Glaucoma is a disease of high pressure in the eye that causes damage to the optic nerve, ultimately leading to vision loss. This typically starts with peripheral vision changes and therefore most patients do not realize that they are losing vision before they are diagnosed.

Glaucoma is largely an asymptomatic disease. Therefore, it is important to have yearly eye exams by a trained profession to ensure that you are not developing glaucoma. It is typically diagnosed by measuring the pressure in the eye, the thickness of the cornea, and measurements of the optic nerve. When someone is labeled as a glaucoma suspect, they typically will receive annual visual field tests to determine if there has been any loss of peripheral vision.

Intraocular Pressure, or IOP, is the pressure inside of the eye. Normal pressure is between 9-21 mmHg. While glaucoma is typically diagnosed when IOP is >21 mmHg, certain people may suffer from glaucoma with “normal” IOPs. We call this normal tension glaucoma (NTG).

OCT, or optical coherence tomography, is a test used to measure the thickness of the optic nerve. When patients have glaucoma, the high pressure in the eye tends to cause damage to the optic nerve. We can typically detect these changes before visual field loss occurs.

Visual field tests examine the peripheral vision of a glaucoma patient. While looking into the machine, the patient typically clicks a button each time they see a flashing light. By the end of the test, we are able to tell if there has been any vision loss. These tests are difficult to take and we often have to repeat them in order to ensure accuracy and reliability.

Thin corneas have been associated with higher risk of progression in glaucoma. Therefore, we measure the thickness of the cornea at the first glaucoma visit for every patient. This gives us a general sense of the overall risk for progression to vision loss in glaucoma.

Unfortunately, family history does play a role in development of glaucoma. Patients with immediate family members with glaucoma are at higher risk of developing it themselves.

The “Angle” refers to the area on the inside of the eye where fluid naturally drains. When the drain is open, but the pressure is still elevated, that is called open angle glaucoma. This is the most common type of glaucoma. When the drain is closed, this is called closed angle glaucoma. If the drain closes abruptly, this can cause extremely high pressures with pain, sensitivity to light, and loss of vision. This is a medical emergency.

Unfortunately, glaucoma is a “silent blinder” because most patients do not experience any symptoms before they begin to suffer vision loss. In acute angle closure glaucoma, the eye pressure goes high very quickly and patients can experience pain, sensitivity to light, and loss of vision.

The goal in treating glaucoma is to lower the pressure in the eye. This can be done with medicine, lasers, surgery, or a combination of all three. Typically, over the course of the lifetime of a glaucoma patient, we will use all of these types of treatment. Depending on the stage and type of your glaucoma, we will determine the individualized approach for you.

Eye drops are not fun for anyone. They can cause eye redness, irritation, and blurry vision. Not to mention how hard it is to remember to use them. One of Dr. Shafer’s areas of expertise is in the field of interventional glaucoma. This is where he uses drug delivery, lasers, and surgery to minimize the need for eye drops while ensuring that your treatment is safe and effective.

Glaucoma can be treated in many different ways. The only modifiable risk factor for progression in glaucoma is the IOP, and there are many ways to lower the pressure. The most successful ways available to us now involve medical, laser, and surgical procedures. Eye drops work as well, but most patients prefer to minimize the amount of drops and the amount of time on them. Dr. Shafer is passionate about minimizing the drop burden in glaucoma.

If only! As with all things in life, there is an expected timeframe for duration of effect. Each procedure is intended to lower the IOP, but none of them are perfect. This is why it is critical to be in the hands of a surgeon who plans multiple steps ahead. Dr. Shafer lectures nationally on the “Shafer Protocol” that he uses to help guide long-term success.

Durysta is a pellet filled with Bimatoprost, or Lumigan, that is implanted into the front part of the eye in a quick, painless procedure performed right in the office. The procedure takes no more than a minute. The medicine dissolves over 4 months, but many patients experience IOP reduction for up to 2 years! Dr. Shafer often combines the use of Durysta with other treatment modalities such as lasers and minimally invasive surgery. This is a great option for patients who snowbird in Florida and don’t have a glaucoma specialist down south!

SLT, or Selective Laser Trabeculoplasty, is a laser procedure that is performed to lower the pressure inside of the eye. The procedure has been shown to be a safe and effective first-line treatment for glaucoma and can help minimize the need for eye drops or other interventions for many years. After the procedure, you will use a steroid eye drop for 4 days to prevent inflammation.

In open angle glaucoma, the drain of the eye becomes clogged. To help unclog it, Dr. Shafer can place a stent into the very narrow drain. This minimally invasive procedure has been shown to lead to lower intraocular pressures with a very high safety profile.

When the drain of the eye gets too clogged, it may be helpful to flush all of the debris through the system and remove the clogged drain. This is performed in the operating room and typically takes around 10 minutes. This procedure is often used to try and prevent more invasive surgery and this may be combined with a stent.

When glaucoma is more advanced, it may become necessary to create a new drain for the eye. A glaucoma tube acts as a new pathway for fluid to flow from the inside to the outside of the eye. While this procedure is more invasive that a stent, it may be necessary to prevent permanent vision loss. Recovery tends to be longer with a higher likelihood of needing more surgery in the future.

The Xen Gel Stent is a small stent that goes from the inside of the eye and out underneath the conjunctiva to create a “bleb” of fluid. This procedure has a high success rate at lowering the IOP, however it may require some maintenance. The bleb can scar, and this may require more interventions to encourage it to work. This is often a procedure performed by Dr. Shafer for patients with more advanced forms of glaucoma.

If the drain of the eye is no longer functional, but the pressure is still high, micropulse CPC may be used to decrease the production of fluid inside of the eye. This is a quick procedure that is performed in the operating room. The procedure can create inflammation, and therefore you will be placed on steroids afterwards to minimize discomfort.

Glaucoma is a challenging disease. It likes to fight us. Dr. Shafer prides himself on never giving up and fighting back even harder. It is normal for some glaucoma surgeries to fail over time. This does not mean that all is lost. It just means it is time for the next intervention.