Monday, Feb. 16, 2015

GLAUCOMA

Treatment options vary depending on types

The way in which the world is seen, through vision and eyesight, should be a top priority in maintaining a healthy body. A common, but potentially troublesome disease that affects eye health is glaucoma.

“Glaucoma is a disease of the optic nerve, the eye that connects the eye to the brain,” Dr. Brian Planchard of the Planchard Eye and Laser Center said. “It is usually characterized by having high eye pressure, though this is not always the case. The eye has a natural pressure that it maintains to keep its shape and function. If the pressure stays too high for a long time in some patients, damage to the optic nerve can occur.”

The dangers of glaucoma are most significant if the problem goes undetected or untreated once damage has taken course.

“In early glaucoma, there are often no changes to the eyesight,” Planchard said. “Over time, the peripheral, or side vision can be lost, and in the late stages of glaucoma, the central vision can be lost as well. Unfortunately, the visual changes, once identified, can only be prevented from getting worse they cannot be reversed.”

Planchard said there are two primary types of glaucoma: closed angle and open angle. Closed angle symptoms can include high pressure, sudden pain and loss of vision – it is often treated on an emergency basis. Planchard said open angle is the more frequent type of glaucoma that is treated in the United States. Early stages don’t typically present with symptoms, which stresses the need for careful screening.

“There are many signs of the disease in both open and closed angle glaucoma that an ophthalmologist can detect,” Planchard said. “These include: high eye pressure, characteristic appearance of the optic nerve, and loss of peripheral vision on formal testing.”

Unfortunately, open angle glaucoma, the most common type, is not preventable, Planchard said.

“[Open angle glaucoma] is caused either by an overproduction of fluid inside the eye that leads to higher pressure or a failure of drainage from the eye,” he said.

“Closed angle glaucoma, which can present with sudden pain and loss of vision can be prevented with an in-office laser procedure that creates a safety valve in the pigmented part of the eye, the iris.”

Because the effects of glaucoma can cause significant discomfort and impairment to one’s vision, it’s important to be aware of the options available for treatment.

“Treatment options for glaucoma depend on the type,” Planchard said. “For the most common type, open angle glaucoma, there are three categories: medications, laser, and eye surgery. The goal of all of these treatments is to reduce the pressure inside the eye.”

Planchard said medications include eye drops, sometimes more than one, that reduce the pressure inside the eye.

“There is also a laser treatment that can enhance or take the place of one of the drops, called a selective laser trabeculoplasty, or SLT,” he said. “The laser is usually not painful, has little side effects and can be used first instead of taking medications initially. If these treatments are not successful, then the ophthalmologist may need to perform eye surgery to lower the eye pressure.

“Sometimes removing a patient’s cataract, if present, is enough to help the eye pressure,” Planchard said. “Other surgeries for glaucoma involve creating a permanent filtering system that drains fluid from the front part of the eye, either with an implanted device or not, that can help dramatically lower the pressure.”

Living with glaucoma can come with certain changes in order to maintain healthy vision or preserve what may be left, and some changes may require more effort than others.

“The biggest lifestyle adjustment that most patients have to make is learning to take the drops and to carefully follow up with their ophthalmologist as scheduled,” Planchard said. “This can often be challenging, especially for elderly patients.

For patients with advanced vision loss from glaucoma, there can be significant lifestyle changes. Patients can become blind from glaucoma or have significant visual loss that can prevent them from driving or performing their normal activities of daily living. This is why treating glaucoma before vision loss occurs is so important.”

While there may be many choices in where to receive treatment for glaucoma, Planchard said that he and his father, who is also a board-certified ophthalmologist, use their combined decades of experience to provide thorough and careful screening, and treatment of patients. Their office offers the SLT laser treatment, as well as many other treatment options for a variety of needs.

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