Newest Glaucoma Surgery

As the U.S. population ages we are seeing more and more cases of Glaucoma, damage to the optic nerve usually associated with high pressure inside the eye. In America the treatment strategy usually involves eyedrops and lasers with surgeries reserved for the most advanced cases. This is not the case in the United Kingdom where surgery is most frequently used if a single eyedrop is not effective enough to control the eye pressure. The surgery most often used in both the U.S. and the U.K. is a trabeculectomy, but newer surgeries now available will probably be used instead of the trabeculectomy. Glaucoma is very likely to become a surgical rather than a medical disease.

The company Glaukos very recently had approval granted for a unique and exciting glaucoma implant called the micro-bypass iStent. This tiny instrument is inserted into the eye's natural drainage system called the trabecular meshwork. It functions as an enhanced drain to decrease eye pressure. Usually inserted along with cataract surgery, it can also be used in stand-alone glaucoma surgery.

The studies that were used to prove that the iStent is effective have shown that a single shunt will decrease pressure to the point where pressure is very often controlled with one or no eyedrops! In addition, two or more iSent devices can be implanted at the same time to give a greater decrease in eye pressure. You don't have to use them during cataract surgery; the iStent can be implanted in a stand-alone procedure for Glaucoma only.

Research into new medicines and surgeries for Glaucoma continues. At SkyVision Centers we pledge to remain on the front line in fighting this disease.

Glaucoma 201: Side Vision Loss

Why is Glaucoma such a devastating disease? Well, two reasons. The first, of course, is that it robs you of your vision. The second is that this "thief" steals your vision slowly and painlessly, and you may not even know you have glaucoma until it's too late!

Your peripheral, or side vision is the first part of your vision to be lost in glaucoma. This is one of the reasons it's so hard to know that you have the disease, because your central vision, the vision you read and drive with, is preserved until very late in the disease.

We measure your side vision with a test called a "Visual Field" or Perimetry test. Modern testing is computerized. You place your chin on a chin rest and look into a dim, white bowl. When you see a light come into view you press a button. The readout looks like this: 

   

In the early stages you might only lose a very small portion of your vision.

In very late stages much of your side vision is gone; it can be like looking through a tunnel.

Don't let glaucoma steal your vision!                  

Glaucoma 101

Glaucoma is one of the "silent blindness" disease of older folks all over the world. Most glaucoma has no symptoms at all, no warning that there is a problem. The only way to know that you have glaucoma is to have a complete eye examination performed by an eye doctor. Even then addtional testing might be necessary.

Glaucoma is damage to the optic nerve, the nerve that carries "light" from the eye to the brain. It usually comes with high eye pressure, but not always. There are lots of people who have glaucoma who have eye pressure that seems normal, and there are even more people who have high pressure who will never get glaucoma. The "normal" pressure in the eye is 11-21. Most people who get glaucoma are older, usually older than 60.

There are several ways to measure pressure in the eye. The two most common methods are Non-Contact Tonometry--the air puff-- and Contact Tonometry--the blue light. The "blue light" technique is much more accurate and is necessary to treat glaucoma. The "air puff" is a great screening test for glaucoma because it's easy to do, and easy to have done.

There's lots to talk about with Glaucoma so we'll try to teach you as much as we can here on the Skyvision Blog. All of our Doctors, Dr. White, Dr. Kaye, and Dr. Schlegel have lots of experience in treating people with glaucoma here in Cleveland. Stay tuned!

Eye Doc Education 3.0!

This evening the doctors of SkyVision Centers will be hosting their 3rd educational seminar for local eye doctors. The first two seminars were rousing successes and we expect nothing less tonight. Each session has included two talks by either our very own SkyVision docs or invited guests. The topics covered have included the new Tear Osmolarity technology and Cataract Implants for Astigmatism among others. In addition, the two meetings have included very interesting dinner fare!

Attendees at 1.0 were treated to an Italian feast with accompanying Italian wines, while 2.0 featured artisinal pizza and Brew Kettle beer brewed especially for the meeting!

Tonight the speakers will be Dr. Darrell White and Dr. Scott Schlegel. Dr. White will introduce the concept of "service lines" in the development of protocols to diagnose, treat, and follow specific diseases in "Glaucoma Protocol Development I". Dr. Schlegel will be tackling the subject of introducing a patient with cataracts to the choices they will face when then are trying to decide what type of Intra-Ocular lens to use for their surgery.

What about dinner? Well, tonight we will be serving Mexican! Their will be a fajita bar with all of the fixin's, traditional Mexican cookies, and of course something interesting to wash it all down! We are all looking forward to seeing our friends in the eye care community as we gather to improve our collective understanding of how best to treat our patients.

Family History and Glaucoma Screening

You've seen them at the mall or at a health fair, the Glaucoma screening booths. The dreaded "air puff" to check your eye pressure to see if you might have Glaucoma. There are actually lots of different ways to screen for Glaucoma risk, and this is a very active area of research for eye doctors. What's the best way to screen for Glaucoma?

First, a couple of thoughts on what a screening test should do and not do. When you have a disease that is sneaky, like Glaucoma, and it doesn't have any outward symptoms to let you know it is there, sometimes it makes sense to have some kind of test that will let you know that you DO either have the disease or at a high risk to get it. Glaucoma is like this; there are no symptoms in early Glaucoma, and by the time your vision is affected to a point where you know something is wrong it's too late.

A screening test should be easy to do. It should be relatively inexpensive. It shouldn't hurt! The test should be able to identify pretty much anyone who MIGHT have the disease, and it definitely shouldn't miss anyone who actually HAS the disease (a false negative result). In a perfect world the screening test would not falsely find that healthy people have a the test (a false positive result), but we usually accept less accuracy here because we don't want to miss anyone who is at risk.

So how about Glaucoma screening? Well, high pressure is a risk factor for Glaucoma, so identifying people with high pressure will get them referred to an eye doctor which is what we want. There is something called a "nerve fiber analyzer" which will also do the same thing but with a little higher accuracy. Both of these screenings suffer from the expense of the equipment and the need to have trained people doing the test.

It turns out that for Glaucoma there is a really effective screening test that identifies one of the top two risk factors for developing the disease and losing vision: ask someone if they have a family member who has or had Glaucoma! Research has shown that a family history of Glaucoma, especially vision loss from Glaucoma, is the most important risk factor, and that if you DO have a family history you should have a complete Glaucoma examination at the eye doctor's office. Like Skyvision in Cleveland!

Do you have Glaucoma? Tell all of your relatives to have a complete eye exam.