Diagnosing Glaucoma

Glaucoma is the leading cause of irreversible blindness worldwide. It is a group of eye conditions that damage the optic nerve, which is responsible for transmitting visual information from the eye to the brain. The damage to the optic nerve is often associated with increased intraocular pressure (IOP), but it can also occur with normal or even low IOP.

The two main types of glaucoma are primary open-angle glaucoma (POAG) and angle-closure glaucoma. POAG is the most common type and usually develops slowly over time without any noticeable symptoms in the early stages. Angle-closure glaucoma is less common but can develop rapidly and cause severe symptoms such as eye pain, headache, and vision disturbances.

Glaucoma tends to be more prevalent in older adults, but it can affect people of all ages. Other risk factors for glaucoma include a family history of the disease, being of African, Asian, or Hispanic descent, having high intraocular pressure, having thin corneas, and certain medical conditions like diabetes.

Early detection and timely treatment are crucial in managing glaucoma and preventing vision loss. Regular eye examinations with an eye care professional can help detect glaucoma in its early stages when interventions 


may be most effective. Treatment options for glaucoma may include eye drops to lower intraocular pressure, laser therapy (called SLT), or surgery, depending on the severity of the condition.

It is essential to raise awareness about glaucoma and encourage regular eye check-ups to detect and manage the disease promptly, helping to reduce the risk of irreversible blindness and preserving vision for those affected.

Glaucoma Treatments

There are several glaucoma treatments that can reduce intraocular pressure to help slow or prevent vision loss, including eye drops, laser treatments called SLT or selective laser trabeculoplasty, MIGS or microincisional glaucoma surgery, or drainage glaucoma surgery.  

Prescription eye drops are often the first method that doctors use in attempts to treat glaucoma. Depending on the type of eye drops, they can either help improve fluid outflow from your eye or decrease fluid production. Both types aim to decrease eye pressure, and you may use more than one if you have significantly increased eye pressure. 

Selective Laser Trabeculoplasty (SLT) is a medical procedure used to treat glaucoma. SLT uses a low-energy, short-duration laser to target specific cells in the trabecular meshwork, which is responsible for draining the fluid (aqueous humor) from the eye.

During the procedure, the laser stimulates these cells, leading to improved drainage and a reduction in intraocular pressure. The treatment is called “selective” because it is designed to target only specific cells, leaving the surrounding tissues largely unaffected. SLT is typically performed as an outpatient procedure and is considered safe and effective in lowering intraocular pressure in certain types of glaucoma, especially open-angle glaucoma.

The NIH funded, Laser in Glaucoma and Ocular Hypertension (LiGHT) Study has shown SLT to be clinically and cost-effective as a primary treatment of glaucoma. SLT is a safe treatment, providing better long-term disease control than eye drops, with decreased need for major glaucoma and cataract surgery.

Micro-Incision Glaucoma Surgery (MIGS) refers to a group of advanced surgical techniques used to treat glaucoma. MIGS procedures are designed to be minimally invasive, using tiny incisions and specialized devices to reduce intraocular pressure and manage glaucoma while minimizing the risks and complications associated with traditional glaucoma surgeries.

1. Minimally Invasive: MIGS procedures are performed through small, self-sealing incisions, often requiring less surgical manipulation and tissue disruption than traditional glaucoma surgeries.

2. Safe and Effective: MIGS aims to provide effective intraocular pressure reduction while maintaining a favorable safety profile with reduced risk of serious complications. Of course there are risks with any procedure.

3. Complementary to Cataract Surgery: Many MIGS procedures can be combined with cataract surgery.

4. Rapid Recovery: Due to their minimally invasive nature, MIGS procedures typically involve quicker post-operative recovery and reduced downtime compared to traditional glaucoma surgeries. However results vary and it is not possible to guaranty outcomes or recoveries.

Several types of MIGS procedures exist, and new techniques may continue to emerge as research advances. Some common examples of MIGS procedures include:

•iStent: In this procedure, a tiny titanium stent is inserted into the trabecular meshwork to create a bypass, facilitating drainage and lowering IOP.

•Trabectome: This procedure uses an electrocautery device to remove a portion of the trabecular meshwork, which is the drainage structure in the eye, to improve aqueous humor outflow.

• Canaloplasty improves the natural drainage system of the eye to lower intraocular pressure. Through a small incision into Schlemm’s canal, a microcatheter is then used to gently dilate and open the canal. This is somewhat analogous to snaking a clogged drain which then improves the natural outflow drainage of the eye.

Blood Pressure
Please avoid calcium channel blockers which are used to treat high blood pressure:
Amlodipine (Norvasc), Nifedipine (Procardia), Verapamil (Calan), Diltiazem (Cardizem), Felodipine (Plendil), Isradipine (DynaCirc), and Nicardipine (Cardene). Please consult your regular doctor before making any changes. There is a 39% higher odds of developing glaucoma while on this medication.Avoid taking blood pressure medication before bedtime if possible. Blood pressure naturally falls at nighttime and further lowering can decrease the perfusion pressure to your eyes. Please consult your regular doctor before making any changes.

Some evidence has shown that higher levels triglycerides (fats in the blood) was associated with an increased risk of glaucoma. Another study found that people who eat 3 or more fruit servings per day were 79% less likely to have glaucoma compared to those who ate 1 serving. Also individuals who eat more green leafy vegetables have 20-30% lower risk of developing glaucoma. According to a study published in the British Journal of Ophthalmology, people who drank at least one cup of hot tea daily lowered their risk of developing glaucoma by 74% compared to those who did not.

Physical Activity
Moderate to vigorous physical activity has been shown on several research studies to not only reduce eye pressure but also protect the eyes from worsening glaucoma damage. More physical activity people correlated with less glaucoma damage in multiple studies. Even 10 min of moderate to vigorous physical activity per day was associated with 85% less odds of progressive visual field loss. There is an association with severe visual field loss and sedentary lifestyle.

Dietary flavonoids include berries, tea, vegetables, fruits, nuts, dark chocolate, onions and peppers. Flavonoids may play a role in glaucoma by reducing oxidative stress, improve blood flow, and have been shown to slow glaucoma damage. People who have higher intake of flavonoids have a reduced risk of developing glaucoma. In human studies, lower niacin intake is associated with a low-pressure glaucoma, and lower concentrations of niacin have been measured in the blood of glaucoma patients.What else can be done
Unfortunately, we don’t yet know how to restore damage lost from glaucoma, but your ophthalmologist can help prevent further damage by following these principles: regular eye exams, medication compliance, Quit Smoking, and good sleep. For glaucoma early detection and appropriate medical management are crucial in preserving your vision.

There are different types of glaucoma surgery, each with its own approach and purpose. Some common types of glaucoma surgery include:

1. Trabeculectomy: This is a traditional glaucoma surgery that involves creating a new drainage channel for the aqueous humor (fluid inside the eye) to flow out, thus reducing intraocular pressure.

2. Tube Shunt Surgery: Also known as a glaucoma drainage device or implant surgery, this procedure involves placing a small tube with a drainage device in the eye to facilitate fluid drainage and lower intraocular pressure.

3. Cyclophotocoagulation: This procedure uses laser energy to target and reduce the production of aqueous humor, thereby lowering intraocular pressure.

4. Minimally Invasive Glaucoma Surgery (MIGS):These are newer, minimally invasive procedures that aim to improve fluid drainage and lower intraocular pressure using tiny incisions and implantable devices.

5. Selective Laser Trabeculoplasty (SLT): This laser procedure targets specific cells in the drainage angle to enhance fluid drainage without causing significant damage to surrounding tissues.

6. Laser Iridotomy: This procedure creates a small hole in the iris to improve the flow of aqueous humor and reduce intraocular pressure.

7. Canaloplasty: A microcatheter is used to expand the eye’s natural drainage canal, allowing for improved fluid outflow.

The choice of glaucoma surgery depends on factors such as the type and severity of glaucoma, the patient’s overall eye health, and their response to other treatments. Dr Shomer has been performing glaucoma surgeries for over 17 years. The ultimate goal of glaucoma surgery is to preserve vision by effectively managing intraocular pressure and preventing further damage to the optic nerve. An ophthalmologist or glaucoma specialist will recommend the most suitable surgery based on individual circumstances.

Reliable Eye Exams & Ophthalmologic Care

Our Eye MDs (ophthalmologist) focus on long-term eye health and work to improve or maintain your vision. Many problems do not appear until the later stages of life and require thorough care to resolve or manage them. We conduct comprehensive eye exams to monitor and detect the early signs of eye diseases.

Eye MDs of Inland addresses adult optometric and ophthalmologic concerns, including the following:

Open-angle vs. Acute Angle-closure Glaucoma

Call Eye MDs Today

The team at Eye MDs is dedicated to quality, responsive diagnoses and treatments of glaucoma. Call us today to schedule an eye evaluation and catch glaucoma in its early stages to prevent further damage and vision loss.

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