Glaucoma is a chronic disease defined by characteristic optic nerve damage. It is a multi-factorial disease and affects over 40 million people worldwide. Glaucoma is a slowly progressive and irreversible disease and in most cases, causes a painless loss of eyesight. It is, in short, “the silent thief of sight.”
The damage to the optic nerve is commonly caused by a fluid imbalance, or pressure, in the eye, as well as possible alterations in the blood flow to the optic nerve. It is well established that lowering the intraocular pressure can slow the process of the optic nerve damage. The degree of pressure lowering necessary to prevent optic nerve damage is individualized for each person and each optic nerve. The greater the optic nerve damage, the lower the intraocular pressure is needed to achieve stability and prevent further optic nerve damage and further visual field loss.
Commonly, in the United States, topical medications are used as a first line treatment. In many situations, multiple medications are tried to achieve the desired pressure level. When glaucoma is well controlled with drops, routine pressure checks every few months (and at least twice a year) along with regular optic nerve examinations are essential to monitoring control. Examinations are commonly aided by testing of the nerve fiber layer thickness of the optic nerve and visual field testing. This testing can be done yearly or more frequently based on the level of glaucoma progression.
Unfortunately, there can be difficulties with compliance, cost and side effects with many of these medications and laser therapy is commonly substituted as a first line therapy. Recently there have been further technologic advances for better control of the intraocular pressure. Minimally invasive glaucoma surgical procedures, so-called MIGS involve alterations of the drainage area that are performed inside the eye.