Glaucoma is known as the "silent thief" of sight because it steals your vision often without warning signs or symptoms. In fact, nearly 2.5 million people have glaucoma, and more than half don't even realize it.
Glaucoma is a disease that damages the optic nerve. Like a cable wire, the optic nerve is responsible for carrying the images we see to the brain. Damage to the optic nerve can occur when pressure within the eye increases, usually due to a build-up of fluid inside the eye. This leads to the development of blind spots in our field of vision. Without routine eye exams to check the health of your eyes, these blind spots can go undetected until the optic nerve is significantly damaged and a great loss of peripheral vision has already occurred.
Types of Glaucoma - Not every type of glaucoma is the same or will have the same impact on your life. If you have been diagnosed with glaucoma, please familiarize yourself with the different types of glaucoma below.
Open-angle glaucoma - This is the most common type of glaucoma. The drainage angle (where the fluids in the eye drain) is open but working less efficiently. This inability to drain causes pressure within the eye to rise, which results in a gradual loss of side-vision. This can be likened to an air filter, which gathers dust over time and eventually becomes too laden with dust to work properly.
Angle-closure glaucoma - Angle-closure glaucoma occurs when the drainage angle is completely blocked, often by the iris. This prevents any fluid to drain from the eye, causing pressure within the eye to suddenly rise. This extreme rise in pressure results in blurred vision, headaches, severe eye pain and the appearance of halos around lights.
Chronic angle-closure glaucoma - With this type of glaucoma, the condition is painless and involves a more gradual closing of the drainage angle. Chronic angle-closure glaucoma occurs most frequently in people of Asian descent.
Secondary glaucoma - Secondary glaucoma progresses very much like chronic open-angle glaucoma, occurring when scar tissue or pigment blocks the drainage angle. The first symptom is a loss of side-vision. Pseudoexfoliation glaucoma and pigment dispersion glaucoma are examples of secondary glaucoma.
Congenital glaucoma - Congenital glaucoma is a rare birth defect affecting the drainage angle. To prevent blindness, this condition must be treated shortly after birth. Symptoms include enlarged eyes, a cloudy cornea, light sensitivity and excessive tearing.
Led by Dr. John Berdahl, Dr. Michael Greenwood, and Dr. Russell Swan, our board-certified or board-eligible ophthalmologist surgeons are working to halt the progression of glaucoma through cutting edge research, treatment and surgical options at our state-of-the-art facilities at Vance Thompson Vision.
"If you are considering cataract surgery, Dr. Swan and the staff at Vance Thompson Vision in Bozeman are the team you want in your corner. They are both knowledgeable and professional while still remaining personable, kind and compassionate. The office is equipped with the latest in advanced technology making the process easier and safer than ever. I felt taken care of from the moment I walked in the door. The staff, Briana in particular, and Dr. Swan, went over every aspect of the surgery with me. They answered all my questions, and spent a substantial amount of time examining me and reviewing the available options for my specific situation. I wholeheartedly recommend Dr. Swan an Vance Thompson Vision in Bozeman."- J.D. / Google / Sep 02, 2018
"My husband was referred by his eye doctor in Helena and we were pleased to get an appointment within a few days. The appointment was a pleasant experience, with friendly, knowledgeable staff. Kacie did the preliminary tests and was very good to my husband and very professional on her knowledge. Dr Swan has a very easy manner and was very thorough and really informative. He spent plenty of time explaining and was clear about the benefits and drawbacks to my husbands procedure. The whole appointment was very relaxed and informative. We'll post how the procedure went soon!"- G.J. / Yelp / Aug 06, 2018
"Very friendly and accommodating staff. I have a corneal disease and they really know their stuff!"- C.S. / Facebook / Jul 31, 2018
"Our son had a difficult case of Keratoconus that had not been diagnosed for 35 years. When it was diagnosed we took him to Dr. Swan and he found that cross linking was a good option. They were very caring and professional throughout the process. They explained things well and answered all questions that were asked. Upon completion of the cross linking they referred him to get scleral lenses at Advanced Eye Care. He started out with about 20/200 vision and after cross linking and the scleral lenses he how has 20/25 vision. That is a miracle. Dr Swan is the real thing and we cannot say enough about the fantastic, professional and life changing service that they provide at Vance Thompson Vision."- O. / Google / Jul 24, 2018
"The care I received in beyond compare. The doctor and all of the staff actually do their best to make sure the patient is fully knowledgeable about options. The information provide before and after surgeries made me comfortable and positive about the results. That attitude alone helped me heal quickly and with confidence. I don't say that lightly. Can't imagine a more professional doctor and staff!!!"- K.W. / Google / Jul 18, 2018
WHO IS AT RISK FOR GLAUCOMA?
Since glaucoma can affect any adult regardless of gender or race, it is important to receive regular, comprehensive eye examinations as directed by your eye care provider. There are certain factors that can increase your risk, such as:
- Being 45 years or older
- Having increased eye pressure
- Having a family history of glaucoma
- If you are severely nearsighted
- Being of African-American, Hispanic, or Asian descent
- Having a history of eye injuries causing bleeding in the eye
Although patients can be nervous about a new diagnosis of glaucoma, it is important to keep a positive attitude. Glaucoma does not have to limit your lifestyle, and for the most part, you should be able to continue with your regular habits and activities.
Glaucoma needs to be taken seriously now more than ever. Although glaucoma is the second leading cause of blindness in the U.S. and can be extremely problematic to your vision, most people with glaucoma lead a normal life.
If you've been diagnosed with glaucoma, your eye doctor will make a suggested treatment protocol based on taking medication, laser treatment or surgery.
At Vance Thompson Vision, we are proud to perform the state-of-the-art MIGS (minimally invasive glaucoma surgery), which continues to change the lives of our patients.
Additional treatment options for glaucoma include:
Glaucoma can be treated with daily eye drops that decrease eye pressure either by slowing the amount of fluid produced within the eye or by improving the flow through the drainage angle. Glaucoma medications may have side effects, so be sure to talk to your doctor if you experience any unusual symptoms.
Selective Laser Trabeculoplasty (SLT) is a good in-office treatment option for glaucoma that is completely painless. By engaging in this laser technology, ophthalmologists can lower pressure and possibly help a patient avoid a more invasive surgery. The surgery may even reduce dependence on medications or drops.
In a standard operating room procedure, your doctor can also use fine, microsurgical instruments to create a new drainage channel for outflow of aqueous fluid. Though serious complications of modern glaucoma surgery are uncommon, they can occur. Surgery is recommended if your ophthalmologist feels that it is necessary to prevent further damage to the optic nerve. Before considering surgery, it is important you visit a qualified surgeon who can educate you about all of your surgical options. Vance Thompson Vision’s glaucoma surgeons, led by Dr. John Berdahl, specialize in glaucoma treatment, which reduces the need for eye drops. This ensures that you will know all of your options prior to surgery and can choose best option for your vision and lifestyle.
Trabeculectomy & Tube Shunts
Trabeculectomy and tube shunt procedures are performed by an ophthalmologist, and can lower the pressure in your eye to help prevent further damage to the optic nerve. However, any damage that has already been done is irreversible.
During a trabeculectomy or tube shunt, your surgeon creates a passageway that drains fluid from the inside of your eye to behind it. These surgeries are more commonly used after medications have not worked as planned, if laser surgery has not been effective, or if other methods of treatment such as the Glaukos iStent are simply not stopping the increase in intraocular pressure.
Although patients can be nervous about a new diagnosis of glaucoma, it is important to keep a positive attitude. Glaucoma does not have to limit your lifestyle, and for the most part, you should be able to continue with your regular habits and activities. Take comfort in knowing that many individuals, including our doctors, are stepping up to help glaucoma research initiatives. The eye care community, including the Glaucoma Research Foundation, surges forward in an effort to find better methods to treat glaucoma. Someday there may even be a cure for this disease.
Minimally Invasive Glaucoma Surgery (MIGS) is a tremendous recent advance in glaucoma care. Prior to MIGS, treatment options were limited to medications, laser, and major glaucoma surgeries. Using devices like the Glaukos iStent, MIGS provides a less invasive and very safe surgical approach to glaucoma surgery. MIGS is usually, but not always, performed at the same time as cataract surgery in patients with mild to moderate glaucoma. The iStent is the smallest medical device ever implanted into humans, and is used to decrease eye pressure by internally bypassing the high resistance portion of the eye’s drainage system. The iStent was approved by the FDA in the summer of 2012, and is the most thoroughly studied glaucoma device on the market today. Other MIGS include:
- KDB: The Kahook Dual Blade (KDB) is an elegant, single-use, ophthalmic blade designed to excise a clean strip of trabecular meshwork. It can be a standalone procedure or performed in combination with cataract surgery in patients with mild to moderate glaucoma.
- ABiC: Ab Interno Canaloplasty (ABiC) is a procedure designed to improve the natural drainage in the eye. In the ABiC procedure, the surgeon inserts a microcatheter into the eye through a tiny incision and then rotates the tool to open up the entry point. The surgeon then inserts gel into the canal, which enlarges the drainage area. Through this surgery, the doctor increases and restores the eye’s natural outflow passage. By improving the drainage pathway, fluid can drain more normally and allow the eye pressure to lower.
- ECP: Endoscopic cyclophotocoagulation (ECP) is a procedure used to treat glaucoma that applies laser energy to the ciliary body epithelium in an effort to lower eye pressure. ECP’s initial studies have shown it to be more promising than its predecessors. Its advantages consist of precise tissue treatment, short surgical times, rapid postoperative recovery, and reduced complications.
- CyPass: The CyPass Micro-Stent is a small device used to improve the natural fluid drainage of the eye and, in turn, lower eye pressure. It is designed to aid in the treatment of patients with open-angle glaucoma. Less invasive than traditional surgery for glaucoma, the device is intended to stabilize intraocular pressure (IOP), and it can be inserted during cataract surgery. The device may decrease a patient’s need for glaucoma medications.
- XEN Gel Stent: The XEN Gel Stent is a soft, gelatinous device inserted into the eye to decrease the eye’s intraocular pressure (IOP). The stent is designed to treat glaucoma with a less invasive procedure with fewer complications than traditional glaucoma treatments. The stent is about as wide as a human hair, and it is 6mm long. The device is inserted through a small, corneal incision intended to seal itself.
- iStent: The iStent Trabecular Micro-Bypass Stent is the smallest FDA approved implantable device, measuring only 1mm by .3mm. The iStent is a tiny device placed in the eye to improve fluid drainage. It creates a pathway through the eye, which helps fluid drain naturally from the eye (in turn, lowering intraocular pressure). The iStent is generally implanted during cataract surgery.
- Visco360: When the aqueous fluid is low in the Schlemm's canal, the Visco360 cannula can be inserted through a single incision to inject viscoelastic fluid (through a microcatheter) into the cornea. This technique will help decrease intraocular pressure on the optic nerve with the addition of controlled volumes of viscoelastic fluid.
Relieve Your Glaucoma
Please feel free to consult with Dr. Swan at Vance Thompson Vision's Bozeman location for your glaucoma treatment and care. Our team is nationally recognized for glaucoma research and surgery, authoring numerous book chapters and scientific articles in addition to lecturing nationally and internationally. We are committed to using the world’s most advanced technology and techniques to halt glaucoma progression so you can live a life full of sight. To set up an appointment or ask us a few questions, please contact us today.