During Glaucoma Awareness Month in January, the American Academy of Ophthalmology advises the public that the best defense against developing glaucoma-related blindness is by having routine, comprehensive eye exams. Our glaucoma specialists are commonly asked, “Can I go blind from Glaucoma?”. The short answer is yes, but it can be avoided.

Glaucoma can cause blindness, but loss of vision can be prevented. If Glaucoma is diagnosed at an early stage, the damage can be controlled. If you don’t treat it at the right time, it can lead to loss of peripheral vision first and then the central vision, which may result in complete blindness. Sadly, this vision loss can occur over time, without the individual realizing it.

What is Glaucoma?

Glaucoma is a group of vision-threatening eye diseases that can cause damage to the nerve fibers within the optic nerve, that connect to the brain at the back of the eye. This progressive and irreversible damage to the optic nerve sadly makes this one of the leading causes of vision loss. The vision loss maybe temporary or permanent, if not treated properly. The most common form of damage, in Glaucoma, occurs by a change in the eye’s internal fluid pressure, also termed as intraocular pressure (IOP). But it does not stop here; there have been cases where people with Glaucoma have experienced optic nerve damage even when their eye pressure was normal. That is why Glaucoma is often referred to as ‘A group of related conditions,’ because there are a lot of variances and differences in causes and types.

How is Glaucoma detected?

The go-to test for Glaucoma is a simple and painless procedure called Tonometry. It measures the internal pressure of your eye, so the eye doctor can identify any alarming changes. Other common forms of tests used to diagnose Glaucoma include checking your eyesight and the health of the optic nerve, with regular eye exams.

What are some misconceptions about Glaucoma?

Minnesota Eye Consultants Glaucoma Specialist, Dr. Patrick Riedel, says there are three things patients should know about Glaucoma:

1. “Glaucoma is NOT high eye pressure. Glaucoma is a disease of the optic nerve that can lead to blindness.
2. High eye pressure is a risk factor for developing glaucoma, but it is NOT the disease in and of itself.
3. The confusion comes from the fact the only thing proven to slow down or stop the progression of glaucoma is lowering of the eye pressure (which we do with eye drop medications, lasers, and surgeries).”

Can Glaucoma be prevented?

The key to preventing serious vision loss or blindness is early detection. An annual fully dilated eye examination is highly recommended and could uncover this disease before symptoms even occur. Although vision loss can’t be recovered, Minnesota Eye Consultants is fortunate to have plenty of treatment options available to help halt the progression of this disease and avoid further vision damage.

If you have experienced a loss of peripheral vision or are having other difficulties with your vision, schedule a complete eye examination with your primary eye doctor.

Sources: American Academy of Ophthalmology, National Eye Institute

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Glaucoma is a group of vision-threatening eye diseases that can cause damage to the optic nerve, which connects to the brain at the back of the eye. The damage caused by glaucoma is irreversible and unfortunately is one of the leading causes of vision loss. As a sub-specialty practice, our team of eye care providers is devoted to the management of glaucoma and is frequently involved in research studies as we strive to advance the safety and efficacy of the treatment options available to our patients.

The first-generation iStent was approved by the FDA in 2012, and Minnesota Eye Consultants is proud to have had Dr. Thomas W. Samuelson perform the first two iStent procedures in the state of Minnesota. Since then, the iStent has been widely used at Minnesota Eye Consultants as an exceptional option for a portion of our mild-to-moderate open-angle glaucoma patients.

The iStent and iStent inject fall under a newer category of glaucoma procedures, called MIGS (Micro-Invasive Glaucoma Surgery). For many patients, glaucoma can be safely and effectively managed with medications and laser procedures, but for glaucoma that continues to progress, invasive surgical intervention like tubes and trabeculectomies may be recommended. Although effective, these surgical procedures are more aggressive and are often associated with increased risk. The iStent inject and other MIGS devices fall between these two extremes, presenting surgical options that have increased safety with moderate efficacy. Many patients experience reductions in eye pressure and are able to use fewer medications following an iStent inject procedure, while some are able to discontinue medications entirely.

The iStent inject is considered a micro-bypass stent, the smallest known device ever implanted in the human body. Performed at the same time as cataract surgery, this newly approved preloaded system offers precise implantation of the iStent inject into the trabecular meshwork, optimizing the eye’s natural outflow of fluids.

For more information on the iStent inject, you can view the official Press Release here.

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What Is Glaucoma?

Glaucoma is a condition that causes elevated eye pressure, which over time can permanently damage the optic nerve. Damage to the optic nerve causes permanent vision loss. Left untreated, glaucoma can cause total blindness.

Glaucoma is often called the “silent thief of sight.” This is because vision loss often occurs with no signs or symptoms. There is no way to detect glaucoma on your own, so many people do not realize they have it until they start noticing changes in their vision. At that point, any vision loss is permanent.

So, how can you prevent glaucoma-related vision loss if there are no symptoms?

Comprehensive Eye Examinations

This may sound obvious to some, but the only real way to be proactive about vision loss is to attend regular comprehensive eye examinations. During all eye exams, doctors will test for elevated pressure in the eye. While elevated intraocular pressure (IOP) doesn’t always mean you have glaucoma, it is a major risk factor. If you test for high IOP, your eye doctor will devise a plan to prevent glaucoma-related vision loss.

People who are at high risk for glaucoma should attend these eye examinations once a year. People with low risk should be tested every two to three years. Risk factors for glaucoma include:

• High IOP
• Being of Hispanic or African descent
• Being over the age of 60
• Having a family history of the condition
• Having eye conditions like nearsightedness
• Having medical conditions like diabetes, heart disease, and hypertension
• Having an eye injury or previous eye surgery

Acute Closed-Angle Glaucoma

Typically when we’re talking about glaucoma, we’re referring to the most common type: open angle glaucoma. There are many different types of glaucoma, however. Another type that is important to watch out for is called acute closed-angle glaucoma.

With open-angle glaucoma, the pressure in the eye builds up slowly as a result of a slight fluid blockage. The fluid is not able to drain fast enough, resulting in slowly worsening IOP. Acute closed-angle glaucoma is much different than open-angle glaucoma.

Closed-angle glaucoma is caused by a sudden, complete blockage of the drainage system in the eye. This means fluid builds up rapidly, causing sudden symptoms. These symptoms include headache, eye pain, dizziness, nausea, and vomiting. If you experience these symptoms, contact emergency services.

Glaucoma Treatments

If you are diagnosed with glaucoma, you have options. Hopefully, your glaucoma was diagnosed before any vision loss occurred. If not, your doctor will be there to help prevent further vision loss, as well as offer coping advice for living with low vision or blind spots.

Preventing further vision loss may require a combination of treatments. Medications and surgery can be used together or separately to control glaucoma.

If you have been diagnosed with glaucoma and would like to schedule an appointment, contact Minnesota Eye Consultants in Minneapolis. Our Minneapolis glaucoma experts are able to quickly diagnose you and get you on the path to treatment. Our glaucoma doctors value prevention and can guide you on how best to avoid vision loss. Contact us today!

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Maintaining healthy vision and overall general health is obviously the main goal. Did you know there are a slew of health issues that can be detected during an eye exam? For instance, glancing at the back of the eye may uncover some indications of Diabetes, Hypertension and Autoimmune disorders. Examining the outside of the eye may suggest High Cholesterol if there’s a yellowish tint or a yellow ring around the cornea, and bulging eyes may indicate Thyroid Disease.

Cataracts, glaucoma and oculofacial concerns are all common findings within a routine eye exam as well.

Cataracts are the clouding of the eye’s natural lens and can be treated by removing the old lens and replacing it with a new, intraocular lens implant.

Glaucoma is a group of eye diseases that damages the optic nerve due to increased fluid and pressure within the eye. Lost vision from glaucoma cannot be restored, so early detection is crucial in preserving vision and undergoing treatments to try and halt or slow the progression.

Many patients are seen for droopy eyelids obstructing their vision, and are shocked to find out that insurance may cover the surgery to treat this.

Seeing your eye doctor regularly not only promotes healthy vision by addressing any immediate vision concerns you’re having, but also detecting any quiet, potential underlying issues.

A few of our surgeons will be featured on WCCO encouraging routine eye exams. Check out their clips!

Dr. Richard L. Lindstrom – Cataracts 

Dr. Thomas W. Samuelson – Glaucoma

Dr. Jill S. Melicher – Oculofacial Treatments

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Listen as Dr. Thomas Samuelson explains the various glaucoma procedures offered at MN Eye, including newer options such as the iStent, CyPass, XEN and MicroPulse. These procedures are intended for patients with moderate glaucoma who have exhausted medications as a treatment option but aren’t in need of the more intrusive, riskier procedures.

We are proud to say we played a part in some of the FDA trials for these treatment options. MN Eye Consultants performed the first two iStent surgeries in the state of Minnesota, and Dr. Samuelson recently completed the first XEN procedure in Minnesota since the FDA approval passed.

Video Links

Cypass | Dr. Thomas W. Samuelson
iStent | Dr. Thomas W. Samuelson
XEN | Dr. Thomas W. Samuelson
MicroPulse | Dr. Thomas W. Samuelson

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CyPass Micro-Stent

This micro-invasive surgical device is used for patients suffering from mild to moderate open-angle glaucoma. Intraocular pressure is reduced when the tiny stent creates a channel for liquids to exit from the inner chamber of the eye. The CyPass Micro-Stent is done in conjunction with Cataract Surgery, so patients must also have the need for cataract removal in order to qualify. Recently approved by the FDA, many insurance companies are still considering this procedure “investigational”, however we are doing our best to obtain Prior Authorizations and acquire reimbursement for patients undergoing this procedure. (Pictured above is the CyPass Micro-Stent in comparison to a dime.)

GATT (Gonioscopy-Assisted Transluminal Trabeculotomy)

GATT is a modified Trabeculectomy – a glaucoma procedure commonly performed at MN Eye Consultants. A Trabeculectomy creates a new drainage system from the eye’s natural tissue for the aqueous humor to exit (the transparent fluid within the eye that can cause high pressures), while the GATT procedure aims at enhancing the patient’s own natural drainage system. Through a small incision, a tiny catheter is placed and rotated around the Schlemm’s canal 360 degrees. This minimally invasive surgery treats patients with open angle glaucoma and is performed within our Ambulatory Surgery Centers.

Kahook Dual Blade (KDB)

The Kahook Dual Blade (KDB) is an ophthalmic blade that makes parallel incisions in the trabecular meshwork and inner wall of the Canal of Schlemm. Incisions created with this device precisely remove tissue from the meshwork and as a result, help reduce intraocular pressure behind the eye. On the day of the procedure, the surgeon will determine whether or not this innovative surgical tool will be beneficial during the surgery. Currently this device is available at our Ambulatory Surgery Centers.

Speak with your glaucoma surgeon to see if you qualify for any of these advanced procedures.

Sources: medgadget.com, glaucomaassociates.com, www.eyeworld.org, www.kdbcert.com

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Glaucoma Infographic

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Glaucoma Infographic

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• Ocular Surgery News U.S. Edition, July 25, 2012
  Richard L. Lindstrom, MD

On the positive side, in both cases the physician has multiple medication options with different and synergistic mechanisms of action. On the negative side, patient compliance with the recommended regimen is universally poor, as no immediate positive quality-of-life impact is noted when the medication is taken, nor is any immediate negative impact on quality of life experienced when doses are skipped. Thus, there is only the somewhat nebulous long-term fear of chronic damage to sensitive structures, including the heart and kidneys, and the increased risk of stroke to motivate the patient with hypertension and the fear of chronic optic nerve damage or a retinal vascular occlusion in glaucoma to motivate good compliance.

Study after study confirms that these motivations are inadequate to ensure good compliance in these patients. The ophthalmologist is more fortunate than primary care colleagues because highly effective laser and incisional surgical treatments are available as alternatives, and with the recent U.S. Food and Drug Administration approval of the Glaukos iStent, we have a new and safe option that can reduce IOP and medication burden.

As we add effective and safe surgical treatment options over the next decade, I expect glaucoma to be more frequently managed by surgery in the future, but medical therapy remains the core treatment option today. Just as in hypertension, in which lowering blood pressure is the primary method of treatment, lowering IOP is the mainstay of glaucoma therapy. The primary care physician would love to have a safe and effective medication that makes the blood vessels, heart, kidneys and brain less sensitive to the long-term damage of untreated hypertension, but to date no such medication exists.

The same is true in glaucoma, in which neuroprotection has been a graveyard for many promising pharmaceutical agents. Some patients and physicians turn to over-the-counter nutritional supplements such as ginkgo biloba, but good data supporting its use are lacking, and chronic use of this herbal remedy is not without risk. I am not optimistic that we will see the market release of a truly effective neuroprotective agent in the foreseeable future.

Thus, other than continuing to treat more glaucoma patients with laser and incisional surgery, which in my opinion is a trend that is firmly in place and quite defensible, we are faced with the challenge of enhancing patient compliance. On the positive side, we have topical medications that are quite safe and effective. On the negative side, no amount of encouraging, cajoling or threatening seems capable of getting many, if not most, patients to take them. We do know that once-daily or at most twice-a-day medications have a higher compliance rate than those that require more frequent administration, and fortunately we have drugs such as prostaglandin analogues and beta blockers that require only once-a-day dosing. As we add second and third medications, compliance goes down, and combination drops can be helpful in this regard.

I personally would like to see more combination drops available, and even though not more effective than each drop taken individually, the enhanced ease of use, potential reduced cost with fewer co-pays and compliance make them attractive to many patients and physicians. In many cases, such as postsurgical management of infection and inflammation, significant differences in dosing regimen and duration of treatment make a combination product less logical. In glaucoma, two once-a-day medications given as a single dose can be expected to enhance compliance significantly.

There is new research that suggests that daily reminders to take a medication can enhance compliance significantly, and I find the concept of increased use with such reminders quite promising. Now that my iPhone and I can have a constructive conversation, I look forward to the day when it can routinely remind me and my patients to complete tasks such as taking medications in a timely fashion. I recently heard of an application called iDrops that is designed to do exactly that.

Finally, tremendous amounts of financial and human capital are being invested in developing drug delivery devices that will make our concerns with patient compliance a historical footnote. Sustained drug delivery devices include implants; injectables into the anterior chamber, vitreous, suprachoroidal, subconjunctival and sub-Tenon’s space; refillable reservoirs; contact lenses; implants in the conjunctival fornices; and punctal plugs, to mention only a few. These devices hold the promise of enhancing compliance, but increased cost will be an issue. In addition, if we are seeing our patients once every 6 months, we need a high level of confidence that the sustained-release device will remain in place and continue to operate reliably throughout the treatment period.

While topical drops taken reliably work well, as will many of the sustained-release devices in development, I must admit that I am most excited about the new generation of minimally invasive glaucoma surgery devices and look forward to resolving the compliance issue by making more of my patients independent of medication by operating on them. I admit that I have a surgical bias in the treatment of disease, but if I could undergo a procedure as low risk as selective laser trabeculoplasty or iStent implantation to cure my hypertension, I would be scheduling surgery next week. Successful surgery has much to offer patients, physicians and society, including enhanced quality of life without the hassle of medication refills and management, elimination of compliance issues, and potentially reduced cost. As safer and more effective glaucoma procedures evolve, transitioning to a surgery-first approach for glaucoma is extremely attractive.

http://www.healio.com/ophthalmology/glaucoma/news/print/ocular-surgery-news/%7B2BAFE8D9-FCE0-477B-A55A-6D884C582DCF%7D/Glaucoma-may-transition-to-surgery-first-management

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