Archive for October, 2009
Laser Treatment for Glaucoma
Friday, October 30th, 2009
The use of lasers in the management of glaucoma has become more frequent than ever. In past years, the use of lasers for lowering had been reserved for late in the course of the disease. Over the past 5 years, however, the development of a new laser treatment known as “Selective Laser Trabeculoplasty” or SLT has allowed the lasers to be used earlier in the disease cycle.
SLT is an office based laser which can be performed as an outpatient procedure. The treatment is painless, and generally takes only a few minutes to complete. The patient has one eye treated at a time, and can resume routine activities on the following day. SLT does not replace the use of eyedrops in the management of glaucoma, but rather can be used as an adjunct or supplement to medications. Perhaps the most exciting upside of SLT is that it can be used repeatedly over the patient’s lifetime.
Unlike previous laser treatments for glaucoma which could only be performed twice in a patient’s life, the newer SLT does not have this limitation. The laser lowers intraocular pressure by stimulating the body’s own immune system which then works to “clean out the clogged drain” in the eye. As a general principle, patients with newly diagnosed glaucoma are placed on medications in the form of eyedrops. Many patients require more than one type of eydrop on a routine basis. Not infrequently, patients require three to four types of medications on a daily basis. These patients can have difficulty maintaining strict compliance with their medical regimen. In these patients, SLT can be used to replace at least one and occasionally two of the three to four eyedrops a patient may be using. Across the United States, the application of SLT laser treatment has expanded rapidly over the past 5 years.
Thus, in summary, SLT is a safe, effective technology which can be used to lower the pressure in the eye and prevent glaucomatous nerve damage. A complete article on the role of SLT including its development, its impact, and its role in the management of glaucoma can be obtained by visiting http://www.ophmanagement.com/article.aspx?article=103525
Posted in Glaucoma, Uncategorized
Toric Intraocular Lenses
Thursday, October 15th, 2009
In cataract surgery the cloudy natural lens of the eye is removed and replaced with a perfectly clear intra ocular lens (IOL). There are three types of IOL’s used in modern cataract surgery; monofocal, multifocal and toric. The standard lens we have had for decades is a monofocal IOL. This lens can give good vision at a set distance but won’t correct astigmatism and won’t give both reading and distance vision. A multifocal lens will give good vision for reading and distance without glasses. It does not correct astigmatism so that has to be done separately. I am writing about toric IOL’s.
Until recently we have not been able to correct for astigmatism in the eye without performing a second surgery on the cornea. LASIK, for example, can correct astigmatism. Astigmatism is when the cornea is not dome shaped, like half of a basketball, but steeper on one side and flatter on the other, like half of a football. When an eye has astigmatism it can’t see clearly at any distance without glasses or contacts. This left many people dependent on glasses for near and distance vision after cataract surgery.
A few years ago the Food and Drug Administration approved toric lenses to be placed in the eye at the time of cataract surgery. These toric lenses have astigmatism power built into the lens. Cataract surgery can now correct near sightedness, far sightedness, and astigmatism. Correcting astigmatism with glasses is good, correcting it with contact lenses is better, but correcting astigmatism with a toric lens is the best. The distance vision obtained with the toric lenses is excellent but they don’t give both distance and near vision. That is the only problem with toric IOL’s, patients still need glasses for reading. They are not multifocal (yet!).
A toric IOL is right for you if; you need cataract surgery, you have significant astigmatism, and you don’t mind wearing glasses for reading.
David L. McGarey MD
Posted in Intraocular Lenses, Latest News, Uncategorized