COME SEE US , THEN SEE THE WORLD

Michael Duplessie, MD Taiba Hospital

Department of Ophthalmology Road No 3,

Sabah Al Salem 965-25529019

965-25529019

M ICHAEL DUPLESSIE

GLAUCOMA

TOPICS OF DISCUSSION:

• What is glaucoma ?

• How is glaucoma treated ?

• When should I be examined ?

• Is my treatment covered by insurance ?

& GLAUCOMA SURGERY

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worldwide firsts and

notables

Organizer of First United States Lasik Course

Organizer of Largest Lasik Wet lab course in the world

First textbook chapter written on the lasik technique

First textbook chapter written on hyperopic lasik

First textbook chapter on Suture-less Corneal Transplantation

Editor Advances in Refractive & Corneal Surgery

Over 10,000 cataract surgeries and 30,000 lasik surgeries performed

treatment is usually performed in the office, takes only a few minutes, and is normally painless. Microsurgery-Penetrating Procedure The third way to treat glaucoma is with microsur-gery. Studies have consistently revealed that the eye pres-sure is reduced to a greater degree through surgical intervention than the use of eye drops, laser or a combina-tion of these treatments but with an increased risks of complications. In the United States, we prefer to begin treating glaucoma with eye drops and/or laser applications. In other countries, such as the European nations, surgery is selected earlier. United States eye care professionals have generally held this option for later intervention due to a percentage of patients that have pressures that are too low following the surgery or develop other complications. The surgical procedure that has been considered the “gold standard” for penetrating procedures is trabeculectomy. In this procedure, a small drainage hole is created in the eye, usually located in the upper portion of the eye. This allows fluid to drain out of the eye and into the circulation behind the eye in the eye socket. This pro-cedure effectively drains fluid from the eye as long as the tissues do not scar sufficiently during the healing phase after the procedure. Narrow-Angle Glaucoma Treatment If you are at risk for or have narrow angle glauco-ma, Dr. Duplessie will recommend a preventive laser treatment that creates a small opening in the iris or col-ored part of the eye. Sometimes narrow angle glaucoma is a chronic condition that is treated with the same medicines or microsurgery for open angle glaucoma.

Open-Angle Glaucoma Treatment

There are several ways to treat this disease. There is a growing sentiment among eye care professionals that a healthy lifestyle, cessation from smoking and exercise may be valuable in reducing eye pressure. Most commonly, treatment begins with eye drops that are designed to lower the pressure in the eye. These drops are used from one to four times daily, depending on the medication. They are designed to decrease the amount of fluid produced in the eye, or to increase the amount of fluid drained from the eye. Like all medications, these eye drops can have side effects. There are also oral medications that are available to lower the eye pressure but often with greater side effects then the eye drops. Laser treatment Another method of treating glaucoma is with a laser. There are currently two different types of lasers used to increase the amount of fluid drained from the eye: Argon Laser-a thermal laser that creates micro-burns

in the trabecular meshwork. Selective Laser-a newer non-thermal laser that targets

the pigment cells in the trabecular meshwork. The applications can be repeated more than once. Studies and trials with the Argon laser have shown pressure reduction in Caucasian patients to have a dura-tion of two to three years with the lower pressures re-maining a year or two longer in Black patients. Both lasers may reduce the number of eye drops used to control the pressure but rarely does the laser treatment eliminate the need for the drops. The laser

M ICHAEL DUPLESSIE PAGE 3

Glaucoma is one of the leading causes of permanent blindness in the world. It affects two to three million Ameri-cans, and more than twelve million people worldwide. Glau-coma takes away a victim’s sight slowly, but relentlessly, and in most cases, without any signs or symptoms. Visual damage from glaucoma is irreversible and permanent. Blindness from glaucoma, however, can be prevented with proper pre-ventive eye care. Who is at Risk? Glaucoma can strike people of any age, sex, and race. Certain individuals, however, are at increased risk. Those at increased risk include persons of African de-scent, those with a family history of glaucoma, persons with diabetes and possibly those with nearsightedness or high blood pressure. The risk of glaucoma also increases as one gets older. The risk of glaucoma increases markedly in peo-ple of African descent over the age of 35 years, and in people of Caucasian descent over the age of 50 years. Other risk factors for glaucoma include a history of trauma to the eye.

What is Glaucoma? Glaucoma is a disease of the optic nerve, which is the nerve that connects your eye to your brain. This nerve transmits visual information from the eye to the brain, thereby allowing you to see. In most cases, glaucoma dam-age progresses very slowly, over a period of several years. However, sometimes this damage can progress more rap-idly. As the damage to the nerve progresses, a person be-gins to lose vision. This loss of vision begins with the side, or peripheral, vision. This is vision that you may not be aware of, but is very important in everyday activities of mobility such as walking and driving. The loss of this pe-ripheral vision progresses as long as the disease is not treated. If treatment is not given or not effective, then the visual loss can progress until it begins to involve the cen-tral, or vision used to read and write. It is at this point that a victim of glaucoma may begin to notice problems with vision. If treatment is still not given, then all vision in the eye can be lost. Visual loss from glaucoma is irre-versible. Because vision lost from glaucoma can never be restored, it is critical to detect glaucoma before significant damage has occurred to the nerve and initiate effective treatment. Even if vision loss has occurred, treatment for glaucoma can be provided to prevent further loss of vi-sion. Causes of Glaucoma High pressure inside the eye is known to be one of the factors that cause glaucoma. The normal eye continu-ously produces and drains fluid (aqueous) internally in or-der to maintain the normal shape and pressure of the eye. This pressure balance and shape is necessary for you to see properly. In glaucoma, there may be a blockage of fluid

wavelength perimetry. Different Types of Glaucoma The most common type of glaucoma is open-angle glauco-ma. Open-angle glaucoma means that there is no visible obstruction to the aqueous (fluid) drainage area inside the eye. It is thought that there may be an invisible obstruction (tissue) to fluid drainage in the trabecular meshwork, which is the structure in the eye that drains the fluid. This type of glaucoma typically causes no symp-toms until the damage and visual loss is very advanced. Another type of glaucoma is narrow-angle glauco-ma. This type of glaucoma may cause symptoms of sudden pain, redness, blurred vision, and colored haloes around lights. This condition is called acute narrow-angle glauco-ma, and must be treated immediately. Failure to treat this condition immediately can cause permanent loss of vision. Sometimes narrow-angle glaucoma is a chronic condition that does not cause any symptoms, like open angle glauco-ma.

To test the visual field, you place your head against a headrest and stare at a target light that is placed directly in front of the eye being tested. The machine then flashes lights in your peripheral vision. Some of these lights are bright and easy to see. Others are so dim that they are impossible to see even if you have no visual damage. Most lights are somewhere in between. When you see the light, you press a button and the machine registers your response. The machine then prints out a map showing any areas where you cannot see properly. Dr. Duplessie will repeat this measurement pe-riodically to determine if the glaucoma treatment has been effective in stabilizing the damage. The pressure within the eye or intraocular pressure has classically been thought of as the “key” measure for diagnosis of the disease. The eye pressure varies depend-ing on the time of day that the measurement is obtained. Stability over time is important. There are other types of specialized testing that may also be used including: conofocal scanning laser analy-sis (HRT II); scanning laser polarimetry (GDx); and short

drainage or an excess of fluid production, which leads to high pressure inside the eye. If you have high eye pressure, the increased pres-sure may damage your optic nerve due to compression or reduction of the normal blood flow to the critical struc-tures of the optic nerve. Some people, however, are able to tolerate higher eye pressures without developing glau-coma damage to the optic nerve. The reason for this is un-known. The target for success in many studies has been eye pressure below 21mm, whereas new clinical information reveals that vision is preserved to a much greater degree if pressures are maintained at 16mm or below. Some people develop glaucoma even without evi-dence of increased pressure inside the eye. In fact, recent studies show that up to 50 percent of people with glauco-ma may not have high eye pressure measurements. For example, persons of Japanese descent are more prone to have glaucoma without elevated eye pressure, and normal-pressure glaucoma is more common in Japan than high-pressure glaucoma.

The two leading theories are that damage to the nerve is caused by poor circulation to the nerve, or that abnormally high concentrations of naturally occurring chemicals or hormones cause the damage. Many of these people with normal pressure glaucoma also have other problems with their circulation, such as heart disease, poor circulation to their legs and feet, or hardening of the arteries. Other scientists have shown increased concentra-tions of glutamate, nitric oxide and other chemicals in the eyes of people with glaucoma. These chemicals are natu-rally produced by the body, scientists still have not discov-ered why the body produces abnormally high amounts of these chemicals in eyes with glaucoma nor how to reduce the concentrations to levels that preserve the nerve. Glaucoma Diagnosis Dr. Duplessie can detect glaucoma damage by the appearance of your optic nerve. A normal healthy nerve has a small depression in the center. As damage from glaucoma progresses, this depression or hole in the center of the nerve becomes deeper, enlarges, and damages the healthy tissue of the nerve. Dr. Duples-sie can detect progression of the disease by periodically examining the appearance of the nerve.

If you are a glaucoma suspect, Dr. Duplessie will want to examine your optic nerve two or three times a year, to detect definite glaucoma damage as soon as it oc-curs. This will allow treatment to begin before the glauco-ma has a significant effect on your vision. Another way to diagnose glaucoma is to determine if peripheral or side vision has been lost and if damage has occurred to record the current amount of peripheral loss. Glaucoma does not affect your central reading vision until the late stages of the disease. At this late stage, a glaucoma victim may already be partially blind. There-fore, it is important to measure the peripheral vision in the early stages of the disease so that proper treatment can be given to stabilize vision and prevent blindness. This is accomplished with visual field testing, which is an exami-nation that measures the amount of peripheral and central vision lost.