Glaucoma Treatment

Eye drops to treat glaucoma

Eye drops are the most common form of medication for glaucoma. For most, eye drops are applied one to four times a day on a regular schedule. Five types of eye drops are used in modern ophthalmology:

• Beta blockers
• Topical prostaglandins
• Carbonic anhydrase inhibitors
• Adrenergic agonists
• Miotics

While these drops are effective, they may not work for everyone. In addition, a strict eye drop regimen may affect one's quality of life as eye drops need to be taken as often as every six hours. Sometimes these drops may cause an allergic reaction. If your eyes become red and puffy, stop the drops and contact an eye doctor as soon as possible.

Drops can also cause local side effects such as burning, stinging, tearing, itching, or redness in the eye. One example of a common side effect is that beta blocker eye drops, such as Timolol, can lower blood pressure at the same time as they lower intra-ocular pressure. These side effects can be minimized by carefully following instructions for using eye drops, including placing a finger on the inside corner of the eye for two or three minutes to prevent the eye drops from entering the nasal ducts.

Laser treatment for glaucoma

At the Benjamin Eye Institute, we perform a variety of glaucoma laser treatments to help our patients manage their condition. These procedures include:

SLT Laser for Glaucoma

Our in-office Selective Laser Trabeculoplasty (SLT) laser can help rid glaucoma patients of their dependence on a strict eye drop regimen by reducing their ocular pressure. SLT is a safe and simple in-office laser treatment that effectively reduces the pressure in the eye for most patients with glaucoma.

SLT does not rely on medicines. Instead, it uses an advanced laser system to target only specific cells of the eye—those containing melanin, a natural pigment. This allows for only these cells to be affected, leaving surrounding tissue intact. As a result, your body's own healing response helps lower the pressure in your eye.

Benefits of the Lumenis SLT Laser:

• SLT is not associated with systemic side effects or the compliance and cost issues of medications
• SLT utilizes selective photothermolysis to target only specific cells, leaving the surrounding tissue intact
• It stimulates the body's natural mechanism to enhance outflow of the fluid in your eye
• SLT therapy is reimbursed by Medicare and many other insurance providers, which minimizes your out-of-pocket expenses

Laser Peripheral Iridotomy (LPI)

The YAG laser is also used to perform LPI or Laser Peripheral Iridotomy, a procedure for narrow-angle glaucoma treatment. Narrow-angle glaucoma occurs when the angle between the iris and the cornea in the eye is too small. This causes the iris to block fluid drainage, increasing inner eye pressure. LPI makes a small hole in the iris, allowing it to fall back from the fluid channel and helping the fluid drain out of the eye.

The laser procedure itself causes little sensation. Side effects, if any, may include transient blurring of vision, mild inflammation, temporary elevation of IOP and, less commonly, minimal bleeding at the treatment site. Eye drops are used immediately prior to treatment and for several days thereafter to control inflammation and minimize IOP rise. The small potential for side effects of laser treatment is far outweighed by the serious consequence of angle closure glaucoma if narrow anterior chamber angles are left untreated.

Benefits of the YAG laser:

• YAG procedure is virtually painless
• No anesthesia is needed
• Does not require any preoperative tests
• No operating room needed
• Takes less than 5 minutes
• Does not have any postoperative restrictions

Endo-Optiks/ECP Laser

Endoscopic Cyclo Photocoagulation or ECP, is an exciting new development in the management of most types of glaucoma. ECP is performed on an outpatient basis. The ECP procedure consists of using laser light to cauterize part of the ciliary body, which results in less fluid and lower intra-ocular pressure. This reduces fluid production that in turn, reduces intraocular pressure.

Endoscopic Cyclo Photocoagulation (ECP) is often performed on patients at the time of cataract surgery. It can also be performed on those patients who had SLT procedures, glaucoma filtration surgery, or other surgical procedures that were not successful at controlling intra-ocular pressure.

Benefits of the ECP laser:

Endoscopic Cyclo Photocoagulation (ECP) is a surgical approach to glaucoma treatment that employs light endoscopy and visualized laser application. The ciliary body (which produces aqueous humour) is viewed by the surgeon through the endoscope in real time. The target tissues are easily and accurately identified utilizing endoscopy. This allows discrete treatment of the targeted ciliary processes with clear laser ablation and minimized trauma to peripheral (non targeted) tissues.

Surgery to treat glaucoma

Glaucoma surgery includes a number of procedures designed to lower the IOP by improving the outflow of fluid from the eye. These procedures are sometimes performed solo and sometimes in combination with cataract surgery:

• Trabeculectomy with or without antimetabolites
• Placement of glaucoma shunt devices, such as a Barveldt or Ahmed Valve
• Viscocanalostomy procedure

Penetrating glaucoma surgeries listed here are performed in a surgical center in an outpatient setting. They require close postoperative follow up and care.

Our cutting-edge glaucoma diagnostic technologies

At the Benjamin Eye Institute in Los Angeles, we use a variety of the latest, most cutting-edge technologies to diagnose glaucoma for our patients.

Humphrey Field Analyzer

Visual field testing is an important tool in the diagnosis and management of glaucoma. It is used to:

• Confirm that glaucoma has affected the visual function
• Evaluate the severity of the disease
• Monitor progression of the disease

The Humphrey Field Analyzer is a wheelchair accessible, diagnostic tool used to examine a patient's visual field. It is the recognized standard of care for early diagnosis and management of ocular diseases resulting in visual field loss.

Why we use the Humphrey Field Analyzer:

• The Humphrey Field Analyzer has been shown to be extremely accurate
• Early Glaucoma Detection: this technology has been shown to provide earlier detection of vision loss due to glaucoma
• The Humphrey Field Analyzer measures visual fields in as little as two minutes

PeriData

This specialized software allows us to statistically interpret data from the visual field analyzer.

Visual field testing (VFT) and analysis with PeriData software allows Dr. Benjamin to utilize unique statistical methods for analyzing the visual field performance in patients with glaucoma.

Why we use PeriData:

• Transmission of data from the perimeter to the program PeriData
• Visualization by informative graphics and analysis, which helps patients understand their diagnosis, treatment and outcome
• Integration into our electronic medical records
• Colored maps help with defect recognition
• Intelligent statistical analysis helps us to distinguish normal and pathological visual fields, stable courses, and negative trends

The Ocular Blood Flow Analyzer

Ocular blood flow analysis records valuable information about the dynamics of the eye's vascular network. With this data, we can detect new cases earlier and improve our ability to monitor and manage our current glaucoma patients.

Why we use Ocular Flow Analyzer:

• The OBFA assists in the management and detection of other circulatory abnormalities involving diabetes, retinal and carotid disorders.
• Measures ocular blood flow, as well as intraocular pressure, giving a measurable indication of the vascular health of the eye. It's also helpful with fitting contact lenses and calculating intraocular lens power for cataract surgery.
• Allows us to evaluate your ocular blood flow and thus predict your lifetime risk of developing glaucoma.
• Fast and comprehensive, the Ocular Blood Flow Analyzer provides highly accurate and sensitive measurements.

The Heidelberg Retina Tomograph (HRT)

The Heidelberg Retina Tomograph is an advanced diagnostic tool that can detect glaucoma at its earliest stages: up to eight years earlier than visual fields or photos.

Why we use the Heidelberg Retina Tomograph:

• Study results have confirmed the HRT provides consistent data leading to the precise diagnosis of glaucoma.
• HRT not only identifies those patients at high risk for developing glaucoma; it can also identify those at low risk with greater than 90 percent accuracy at initial assessment.
• The HRT can accurately differentiate between normal eyes and early glaucoma indication, before any vision loss has occurred.
• The three-dimensional analysis by laser scanning tomography has been shown to be superior to all other imaging technologies.
• Because of its advantages, this technology is now generally accepted and used to provide the best service possible for glaucoma patients and patients at risk.
• The HRT uses a special laser to take three-dimensional photographs of the optic nerve and the surrounding retina.

This laser, which is not powerful enough to harm the eye, is first focused on the surface of the optic nerve and captures the image. It is then focused on the layer just below the surface and captures that image. The HRT continues to take images of deeper and deeper layers until the desired depth has been reached. Finally, the instrument takes all these pictures and puts them together to form a three-dimensional image of the entire optic nerve.