Open-Angle Glaucoma

Glaucoma is called the “sneak-thief of sight” because in its early stage, there are no symptoms. Although glaucoma cannot be cured, it can usually be controlled. Left untreated, damage to the optic nerve can result in loss of vision and could eventually lead to blindness.

The eye receives its nourishment from a clear fluid that circulates inside the eye called aqueous that is produced behind the iris. This fluid flows through the pupil and returns to the bloodstream through a drainage canal called the trabecular meshwork. In the case of open-angle glaucoma, this drainage canal stops working properly and the aqueous fluid exits the eye too slowly. This increase in fluid creates pressure on the delicate optic nerve.

A part of your annual eye exam involves checking for high pressure and taking a magnified look at the optic nerve for any sign of change. To control glaucoma, your doctor will choose from four types of treatment: medicines that lower the intraocular pressure inside the eye, laser surgery (YAG or SLT), minimally invasive glaucoma surgery (MIGS) using specialized devices, or surgical trabeculectomy. The goal of all of these treatments is to lower the pressure in the eye and stop the progression of the disease.

Narrow-Angle Glaucoma

A small percentage of people with glaucoma have a condition known as narrow-angle glaucoma. This type of glaucoma can occur slowly and progressively or very quickly and can only be detected through an eye exam. Narrow-angle glaucoma occurs when increased pressure causes the iris to be pushed forwards, blocking the drainage channel completely. Because fluid cannot exit the eye, pressure in the eye spikes rapidly. This can quickly result in an emergency condition called acute closed-angle glaucoma, which can result in blindness if not immediately diagnosed and treated. Possible symptoms of narrow-angle glaucoma include blurred vision, severe eye pain, headaches, halos, or nausea and vomiting. A very important reason to make sure and see your optometrist or ophthalmologist on a yearly basis is to monitor for these conditions. When caught early, they can be controlled and vision can be preserved.

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Dr. Chapman [Bretz] conducted a very thorough eye exam. She was professional, knowledgeable, and able to explain complex issues in a way that I could understand. She also took the time to answer all of my questions without being rushed. I highly recommend her to anyone suffering from glaucoma related eye issues.

D.P.

Commonly Asked Questions About Glaucoma

How do I know if I have glaucoma?

With rare exceptions, glaucoma has no symptoms. There is no pain or discomfort to the eye, only a gradual loss of vision. This change may occur over weeks, months, or even years before you realize you are losing vision. But take heart, The Eye Institute of Utah utilizes a sophisticated instrument option that can detect glaucoma even before symptoms occur. Annual eye exams are critical in detecting glaucoma and preventing permanent vision loss.

Who gets glaucoma?

Those most at risk for the disease include people over 40 years old, African-Americans aged 35 years and older, people with a family history of glaucoma, diabetics, long-term steroid users and very near-sighted people. Trusetd Source Checkbox Trusted Source American Academy of Ophthalmology. What is Glaucoma? Go to Source 1

What causes glaucoma?

In most cases, glaucoma is caused by elevated pressure inside the eye. Yet pressure is not the only risk factor. There are many patients with normal pressures who still have the disease. That’s why it’s important to visit The Eye Institute of Utah on a regular basis to determine if you are developing glaucoma.

How do doctors detect glaucoma?

Measurement of eye pressure, optic nerve health evaluation and side vision testing all provide valuable information in establishing a diagnosis of glaucoma. The Eye Institute uses an infrared laser to measure the thickness of the retinal nerve fiber layer, which is the tissue directly affected by glaucoma. The screening is comfortable and convenient. A computer maps the nerve fibers and instantly compares them to a database of normal readings. Thin nerve fiber readings indicate the onset of glaucoma and the need for further testing.

How is glaucoma treated?

Your eye doctor may recommend medication for treatment. This is usually in the form of eye drops. Medication won’t cure the disease, but can keep it under control. If medication proves ineffective, you may need surgery. This may involve the use of a laser or an operative procedure to create a more efficient, pressure-controlling, drainage system. The surgical staff at The Eye Institute has successfully performed thousands of these procedures.

Minimally Invasive Glaucoma Surgery (MIGS)

iStent® Trabecular Micro-Bypass

Patients suffering from mild-to-moderate open-angle glaucoma may benefit from iStent®, which is designed to create a permanent opening in your trabecular meshwork, and works continuously to improve the outflow of fluid from your eyes to help control eye pressure. The iStent® implant is meant to slow the progression of glaucoma by improving the eye’s ability to drain excess fluid and reduce the pressure in your eye.

Most people with open-angle glaucoma take one, two or even three types of medications daily to control intraocular pressure. Unfortunately, these drops can be inconvenient and expensive. The iStent® allows many patients to reduce or sometimes eliminate the need for glaucoma medications at the discretion of his or her physician. It is important that patients who receive the iStent® continue to regularly visit his or her eye care professional to monitor the progression of their glaucoma.

iStent inject® Trabecular Micro-Bypass System

At The Eye Institute of Utah, we strive to stay abreast of advancements in ophthalmology in order to bring our patients the most effective treatment options available. We are thrilled to offer the newest generation of the iStent implant to treat glaucoma, the iStent inject® Trabecular Micro-Bypass System. This FDA-approved device is designed to regulate eye pressure by creating a pathway for fluid to drain. The iStent inject® is just as tiny as the original iStent, but has a redesigned shape that allows it to be inserted with a more direct path to the trabecular meshwork. An additional benefit of the iStent inject® is a revised delivery method that enables your surgeon to place two iStent devices at once, without exiting and reentering the eye. Multiple eye stents may produce a lower intraocular pressure. Similar to the original iStent®, the iStent inject is intended for insertion in conjunction with cataract surgery for patients with mild to moderate primary open angle glaucoma.

Hydrus® Microstent

The Hydrus Microstent is an innovative MIGS device that is smaller than a single eyelash. The Hydrus is placed in a part of the eye called the Schlemm’s canal and it works by improving drainage to rescue intraocular pressure. This micro device is designed to be placed during cataract surgery for patients who need treatment for both cataracts and glaucoma. Clinical studies show that the Hydrus eliminated the need for prescription eye drops for Trusetd Source Checkbox Trusted Source Samuelson TW, Chang DF, Marquis R, et al; HORIZON Investigators. A Schlemm canal microstent for intraocular pressure reduction in primary open-angle glaucoma and cataract: The HORIZON Study. Ophthalmology. Go to Source up to 78% of patients .2

Kahook Dual Blade® (KDB) Goniotomy

The KDB is a specialized tool used in MIGS surgery for patients with mild, moderate, or severe open-angle glaucoma. This procedure works to reduce intraocular pressure by altering the trabecular meshwork to increase the outflow of fluid. KDB can be used alone or in conjunction with cataract surgery.

Omni® Surgical System

The Omni surgical system is an exciting new approach to glaucoma treatment. This multi-approach device targets three different areas that can contribute to high intraocular pressure: the trabecular meshwork, Schlemm’s canal and collector channels. The Omni system requires two separate procedures, but requires no implants.

Xen® Gel Stent

The XEN® Gel Stent is a very tiny tube-shaped device that is designed to be placed during a MIGS procedure. The gel stent, which is about the size of an eyelash, is placed under the clear membrane of the eye where it works to optimize fluid drainage. Studies show that the XEN® Gel Stent can significantly reduce intraocular pressure and reduce the need for glaucoma medications. Trusetd Source Checkbox Trusted Source Fea AM, Durr GM, Marolo P, Malinverni L, Economou MA, Ahmed I XEN® Gel Stent: A Comprehensive Review on Its Use as a Treatment Option for Refractory Glaucoma. Go to Source 3

Am I a candidate for MIGS?

If you need a more effective glaucoma management plan or if you are seeking an option to reduce your eye drop use, MIGS could be right for you. Schedule a consultation appointment and one of our world-class ophthalmologists can help you determine if you are a good candidate for a MIGS procedure.

Why choose The Eye Institute of Utah for your glaucoma treatment?

The doctors at The Eye Institute Utah were the first eye surgeons in the state of Utah to perform surgery using the iStent® implant, outside of clinical trials. This treatment option for glaucoma patients is new and only offered by a select handful of eye surgeons across the country. At The Eye Institute of Utah, we focus on offering the latest technology and treatment options for patients, and continue being involved in the research and development of cutting edge eye care technology.

If you are interested in learning more about this groundbreaking technology, call The Eye Institute of Utah today at 801-266-2283 to schedule an appointment and find out if the iStent® is right for you!

The Eye Institute of Utah Doctors have either authored or reviewed and approved this content.

Trused Source Icon - Checkbox Sources

1 American Academy of Ophthalmology. What is Glaucoma? Available: https://www.aao.org/eye-health/diseases/what-is-glaucoma. June 28, 2021

2 Samuelson TW, Chang DF, Marquis R, et al; HORIZON Investigators. A Schlemm canal microstent for intraocular pressure reduction in primary open-angle glaucoma and cataract: The HORIZON Study. Ophthalmology. 2019;126:29-37

3 Fea AM, Durr GM, Marolo P, Malinverni L, Economou MA, Ahmed I. XEN® Gel Stent: A Comprehensive Review on Its Use as a Treatment Option for Refractory Glaucoma. Clin Ophthalmol. 2020;14:1805-1832. Published 2020 Jun 30. doi:10.2147/OPTH.S178348

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The Eye Institute of Utah Doctors have either authored or reviewed and approved this content.

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