Barnet Dulaney Perkins Eye Center Official Blog

“This is an excellent procedure available to our patients with Glaucoma in order to help control their intraocular pressure.” Neil Atodaria, MD

Click here to learn more about this procedure:

http://www.glaucoma.org/treating/a_new_type_of_g.php

The most common type of glaucoma among Americans is Primary Open Angle Glaucoma (POAG). This type of glaucoma occurs when the eye’s drainage channels become clogged. The eye normally produces a clear, water like fluid, called “aqueous humor.” The aqueous humor, nourishes the eye, and gives it support. This fluid is produced by a faucet-like structure named the “ciliary body.” Patients at risk for POAG develop clogging of their drainage channels. These drainage channels are called the “trabecular meshwork.” It is obstruction of this meshwork which causes the pressure to rise in the eye, and leads to glaucoma.

Three important concepts in understanding glaucoma are

1.Ciliary Body: Cells which produce the clear water like aqueous humor
2.Aqueous Humor: The fluid which provides nourishment and support to the eye
3.Trabecular Meshwork: Drainage channels for aqueous humor to exit the eye.

Now that we know these three structures we can continue to understand Primary Open Angle glaucoma (POAG.)

In patients with POAG or in patients at risk for POAG, the eye’s faucet produces the aqueous humor at the normal rate. The eye’s drainage channels, the trabecular meshwork, lose their ability to drain the fluid at the same rate that it is produced. This leads to excess fluid in the eye and an elevated intraocular pressure (IOP.) When the intraocular pressure rises above normal limits, it can cause damage to the optic nerve.

In fact, when optic nerve cells are damaged or destroyed, we call that glaucoma. Glaucoma is defined as optic nerve cell death. Future blogs will continue to expand upon the mechanisms and treatments for the glaucomas. For more information about glaucoma, click here: http://goodeyes.com/glaucoma.asp

Glaucoma is considered a  “treatable” but not “curable” disease. There are two main classes of glaucoma, 1) The open angle glaucomas, and 2) The narrow or closed angle glaucomas.

There are many subsets of glaucoma within these two classes and we will over time explore these subsets.  Treatment for the open angle glaucomas also known as Primary Open Angle Glaucoma (POAG) usually starts with medications in the form of eyedrops.  We call these medications ‘topical” because they are applied directly to the eye and not by the oral route which most medications are administered.

Treatment for the Narrow Angle Glaucomas (NAG) involves the initial treatment with a laser surgery performed as an out-patient procedure.  This procedure is called a  Laser Peripheral Iridotomy (LPI).  For many patients, the laser treatment is then followed by long-term treatment with the same topical medications used to treat the open angle glaucomas.  Thus, one striking difference between narrow angle glaucoma and open angle glaucoma is that the narrow angle patients require laser treatment as a first step in their treatment strategy.  For patients with open angle glaucomas, there are laser treatments which can be used as part of their treatment protocol.  However, in most cases of  POAG, the use of laser’s usually comes after at least one medication is introduced.

In most  cases  of POAG as well as NAG  the treatment strategies include both medications (eyedrops) and laser treatment(s) over the course of their lifetime.

The subsequent installments of the glaucoma blog will provide further insight into the types of glaucoma and the types of treatment which exist.