Glaucoma Lasers & Surgeries

Glaucoma is an eye condition that damages the optic nerve, this damage is caused by abnormally elevated eye pressure. In a few cases, damage of the optic nerve can also occur in patients with normal range of eye pressure (10-22 mm Hg). Glaucoma is one of the leading causes of blindness for people above 60 years. 

Why is it important to detect Glaucoma in the early stages?

Symptoms of glaucoma are very subtle and gradually develop that makes it easy to miss. Many people have no noticeable symptoms in early stages of  the disease, which makes it extremely important to have a regular eye exam to detect it in an early stage. Glaucoma nerve damage is irreversible so early detection and treatment is crucial to prevent blindness.
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Glaucoma in majority of patients (open angle glaucoma) is detected with symptoms of advanced disease such as patchy blind spots in your side or central vision and tunnel vision in advanced stages.
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However, in cases of acute angle closure glaucoma, they may present with severe headache, eye pain, nausea, vomiting and blurred vision. 

How can Glaucoma be tested?
  • Optic nerve check (through a comprehensive dilated eye exam)
  • Gonioscopy (to detect the type of glaucoma)
  • Eye pressure check (Tonometry or ocular response analyzer)
  • Visual field assessment (to find out sensitivity of the peripheral vision, where glaucoma strikes first)
  • Corneal thickness (pachymetry or topography)
  • Optic nerve thickness (using Optical Coherence Tomography)

Forms of Glaucoma

Chronic Glaucoma

(Primary Open-angle Glaucoma) is the most common form of this disease.

Acute Glaucoma

(Angle-closure Glaucoma) is when the pressure inside the eye rapidly increases due to iris blocking the drain. An attack of acute Glaucoma is often severe. People suffer pain, nausea, blurred vision and redness of the eye. In such a case, immediate medical help should be sought. If treatment is delayed there can be permanent visual damage in a very short time. Usually, laser surgery performed promptly can clear the blockage and protect against visual impairment.
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Secondary Glaucoma

These glaucomas can develop as a result of other disorders of the eye such as injuries, cataracts, eye inflammations and diabetes. In cases where glaucoma is afflicting a diabetes patient, surgery can be performed successfully by implanting valves, with the Ahmed Valve, now being used most commonly.

Congenital Glaucoma

This rare form of Glaucoma is caused by an abnormal drainage system. It can exist at birth as it can develop later. Parents may note that the child is sensitive to light, has enlarged and cloudy eyes and has excessive watering. In such a case, surgery is usually needed.

Low tension or normal tension Glaucoma

Occasionally, optic nerve damage can occur in people with so-called normal eye pressure. This form of glaucoma is treated in the same manner as Open-angle Glaucoma.

Treatments

Eye drops
  • First line treatment for all glaucoma patients
  • Glaucoma is a lifelong condition. You may need to use eyedrops daily in your life, and in some cases, pills are prescribed to reduce elevated eye pressure. 
Laser treatment (Peripheral Iridotomy)
  • Your doctor might recommend this to help improve fluid drainage from your eye to help reduce eye pressure. 
  • Laser treatment can complement the use of eye drops but may not replace it completely. 
  • Laser treatment result may last up to 5 years, and in some cases it can also be repeated.
Surgery
  • Surgery is usually performed after eye drops and laser have failed to control the eye pressure.
  • It is more invasive but may achieve better eye pressure control compared to drops and laser.
‍There are three types of surgeries for Glaucoma:
  • Trabeculectomy:  A new channel is created for the fluid to leave the eye. During surgery, Mitomycin is used for successful outcome.
  • Ahmed valve implantation: this type of valve is used in complicated cases including diabetic cases.
  • In advanced cases, a special laser treatment called cyclophotocoagulation or cryo is used to reduce the eye pressure without the need for surgical intervention.

Both procedures involve removing the damaged endothelial tissue and replacing it with healthy donor tissue. Few or no stitches are required during endothelial keratoplasty surgeries compared to other keratoplasty procedures. Instead, an air bubble is used to keep the donor cornea in place. The difference between DSAEK and DMEK is the thickness of cornea, DSAEK is thicker and DMEK is thinner.

Decision for the type of transplant will depend on what suits your specific eye condition. Not all patients with diseased corneas are candidates for endothelial keratoplasty. These procedures correct corneal endothelial failure, but are not able to correct corneal scarring, thinning, or surface irregularity.

FAQs


How often should I get my eye checked if I have glaucoma?

You will require 3-12 months follow up depending on the severity of the disease and your eye pressure level (IOP). The more severe the glaucoma, the more frequent the follow up. 

Can patients with glaucoma (elevated eye pressure) undergo Lasik surgery?

Yes, glaucoma patients can undergo refractive surgery once the eye pressure is controlled.

Will Lasik surgery complicate monitoring and detecting glaucoma?

There are different methods of calculating eye pressure after Lasik surgery, making monitoring of glaucoma possible. Diagnosing glaucoma is done with visual field testing and nerve fiber layer imaging of the back of the eye that will not be changed or affected after Lasik surgery. Hence, making it safe for patients to proceed with refractive surgery with easy ways to detect and monitor glaucoma. 

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+973 17 25 25 74

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Building 960 Road 7321 Block 373
Abu Gazalah, Manama, Bahrain

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