GLAUCOMA and the TREATMENT - Opthalmology
Glaucoma is a disorder of the optic nerve which is also defined as the silent thief of the vision. It may lead to loss of vision if left untreated. The underlying reason is largely the increased intraocular pressure. This causative relation is the reason why glaucoma is mistakenly called as elevated eye pressure.
While it has various clinical forms, the majority of cases with glaucoma consists of primary open angle glaucoma which is observed in adults aged over 40 years and does not cause any complaints. The loss of vision developing in the late stages of this disorder is irreversible.
What is the high intraocular pressure?
It originates from the intraocular fluid loading pressure on the ocular membranes. This fluid determines the shape and solidity of the eye and maintains the visual functions. The healthy intraocular pressure is maintained depending on the appropriate and stable inflow and outflow of the intraocular fluid within the eye. Normal intraocular pressure values are approximately between 10-20 mm Hg; yet individual normal and healthy values will vary. While a pressure reading of 18 mm Hg can be considered as normal in one patient, such value may require treatment in another. Your doctor will decide on this condition by imaging your optic nerves and evaluating the results of functional and structural tests.
Why is control of the intraocular pressure important?
High intraocular pressure is the most important risk factor of glaucoma. High pressure and fluctuating or non-stable pressure increase the risk of loss of vision. Other risk factors of open angle glaucoma are uncontrollable factors including age, family history of glaucoma and myopia (near sightedness) in the subject. High intraocular pressure can only be treated if it is timely detected and the development of glaucoma (destruction of the optic nerve) is prevented.
What are the options in the treatment of glaucoma?
There are 3 alternative treatments of the glaucoma; medications, laser and surgery.
Medical therapy (eye drops) is the most commonly used treatment method. However, these drops may lead to difficulties in use due to their local and systematic side effects, or patients avoid using their drops due to getting bored of this procedure which lasts for years. Sometimes we do not want our patients to use their medications anymore because they may not be sufficient to decrease the intraocular pressure, or in spite of adequate pressure control, glaucoma progression may carry on. The second procedure is the laser treatment This treatment may be advised to patients using medication in above mentioned conditions as an alternative or adjunct to the medication. Sometimes, your doctor may advise laser treatment (Selective Laser Trabeculoplasty) at the beginning of the treatment without initiating medication treatment in cases where you do not want to receive medical therapy or your doctor does not expect benefit from the medical therapy. Surgical treatment is the initial treatment method for childhood glaucoma. Nevertheless, it can be applied in adult glaucoma, if other methods do not work.
What is Selective Laser Trabeculoplasty (SLT)?
Selective Laser Trabeculoplasty is a treatment method of glaucoma which is used in open angle glaucoma and also approved by FDA (Food & Drug Administration). It has been successfully used in the treatment of glaucoma since 2001. Laser energy leads to some changes which will facilitate the discharge of intraocular fluid from the eye, and thus, the intraocular pressure is decreased. The laser procedure also ends the progression of the disorder, just as the long term use of medication does. During SLT procedure, first your pupils are contracted (miosis) by administering an eye drop, then, the laser is applied to the eye using a lens. Laser treatment lasts for 2-3 minutes for each eye and the procedure is painless; but the eye drop used for preparation purposes may lead to only a slight and temporary headache. Your doctor may ask you to self-administer several eye drops for a few days following the procedure. He/she may also advise you to continue taking some of your glaucoma drugs, if he/she is not completely sure that your high eye pressure could be decreased to an appropriate range through the laser treatment. The final result of the laser treatment will be evident at the end of 6 weeks. Even though your eye pressure is completely normal after the SLT procedure, you will continue to participate to the follow-up visits. Your eye pressure is measured in 3-month intervals and your optic nerve and vision area evaluations are performed once in every 6-12 months. The frequency of these examinations is determined by your doctor. The purpose of these examinations is to timely detect a possible increase in your eye pressure or destruction in the optic nerve which may occur even when your eye pressure is normal. The effect of Selective Laser Trabeculoplasty may regress in some patients over time and thus, the treatment may be repeated in such cases. SLT treatment has been implemented since the beginning of 2008 in the glaucoma unit of our hospital by our physician, the glaucoma specialist. For detailed information on SLT and the application centers, please visit: http://www.glaucomaslt.com