OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Tom Dow, MD

The resection of sclera that "unroofs the drain" to facilitate the outflow of fluid from the eye to lower the pressure.

The collagen stent that acts as a wick to draw the fluid from the eye.

The layers reapproximated with
the stent in place.

An Improved Outlook for Glaucoma Patients

Tom Dow, MD

A new glaucoma surgical treatment is changing the way professionals and their patients view glaucoma therapy options. Glaucoma is a silent disease that slowly causes the loss of vision if the patientÍs eye pressure increases and is left uncontrolled or above acceptable levels. Patients are often unaware of the problem and do not seek care and remediation. Regular eye exams can help to detect the symptoms and allows the patient to consider options to preserve their vision and quality of life.

The primary treatment for reducing eye pressure is the use of eye drops. However, there are many patients that do not take the eye drops prescribed by their doctor due to discomfort from the drop(s), forgetting to instill the medications at the proper times, or the cost of the medications. While new drugs continue to be introduced that are effective at lowering intraocular pressure, the cost of these eye drops continues to rise. A recently published study estimates maximum medical therapy for glaucoma treatment to exceed $2000 per year, which may exceed the fixed income level of many elderly patients.

Secondary treatment for reduction of eye pressure involves the use of lasers. While this procedure lowers pressure in the range of 25-30%, most patients must remain on their drops to achieve needed target pressure and levels. Thermal lasers are limited to one treatment due to the scarring created and recent studies show a three to five year effective reduction period. New non-thermal lasers allow for pressure reduction without burns.The advantage of non-thermal lasers is the ability to repeat the procedure in the same area of treatment. The disadvantage of laser procedures is the necessity of many patients (55-72%) to continue their eye drops to reach the level of pressure reduction necessary to preserve vision. For patients wanting to reduce their dependence on drops, this may not be the best option short term and even worse long-term due to the limited time of effective lowering of the pressure.

In the past, patients with glaucoma that is uncontrolled with eye drops and/or laser therapy were directed to a surgical procedure (trabeculectomy) that created an opening in the eye to drain the aqueous fluid. While this treatment was effective at lowering pressure, the adverse effects were greater than patients or eye doctors would prefer. A new non-penetrating procedure does not create an opening in the eye but maintains a thin, natural barrier to allow controlled outflow of aqueous fluid and avoid most of the complications associated with the older style surgery. The AquaFlow is a small collagen device placed under the sclera or white of the eye to maintain the space and create an outflow channel, which is critical to successful ongoing lower eye pressures.

A patientÍs visual acuity returns to normal usually within a week with the AquaFlow procedure, compared to a month with trabeculectomy surgery. As with any treatment there are patients that improve but donÍt achieve optimal results and pressures at the desired target levels. The good news is that a secondary non-invasive laser procedure can be performed as soon as three weeks following initial surgery to further lower the eye pressure. This combination ensures that most patients will severely reduce or eliminate expensive eye drops and be able to maintain their vision and quality of life.

For more information, call Chippewa Valley Eye Clinic é 715.834.8471