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In order to preserve eyesight, it is critical to decrease and control the elevated intraocular pressure (IOP) associated with glaucoma. Depending on your individual situation, there are several treatment options available:
Medication (eye drops) is the most common form of treatment for glaucoma; however, there are side effects, and medication is not effective for all patients – and you have to remember to take your medication every day. There are a number of different types of eye drops, but all are used to either decrease the amount of fluid (aqueous humor) in the eye or to improve the outflow of this fluid in order to stabilize or reduce IOP. Your doctor will decide which medication is best suited to you based on a number of considerations, including: medical history and current medication regimen. Your doctor may also elect to prescribe a combination of eye drops.
ABiC™ (ab interno canaloplasty) is a new minimally invasive glaucoma surgery (MIGS). Unlike other MIGS procedures, which bypass the natural outflow pathway, ABiC™ is unique in that it acts to restore the eye’s natural drainage system. To date, ABiC™ is the only MIGS procedure that successfully addresses all aspects of potential outflow resistance, including the trabecular meshwork (1), Schlemm’s canal (2) and the Collector Channel system (3). By addressing all aspects of outflow resistance ABiC™ is able to deliver an average reduction in eye pressure of 30%.1 It can also reduce your glaucoma medications by 50%.1
First, your doctor will make a small incision in the eye. A microcatheter designed specifically for ABiC™ is then inserted into the eye’s drainage canal. Your doctor will advance the microcatheter 360 degrees around the canal to open up the channel and enlarge it. Once the end of the catheter has circumnavigated to its point of entry, the microcatheter tip is slowly pulled back while sterile, viscoelastic gel is injected into the canal to dilate it to 2-3 times its normal size. The microcatheter is then withdrawn from the eye. It is important to note that there are no permanent implants or devices left in the eye.
ABiC™ can be performed during cataract surgery, or as a stand-alone procedure. Your doctor will be able to determine which option is best for you.
SLT or Selective Laser Trabeculoplasty, is a gentle, low-energy laser therapy, which triggers a natural healing response in the eye in order to reduce the IOP associated with glaucoma. SLT effectively lowers eye pressure in the majority of patients, but the length of time that pressure remains low depends on many factors, including: age of the patient, the type of glaucoma, and other medical conditions that may be present. In many cases medication may still be necessary, but in reduced amounts.
Note: Previously, Argon Laser Trabeculoplasty (ALT) was used to treat glaucoma. ALT uses a high-energy laser to “open” the clogged areas of the trabecular meshwork (the eye’s drainage system), allowing fluid to bypass this drainage system and flow out of the eye. However, unlike SLT, ALT causes permanent coagulative damage to the eye and cannot be repeated.
SLT treatment takes just a few minutes to perform. Prior to treatment, your doctor will administer eye drops in order to prepare the eye and provide mild anesthesia. Then, gentle pulses of SLT laser light are delivered through a specially designed microscope, known as a slit lamp. The entire process takes just a few minutes. Once complete, your doctor may treat your eye with anti-inflammatory eye drops. One to three days after the procedure, your IOP should drop significantly. And of course, your doctor will want to re-check the treated eye during periodic follow-up visits.
Canaloplasty is an advanced treatment for your glaucoma. It uses breakthrough microcatheter technology, similar to angioplasty, to enlarge your eye’s natural drainage system. Importantly, Canaloplasty is less invasive than traditional surgical treatments.
First, your doctor will make a small incision in the eye. The advanced Canaloplasty microcatheter will be inserted into the eye’s drainage system canal. Using the microcatheter, your doctor will circle the canal and enlarge it via visco-dilation, which will help the aqueous fluid drain properly. The microcatheter is then removed and a suture is placed within the canal to keep it open. By restoring your eye’s natural drainage system, the pressure inside your eye is usually lowered. Canaloplasty can also be performed when other surgeries have failed (even those offered for late-stage disease) and with a very good success rate.
Surgery may be attempted to create a new drainage channel, by-passing the natural outflow pathways, if very low IOP is required to prevent glaucoma progression. Such surgery is generally used to treat more aggressive or advanced stage open-angle glaucoma:
Trabeculectomy is normally performed with local anesthetic and on an outpatient basis, but may require an overnight stay in a hospital. During the surgery the ophthalmologist will cut a flap in the white part of the eye (sclera) and remove a piece of trabecular meshwork, creating a new opening through which the eye’s fluid will flow.
Potential side effects include blurred vision, bleeding in the eye, infection and discomfort.
Tube/shunt surgery involves placing a tube through which the aqueous will exit the eye and a valve placed on the eye’s surface to regulate the flow.
Laser surgery may be attempted through the sclera, targeting the ciliary processes, in order to reduce the production of aqueous (trans-scleral cyclocoagulation).