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Glaucoma Treatment in Cape Town

If your doctor recently told you that you have glaucoma, you may be wondering what that means, what glaucoma treatment entails and how it can affect your sight. Glaucoma is a serious disease, but in most cases it can be diagnosed and controlled. The following information can help you learn more about glaucoma and what you can do in order to prevent further loss of vision and lead a normal life.

What is Glaucoma?

Fluid always flows through the inside of your eye but if you have glaucoma, the outflow is abnormal, or your eye produces too much fluid. As a result, the pressure inside your eye rises and it slowly destroys the delicate fibres in the optic nerve that send visual messages to the brain. As nerve fibres die, the optic disc changes. Nerve fibres that control side vision are damaged first. If your pressure remains high, it can eventually cause blindness.

OPEN ANGLE GLAUCOMA is the most common kind of glaucoma. Pressure inside the eye rises slowly and destroys vision gradually, starting with side vision. This usually causes no pain and there are no other warning signs. In some cases vision may be lost, even though pressure stays within a normal range.

CLOSED ANGLE GLAUCOMA is less common. Pressure inside the eye rises suddenly and must be lowered right away to prevent blindness. Severe pain and blurred vision can occur with an acute attack. A chronic form of closed angle glaucoma occurs more slowly and often without any symptoms.

OTHER KINDS OF GLAUCOMA can be linked to an injury or inflammation of the eye, a cataract (clouding of the lens of the eye), an eye tumour, advanced diabetes (high blood sugar), uveitis, or other genetic causes.

Who is affected by Glaucoma?

The major risk factor is age. Chronic Open Angle Glaucoma most often affects people over 40, but everyone over 35 should be tested at least every two years. You also have a higher risk of developing glaucoma if a close family member has had the disease or if you have high blood pressure or high blood sugar (diabetes). People who are very short-sighted are also at higher risk of developing glaucoma.

How is Glaucoma diagnosed?

Taking your medical history

Because glaucoma is often hereditary, your eye doctor needs to know if other members of your family have the disease. You also need to tell your doctor about any medication you take and any medical conditions you have that could affect your eye pressure such as high blood sugar, high blood pressure, irregular heartbeat or lung disease.

Measuring your eye pressure

An instrument called a tonometer, measures the pressure inside your eyes. Your doctor lightly touches a plastic prism to your eyeball while your eye is numbed with drops, so this should be painless. Sometimes your pressure may be measured by a tonometer that sends a puff of air onto the cornea.

Examining your optic disc

The inside of your eye is examined for changes in your optic disc. Fundus photographs may be taken to record changes in your optic disc. Heidelberg Retinal Tomography and OCT scanning are ways of scanning and documenting the optic nerve. This enables the ophthalmologist to pick up even very small changes in the optic nerve and retinal nerve fibre layer. It is necessary to have these tests at least once a year.

Checking your drainage angle

The angle between the iris and cornea, where the drainage holes lie is examined. First you are given drops to numb your eyes. A lens (gonioscope), which contains a mirror to enable the doctor to see whether the drainage angle is open or closed, is placed onto your eye.

Testing your field of vision

A visual field test, called perimetry, tells whether you have lost any side, or peripheral, vision. You sit in front of a dome-shaped screen. One eye is covered while you look straight ahead with the other eye into the dome. Small lights flash inside this dome, and you have to respond by pressing a button every time you see a light flash. A printout map then shows your field of vision, and where any loss of visual field may be. It is necessary to have this test at least once a year.

Measuring your corneal thickness (Pachymetry)

The latest studies have shown that corneal thickness (pachymetry) is a special risk factor for developing optic nerve damage due to increased intra-ocular pressure. Corneal thickness determines the risk and prognosis of the glaucoma. A thin cornea (less than 500 microns) together with high pressure is a high risk factor.

How can vision loss be prevented?

Your eye doctor can’t restore vision that has already been lost, but in most cases eye pressure can be lowered to prevent further loss of sight. Your glaucoma treatment depends on the kind of glaucoma you have and how it responds to medication. In some cases, your doctor may do glaucoma laser surgery or glaucoma eye surgery.

Glaucoma treatment goals

The only way to control pressure and prevent loss of vision is to either decrease production of fluid or increase drainage of fluid. To decrease production of fluid, eye drops or pills may be prescribed. To increase drainage, eye drops, eye laser treatment, or surgery may be advised.

How is Glaucoma treated?

1.Eye drops and pills

Eye drops and pills are the most commonly used glaucoma treatments.

2. Laser Treatment

Sometimes eye pressure can’t be controlled with eye drops and pills, or these medications cause side effects. In such cases glaucoma laser surgery (called a trabeculoplasty) is recommended. During a trabeculoplasty, the clogged drainage holes are opened with a laser.

3. Surgery

Sometimes medication and laser treatment can’t control your pressure, or laser treatment isn’t recommended for you. In such a case a glaucoma procedure called a trabeculectomy is suggested. It is also recommended if your disease is progressive, if you have too many medications to take, or if you have too many side effects from medication.

During glaucoma eye surgery, a new drain is made in your eye so that fluid can bypass the clogged drainage holes.

Another form of glaucoma eye surgery which has proven to be highly successful is the implantation of a collagen implant underneath the trabeculectomy flap. Other implants include the Ahmed valve and Mini Xpress implant. Dr. Krüger has a lot of experience in this field and has been doing this type of surgery since 1989.

The Trabectome procedure is another new procedure that is designed to improve fluid drainage from the eye and balance intra-ocular pressure. The Trabectome procedure is safe, economical and effective and can be easily combined with cataract surgery.

Looking ahead

Although Glaucoma can’t yet be prevented or cured, new medication and treatments are continuously being tested. Right now, you can help save your sight and continue to do the things you enjoy by taking your medication and seeing your eye doctor regularly.

Please contact us at 021-910-0300 if you require any further information with regard to Glaucoma treatment or Glaucoma eye surgery.