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Glaucoma EdisonGlaucoma Doctors in New Jersey

Glaucoma is a disease of the optic nerve, which transmits the images you see from the eye to the brain. The optic nerve is made up of many nerve fibers (like an electric cable with its numerous wires). Glaucoma damages nerve fibers, which can cause blind spots and vision loss. Glaucoma is often, but not always, caused by a buildup of the pressure inside the eye, known as intraocular pressure.

Normally, the eye makes aqueous humor (a clear liquid that provides nutrients to the eye), which exits through the trabecular meshwork (the complex drainage system of the eye). When the aqueous humor cannot drain properly, pressure builds up in the eye. The resulting increase in intraocular pressure can damage the optic nerve and lead to vision loss.

The most common form of glaucoma is Primary Open-Angle Glaucoma. In this type of glaucoma, the outermost portion of the trabecular meshwork is visible by examination, or “appears open”. The area of outflow blockage is further down the trabecular meshwork, and cannot be directly seen with typical examination techniques. Most people who develop primary open-angle glaucoma notice no symptoms until their vision is already impaired. Vision loss from glaucoma is not reversible.

In narrow-angle or close angle glaucoma, the trabecular meshwork is not visible by examination. Generally, other ocular structures (such as cataracts) have enlarged to obstruct the outermost portion of the drainage system so that the aqueous humor of the eye cannot exit the eye, leading to an increase in the eye pressure. The obstruction is generally a slow process that may produce no symptoms other than impaired vision. Sometimes if the obstruction happens relatively quickly, patients may experience significant eye pain, redness, blurred vision, halos around lights, or even nausea, vomiting, and headache.

Glaucoma can often be caused by another eye condition or disease. This is known as secondary glaucoma. Secondary glaucoma can occur in people who have: eye injuries, inflammation of the eye, abnormal blood vessel formation from uncontrolled diabetes or retinal blood vessel blockages, use of any steroid-containing medications (pills, eyedrops, sprays, lotion, ointment), cancer, pigment dispersion, or pseudoexfoliation.

Glaucoma Risk Factors

  • African American or Hispanic heritage
  • Corneas are thin
  • Family members with glaucoma
  • Certain eye conditions, such as farsightedness or nearsightedness
  • Certain medical conditions such as diabetes, migraines, high blood pressure, poor blood circulation, or autoimmune diseases
  • Over age 40
  • Certain eye injuries or certain types of eye surgery
  • Taking steroid medications, especially eye drops but also steroid creams, ointments, inhalers and nasal sprays, for a long time

People with more than one of these risk factors have an even higher risk of glaucoma and should talk with an ophthalmologist. Early detection and treatment can protect your vision. eyeSmart® Eye health information from the American Academy of Ophthalmology. The Eye M.D. Association.

Treatment Options in the Edison, Warren, and Piscataway areas for Glaucoma

Since vision loss from glaucoma is irreversible, the key to preventing serious vision loss or blindness from glaucoma is early detection. An annual, dilated eye examination is recommended to screen for glaucoma.

If you do have glaucoma, it is a chronic disease that can be controlled but not cured. Fortunately, there are many different ways to treat glaucoma. Glaucoma treatment aims to lower your eye pressure to prevent or slow further vision loss. Your ophthalmologist will recommend treatment if the risk of vision loss is high. Treatment often consists of eye drops but can include laser procedures or surgery to create a new drain (and bypass the nonworking drain) in the eye. Ongoing monitoring (every three to six months) is needed to watch for changes. Ask your eye doctor if you have any questions about glaucoma or your treatment.

Glaucoma Eye Drops

In early stages of open-angle glaucoma, medicated eye drops can be used to lower the eye pressure.  There are multiple different types of glaucoma eye drops.  Depending on what a person’s medical problems, lifestyle, and sensitivities are, your eye doctor can help you determine which ones may work the best for you.

Laser Trabeculoplasty

A laser procedure called laser trabeculoplasty can also be performed in early stages of open-angle glaucoma.  In laser trabeculoplasty, tiny, evenly spaced burns are made in the trabecular meshwork with a laser. These laser holes help to improve the drainage of aqueous humor.  Laser therapy usually takes approximately 10 minutes and has achieved excellent success rates in select patients.  

Laser Peripheral Iridotomy

The treatment for angle-closure glaucoma, or narrow-angle glaucoma, is generally initiated with a different type of laser procedure called a laser iridotomy and can be performed to bypass the normal aqueous fluid flow channels to open up the outermost portion of the drainage system again.  Sometimes cataracts are blocking enough of the drainage system, a laser peripheral iridotomy may not be enough, and cataract surgery may be needed to open up the drainage system again.

Glaucoma Surgery

If the above methods fail to control the eye pressure, your doctor may suggest glaucoma surgery reduce the eye pressure.  This may consist of a trabeculectomy (making a new drain with the natural tissues of the eye), or a glaucoma shunt surgery (placing a device in the eye that drains out the aqueous humor).  Also known as “aqueous shunts” or “glaucoma drainage devices,” we’ll refer to them simply as “implants.”

In conventional glaucoma surgery, a tiny drainage hole is made in the sclera (the white part of the eye). This procedure is known as trabeculectomy or sclerostomy. This opening allows fluid to drain out of the eye under the delicate membrane covering the eyeball known as the conjunctiva. Locally applied medications or injections may be used to help keep the hole open. With implant surgery, most of the device is positioned on the outside of the eye under the conjunctiva. A small tube or filament is carefully inserted into the front chamber of the eye, just in front of the iris (colored part of the eye). The fluid drains through the tube, or along the filament, into the area around the back end of the implant. The fluid collects here and is reabsorbed. Implant devices function by promoting simple passive diffusion of fluid out of a collection compartment. The tube provides a passageway for the movement of this fluid out of the eye and into a place where the capillaries and lymphatic system reabsorb it back into the body.

Complications and Successes

Glaucoma surgery is generally successful at lowering the eye pressure.  There is often an inflammatory reaction initiated by the body immediately after glaucoma surgery.  Close and frequent care in a period of time immediately after surgery is needed with trabeculectomy or implant surgery to help stabilize the eye pressure.

Implants are sometimes used after other surgeries have failed, most often due to healing and scarring over of the surgical opening. When this happens, eye pressures return to the higher, pre-surgery levels. However, implants can have the same problems as trabeculectomies. The small opening in the tube in the front of the eye may become clogged. Or excessive scarring around the external drainage portion of the device might block the reabsorption of fluid, again leading to inadequate IOP control. Other complications may include corneal injury, which can result from mechanical contact between the tube and the tissues of the eye. As with most surgeries, those implants with a smooth uncomplicated surgical course do the best over time.

Glaucoma surgery is unlike cataract surgery and most intraocular surgeries.  The body’s natural response is to heal.  This may happen over weeks, months, or years.  Patients who have had glaucoma surgeries still need close monitoring of eye pressures years after surgery to ensure that eye pressures are not climbing up again.

Contact The Eye Center serving the people of Edison, Warren, and the Piscataway areas today to schedule your glaucoma screening.