hydrus Microstent and into the eye’s natural outflow channel to reduce the intraocular eye pressure.

Kahook Dual Blade

The Kahook Dual Blade is a tool to treat your glaucoma.  The dual blade offers a cutting-edge design for your surgeon to directly target the natural drainage system of your eye.  By creating an opening with the Kahook Dual Blade in the trabecular meshwork, your eye’s fluid is allowed to drain just as they do naturally.

Omni Glaucoma Treatment System

The OMNI Glaucoma Treatment System is the only device that combines tow well-established MIGS procedures into one using a single device.  With dual mechanisms of action targeting the trabecular meshwork and collector channels, OMNI is designed to address the entire natural trabecular canalicular outflow pathway to reduce the intraocular eye pressure.