Eye Surgery Information for Glaucoma Los Angeles

Eye Zone Medical Lasik Center offers testing for Glaucoma at our state of the art facility in Monterey Park. We offer Glaucoma testing and complete comprehensive eye exams for Los Angeles, Orange County, Pasadena and the Inland Empire. Glaucoma is a term that actually represents many different diseases, all with a common end product: nerve damage that results in loss of vision, and even blindness. It is the 2nd biggest worldwide cause of blindness. It’s a very scary word to our patients, but fortunately, today, we do have some good treatments that can slow down or even prevent further vision loss. Usually, patients will not have any symptoms, so they don’t even know they have glaucoma. It is estimated that 4 million Americans may have glaucoma, but only half will actually know it. It is important to understand that vision loss due to nerve damage is permanent, that is not reversible, so it is critical to detect and treat early to prevent blindness – which means you need an eye exam even if you don’t have symptoms.

Glaucoma can be divided into 2 major categories: open angle and closed angle. The “angle” is important because the fluid inside the eye (aqueous) needs to flow out of the eye through the trabecular meshwork found in the angle. The angle is found at the junction between the clear window of the eye, the cornea, and the iris, or the colored muscle inside the eye.

Closed angles cause the fluid to not flow out of the eye. In sudden cases of angle closure, the eye pressure can build up very quickly, and reach levels greater than 50 or 60 millimeters of mercury (mmHg). This will cause sudden pain, nausea, headache, blurred vision, and glare. If this sudden angle closure is not treated quickly within 1-2 days, vision loss and blindness will be permanent. Treatment for angle closure include laser or surgical iridotomy, and sometimes, more involved glaucoma filtering surgery is needed.

Luckily, closed angle type is less common than the open angle type. In open angle glaucoma, it is not clear why the fluid can’t flow out despite access to the trabecular meshwork, but there are several theories. Because the flow is slowed down, there is only a slow build up of pressure, and eye pressures generally are not as high as seen in the closed angle types. There is little pain, and vision changes are slow, so it’s often not even noticed. That’s why they call glaucoma the “silent killer” of vision! But, if detected early, treatments to lower the pressure and slow the damage done by glaucoma can be started. Treatments include eye drops, laser treatments, and sometimes, but less commonly, surgery. Surgery includes filtering surgeries, or the newer canaloplasties. The goal of any treatment, medical or surgical, is to lower the eye pressure about 30%. The actual pressure needed, or “target pressure” is dependent on the individual, and is determined following careful evaluation of the status of the glaucoma.

The key to limiting vision loss due to glaucoma is early detection and early treatment. As noted previously, little or no symptoms are generally noted. So, patients need to be screened for risk factors that will increase the likelihood of glaucoma. Major risk factors include high eye pressure, optic nerve (or disc) changes, disc asymmetry, visual field loss, diabetes, previous eye injury, certain medications, increasing age (over 40), and family history of glaucoma. Certain ethnic groups are also more prone to various types of glaucoma. . It is important to note that although high eye pressure is often a big risk factor, it is not a key factor. That is, glaucoma and disc damage can also develop even if the pressure is “normal”, that is, within the normal range of 10-21 mmHg. Screening exams by ophthalmologists are important to stratify the risk factors using the Glaucoma Risk Calculator, and will go beyond just measuring the eye pressure.

Steps toward early detection include a careful eye exam. If the exam identifies clinical risk factors, then several tests can be done to further assess the risk including visual field, optic disc scanning, gonioscopy (to see the angle), and pachymetry (corneal thickness). At Eye Zone Medical, we have the latest technology to assess the multiple of risk factors for glaucoma.

It is important to understand that treatment is aimed at modifying one risk factor for glaucoma, high eye pressure. It is not a cure, so treatment needs to be continued lifelong. While on treatment, regular monitoring is need to make sure the eye pressure is controlled.

There is another way to categorize glaucoma. Primary types are glaucomas from unknown causes. Secondary types are glaucomas due to a known cause. Treatment is aimed at controlling eye pressure, but more importantly, treating the underlying cause.

A common type of secondary open angle glaucoma is one induced by medications including steroids. Steroid induced glaucoma requires stopping the steroids and lowering eye pressure.

A very important type of secondary closed angle glaucoma is one due to advanced diabetes called neovascular glaucoma. This is a very difficult condition to treat and severe vision loss is very common, both due to the glaucoma and the diabetes. Treatment is aimed at controlling the diabetes, which includes laser treatment of the retina, surgery, and intraocular medications.

Because vision loss due to glaucoma is permanent, at Eye Zone Medical, we routine screen all our patients for glaucoma, and have advanced diagnostic technology available to further evaluate an individual’s risk.