Dr Olivia Read specialises in glaucoma surgery as well as medical retina and squint surgery. The goal of glaucoma treatment and surgery is to reduce or stabilise the intraocular pressure (IOP), or the pressure within the eye. This will help prevent damage to the optic nerve.

Early glaucoma diagnosis is key.

The best way to prevent permanent vision loss from glaucoma is to diagnose and treat it early. Many patients don’t experience severe symptoms when they have glaucoma. If you’re in a high-risk category, you should visit your ophthalmologist regularly for an eye examination, and to have your intraocular pressure checked. 

Who is at risk for glaucoma? 

While we are all at risk of developing glaucoma, there are certain people who have a higher risk than others including:

  • People of African descent have a significantly higher risk of developing glaucoma than those of European descent. Native Alaskans and people of Asian descent have been identified as a high-risk group for angle-closure glaucoma, and Japanese people are at a higher risk for low-tension glaucoma. 
  • People over 60  (in people who are of African descent, the risk factor increases substantially from age 40)
  • Family history of glaucoma
  • If you have diabetes, high blood pressure or heart disease, you are at higher risk of developing glaucoma
  • If your eye has been damaged due to trauma, the drainage angle could be affected
  • Eye tumours, inflammation, and retinal detachment may also trigger glaucoma 
  • Using corticosteroids over a long period of time may increase the risk of developing secondary glaucoma

What are the different types of glaucoma?

There are different types of glaucoma. Each one may require a different treatment approach. Your ophthalmologist will assess your eyes and offer advice on how to manage the condition going forwards. 

Glaucoma occurs when the optic nerve in the eye is damaged. This damage is usually caused by increased pressure inside the eye. As the nerve deteriorates, the patient develops blind spots in their visual field. Decreasing the intraocular pressure in the eye is the most important factor in reducing progression of this disease.

How does pressure build up in the eye?

Your eye is full of clear fluid made by the ciliary body within the eye. This fluid nourishes the eye and keeps it under tension. It usually drains out of the eye through a special spongy tissue called the trabecular meshwork. It is located where your iris and cornea meet in the angle of the front part of the eye. The production of this fluid and its drainage may be affected by various factors that result in an increase in the pressure in the eye and this ultimately damages the optic nerve.

The following brief explanation of the different types of glaucoma is condensed from The Mayo Clinic. 

Open-angle glaucoma:

This is the most common type of glaucoma. It occurs when the drainage angle inside the eye is open, but malfunctions. This means that the fluid inside your eye cannot drain out. It causes a pressure build-up with resultant damage to the optic nerve.

Closed-angle glaucoma:

Fluid may also be prevented from draining out of the eye when the angle of drainage is closed or blocked. It may occur very suddenly in some individuals, and doctors call this sudden onset “acute closed-angle glaucoma”. Symptoms include severe pain and vision loss. This is an Ophthalmological emergency and you need to be seen immediately by your ophthalmologist.

For others, the onset takes longer and symptoms can include severe headaches. Doctors call this “chronic closed-angle glaucoma.”

Congenital glaucoma:

When children are born with a defect that prevents the eye from draining, it is called congenital glaucoma. It is usually easy to diagnose as the signs include cloudy eyes, sensitivity to light, and excessive tearing.

Low-tension or normal-tension glaucoma:

In more rare cases, the optic nerve is damaged despite the pressure in the eye being normal. It is most often related to hypotension (low blood pressure, particularly at night). This is one of the more difficult types of glaucoma to diagnose. Treatment, however, is the same as for regular open-angle glaucoma.

Secondary glaucoma:

This occurs as a result of medications or medical conditions including diabetes, inflammation (uveitis), or even steroid containing eyedrops.

How is glaucoma treated?

Depending on the type of glaucoma you have, your ophthalmologist will consider different treatment options including eye drops, oral medications, and surgery. 

Eye drops or oral medications

Non-surgical treatment options for glaucoma include the use of topical eye medications (glaucoma eye drops) or oral medications (pills). 

Most cases of glaucoma can be controlled with one or more eyedrops. Your doctor will usually monitor your glaucoma every six months. They will perform a clinical examination and do various scans including an OCT scan which looks at the health of the optic nerve. A visual field scan looks at the function of the optic nerve. 

If your ophthalmologist is concerned about the progression of your glaucoma despite optimal medical treatment, then surgery or another intervention may be required.

Selective laser trabeculoplasty (SLT) 

This is a non-invasive laser treatment of the anterior chamber angle in the eye. It has been proven to be very effective in lowering the intraocular pressure in about 90% of people suffering from glaucoma. It is a good option for those who experience negative side-effects from the glaucoma eye drops or who forget to administer the drops. 

Unfortunately, it is not a permanent fix, and those suffering from glaucoma may need to have the procedure repeated within 1-4 years. They may also need to continue administering eye drops on a regular basis. 

Trabeculectomy

This is a surgical treatment for glaucoma where the surgeon creates an artificial drainage area in the eye. This treatment option is suggested when the patient doesn’t respond well to maximal medications, and the glaucoma is progressing.

Other glaucoma surgeries

Your eye surgeon may also insert an implant such as the Ahmed valve to help the eye drain adequately. If the intraocular pressure (pressure inside the eye) only needs to be decreased by a small amount, your ophthalmologist will recommend micro-invasive glaucoma surgery (MIGS). They will insert small devises like the XEN implant or the iStent into the eye to lower the pressure.  

Book an Appointment.

Office

First Floor, Bay Eye Hospital, 241 Main Rd, Walmer, Gqeberha, 6000

Email

reception@oliviaread.co.za

Telephone

+27 (041) 373 4910