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What is Glaucoma?

Minnesota Eye Consultants is proud to have been at the forefront of glaucoma care for decades. Our doctors offer a robust set of individualized treatment options for those living with glaucoma. As true partners in your eye care, our team will work with you to help select individualize treatment options that optimize the balance of effectiveness and risk. Offering the latest advances in eye medications, laser procedures, and surgical interventions, including micro-invasive glaucoma surgery, our glaucoma services are second to none. Schedule an appointment today and learn how the doctors at Minnesota Eye Consultants can effectively manage your glaucoma!

Glaucoma is defined as characteristic damage to the optic nerve as a consequence of pressure within the eye, among other factors. The optic nerve is actually a collection of over one million tiny nerve fibers that connect the retina within the eye to the vision centers within the brain. Damage to the optic nerve from glaucoma is a consequence of intraocular eye pressure, which results from a buildup of fluid that flows throughout the inside of the eye. The level of pressure responsible for this damage varies from person to person and pressure that is well tolerated by one individual may be too high for another person. 

A normal healthy functioning eye produces a clear liquid, called aqueous humor, at a very consistent  rate of 1% per minute. In the normal eye, the natural drainage system drains fluid from the eye at this same rate, keeping the pressure within a tolerable range. However in patients with glaucoma, the fluid doesn’t exit the eye at a fast enough rate, resulting in elevated eye pressure.

The increased force from the additional fluid presses against the delicate nerve fibers at the back of the eye, killing off the irreplaceable nerves that are essential for healthy vision. These damaged optic nerve fibers do not regenerate and result in reduced peripheral (side) vision as the disease progresses. This nerve damage and vision loss is permanent. If the pressure remains too high, it may result in progressive, permanent vision loss and ultimately blindness.

Symptoms

Early on, glaucoma is asymptomatic and the only way to know if you need to be treated is to schedule an annual fully dilated eye examination. Early detection can help halt the progression of the disease and in most cases avoid serious vision damage and blindness. While most glaucoma is asymptomatic in the early stages, some less common forms of glaucoma may cause blurred vision, halos, mild headaches, eye pain, and even nausea. If you are experiencing these, you should see your doctor right away.

Types of Glaucoma

Open-angle

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Open-angle is the most common type of glaucoma and in the USA occurs in approximately 90% of those who suffer from the disease. In this particular type, access to the drainage channels within the “angle” are open, however, there is obstruction within the drain itself  causing the fluid within the eye to drain too slowly. The increased fluid causes pressure within the eye to rise, potentially resulting in damage to the optic nerve.  

In “primary” open-angle glaucoma the cause of this obstruction is not known or identifiable.  It usually develops gradually and without any symptoms or red flags in the earlier stages. As a result, open-angle glaucoma can go undetected for years, leaving patients unaware that this disease is slowly stealing their vision. 

There are numerous forms of “secondary” open-angle glaucoma. In these conditions, there is an identifiable cause of poor drainage. Common examples include pseudoexfoliation related glaucoma, pigmentary glaucoma, steroid related glaucoma, inflammatory glaucoma, and many others.

Angle Closure

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Angle-closure glaucoma, also referred to as “closed-angle” or “narrow-angle”, affects less than 10% of glaucoma patients in the USA and has a much more rapid onset. It is more common in hyperopic or “far sighted” eyes and those of Asian descent. In this form of glaucoma the drainage channels within the eye may be normal but access to the drain is blocked by the iris, the colorful tissue surrounding the pupil.  This occurs when the structures within the eye are more crowded together either because the eye is inherently smaller or when the lens of the eye becomes larger during cataract formation. The peripheral iris protrudes forward and blocks access to the drainage channel. As a result, aqueous fluid can no longer reach the trabecular meshwork at the angle, so the eye pressure spikes rapidly. Symptoms occur suddenly and are much more severe, but the good news this form of glaucoma is potentially curable because the drain itself functions normally, thus if access can be restored with prompt treatment, vision can be preserved.

Angle-closure signs and symptoms include:

  • Severe eye pain 
  • Nausea and vomiting (accompanying the severe eye pain)
  • Sudden onset of visual disturbance, often in low light
  • Sudden blurred vision
  • Headache
  • Rainbow-colored rings or halos around lights
  • Reddening of the eye

Treatment Options

The team at Minnesota Eye Consultants is an industry leader when it comes to the treatment of Glaucoma. We have all the medical, surgical, and diagnostic tools within our offices to monitor patients and provide appropriate treatment plans aimed at lowering intraocular pressure. 

The initial treatment for most patients with open-angle glaucoma is laser therapy and or medical therapy. Most glaucoma specialists now favor a gentle form of laser known as SLT, or “Selective Laser Trabeculoplasty” as the initial treatment. This “laser first” strategy is based on an important clinical trial known as the LiGHT Trial, or “Laser for initial treatment of glaucoma and ocular hypertension. In this trial laser was found to be more effective than eyedrop therapy. So much so that the European Glaucoma Society and the public health system in the United Kingdom recommend that patients have laser initially rather use eyedrops as the initial treatment. Then, if laser alone fails to control the pressure, medications in the form of eyedrops or slow release implants may be used. Some patients may need surgical procedures to control their pressure.

For some glaucoma surgeries (like lasers and MIGS), the goal is to improve the function of your natural drainage pathway, while other surgeries create an entirely new drainage pathway. The benefits of lasers and MIGS are that they are less invasive and safer, while the latter category is more invasive, carries more risk, but is also more effective. The first grouping is more dependent on continuation of some medication while the latter is more likely to reduce or eliminate medications. 

Depending on the type and stage of glaucoma, we may recommend one of the following treatment options.

 

Eye Medications are oftentimes the first line of defense against elevated eye pressures and are a mainstay of early disease intervention. 

With the use of eye medications, we aim to:

  • Reduce the amount of aqueous humor made within the eye or
  • Help this fluid flow better through the natural drainage system

Minnesota Eye Consultants is also proud to offer Durysta, the first and only FDA-approved dissolvable ocular implant to reduce eye pressure in patients with open angle glaucoma or high eye pressure. This may be a good option for those wishing to mitigate challenging eye drop regimens.

Improving Your Natural Drainage Pathway

The last decade has brought great advancements to glaucoma surgery, and we are fortunate to individualize surgical care better than ever before. In the past, treatment of mild to moderate glaucoma was limited to riskier operations, but today, we can offer safer surgical options with Micro-invasive Glaucoma Surgery (MIGS). The benefits of MIGS are remarkable, and the procedure has a high success rate. However, it is important to note that some patients may still require the use of medications to assist in maintaining ideal eye pressures.

The physicians at Minnesota Eye Consultants are proud to offer the latest in FDA Approved Trabecular Micro-Bypass devices, such as the iStent and Hydrus. 

Creating a New Drainage Pathway

Glaucoma surgery may be recommended after less invasive treatments, such as eye medications, laser procedures, and MIGs, have been considered. The traditional surgical procedures for glaucoma create an alternative pathway for the aqueous humor to drain with the use of filtration techniques, implants, tubes, and shunts. These procedures are the most aggressive treatment options for glaucoma but are very effective in lowering eye pressure. In many cases, this means fewer eye drops and a better chance of protecting vision.

Glaucoma Surgery Doctors

locations

Serving Our Community

Minnesota Eye Consultants is proud to offer patients convenient access to eye care across the Twin Cities. We have 4 locations, each with an onsite ambulatory surgery center (ASC).

11091 Ulysses St NE
Clinic: Suite 300
ASC: Suite 400
Blaine, Minnesota 55434
Additional Blaine Information
9801 Dupont Ave S
ASC: Suite 100
Laser Procedures: Suite 120
Clinic: Suite 200
Bloomington, MN 55431
Additional Bloomington Information
10709 Wayzata Blvd
ASC: Suite 100
Laser Procedures: Suite 120
Clinic: Suite 200
Minnetonka, MN 55305
Additional Minnetonka Information
12501 Whitewater Drive, Suite 310
Minnetonka, MN 55343
Additional Crosstown – Coming March 2024 Information
7125 Tamarack Rd
Clinic: Suite 100
ASC: Suite 200
Laser Procedures: Suite 250
Woodbury, MN 55125
Additional Woodbury Information