Quality Eye Care
About Glaucoma
Quality Eye Care provides the latest in glaucoma management, both in diagnostics and treatment. We have at our disposal the Spectralis® OCT imaging device, by Heidelberg, with advanced spectral domain scanning. This machine measures the dimensions of the nerve and also assesses the retinal nerve fiber layer, all of which are damaged in glaucoma. By accurately measuring and following changes over time, Dr. Yu can determine if glaucoma is present, and if present, if it is stable or getting worse. We use the Octopus® Visual Field Analyzer with the latest in software upgrades, one of the fastest visual machines on the market. We use a digital fundus camera, the Zeiss® Visucam Pro NM, with which Dr. Yu can document the appearance of the optic nerve head, so it can be followed objectively, over time, with serial photos viewed in 3-D stereo vision. Despite the availability of newer imaging technology (such as OCT), optic nerve head photos are still considered the gold standard in following changes over time. The Visucam can obtain pictures without your eyes being dilated.
We use both ultrasound and optical pachymeters which are used to measure corneal thickness, an important measurement that has predictive value in glaucoma. Corneal thickness measurement is now standard of care in the field of glaucoma.
Treatment Methods
Selective laser trabeculoplasty or SLT is available for the laser treatment of glaucoma. Typically, SLT is used for patients who don’t respond adequately to one glaucoma eye drop, but it is also an option as first-line, initial treatment of open angle glaucoma. The success rate is good, and the result can last 2-3 years. Dr. Yu offers the endocyclophotocoagulation (ECP) procedure, the iStent®, and other MIGS (minimally invasive glaucoma surgery) procedures; these are typically combined with simultaneous cataract surgery.
The above procedures treat glaucoma by either decreasing the amount of fluid naturally produced inside the eye, or improving the drainage of this fluid from the eye, thus lowering the pressure inside the eye.
Minimally Invasive Glaucoma Surgery (MIGS)
The term Minimally Invasive Glaucoma Surgery refers to glaucoma surgery which is less invasive than the gold standard, end-all procedure, trabeculectomy. The full blown trabeculectomy procedure has typically been used for glaucoma that cannot be adequately treated by eye drops or laser (especially in more advanced glaucoma), but generally is a procedure of last resort because it involves more risk.
Many patients can be treated with less risky procedures and this is where MIGS comes into play. MIGS procedures can help to safely lower the eye pressure in patients inadequately controlled by glaucoma eye drops or laser treatment. In most cases, the MIGS procedures are combined with cataract surgery.
The idea is to add on to cataract surgery, without adding significantly more risk than that associated with the cataract surgery alone. Generally, the pressure can decrease by as much 20-30%. Sometimes, MIGS can allow the doctor to decrease the number of glaucoma drops a patient is using. MIGS surgery include but is not limited to endocyclophotocoagulation (ECP), iStent®, TrabEx, and Hydrus.
Endoscopic Cyclophotocoagulation or ECP
Endoscopic Cyclophotocoagulation or ECP combines a laser with an endoscope that allows the surgeon to see inside the eye. The laser is used to treat the ciliary processes with heat. The ciliary processes are structures found behind the iris, the colored part of the eye. These processes produce a fluid called aqueous humor. This fluid is also being drained from the eye, so that there is a constant turnover of fluid inside the eye. If the fluid does not drain properly from the eye, the fluid can build up, causing the pressure to increase and result in glaucoma. There are a variety of eye drops that can increase the drainage or decrease production of the fluid, but in some cases they are not effective enough to control the pressure and may also have side effects. ECP is designed to reduce production of fluid by the ciliary processes and, as a result, lower intraocular eye pressure. ECP may lower the intraocular pressure enough to reduce the number of glaucoma drops a patient is using. ECP is combined with a cataract operation; therefore, a candidate for ECP must have a visually significant cataract in addition to glaucoma.
iSent®
Recently there have been further technologic advances for better control of the intraocular pressure. The iStent® trabecular micro-bypass stent is a surgical therapy for patients who have mild to moderate open angle glaucoma. It is designed to improve the drainage of fluid inside the eye, to better lower the eye pressure and possibly reduce the need for glaucoma medications. The iStent® is the smallest medical device approved by the FDA to date, 20,000 times smaller than the intraocular lens implant used to replace a cataract. It is placed in your eye into the area where the fluid normally drains out of the eye. The iStent® is not outwardly visible. The iStent® is approved for use with simultaneous cataract surgery. If you have glaucoma and vision problems that might be related to a cataract, make an appointment for an eye exam, to see if you are a candidate for cataract surgery with iStent® placement.
TrabEx™
The TrabEx™ device is a single-use device which is used to excise or remove a strip of trabecular meshwork (TM), opening up the canal or drainage passage through which fluid in the eye drains out. Poor drainage of aqueous humor, the fluid inside the eye, causes build-up of fluid inside the eye, causing the pressure to increase. Allowing easier drainage of fluid helps to lower the pressure inside the eye. This procedure can be done alone or in combination with cataract surgery.
Hydrus®
The Hydrus® microstent is a curved stent that is passed into the canal through which fluid, the aqueous humor, drains out of the eye. This stent allows the fluid to bypass what is thought to be a blockage in access to the canal; it also expands the canal. This stent is used in combination with cataract surgery. It is made of the same material used in cardiac stents, and should be used with caution in patients with nickel allergy.