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There are many different types of glaucoma, but all are related to pressure in the eye, which leads to optic nerve damage. The optic nerve is at the back of the eye and is the connection from the eye to the brain. As the intraocular pressure increases, the patient may begin experiencing peripheral area blind spots and other vision symptoms. 

Symptoms

Patients with acute forms of glaucoma may have more severe symptoms due to the quick increases in ocular pressure. These symptoms may include blurry vision, especially at night, halos, starbursts or rainbows around lights, as well as severe eye pain, or headaches and nausea. 

Treatments

Glaucoma treatment starts with efforts to decrease intraocular pressure in the eye to prevent optic nerve damage. Regimens differ depending on the type of glaucoma. Often an ophthalmologist will begin with prescribed medications and eye drops to reduce pressure by increasing the outflow of fluid from the eye or decreasing the production of fluid in the eyes. Laser treatments are sometimes recommended to increase the opening or open the drainage angle of the eye to reduce eye pressure. New drainage channels can be created surgically, but this is only done when medications are not effective.

If surgical intervention becomes necessary, then there are many different procedures that can be performed ranging from standard procedures that have been performed for decades, to new, cutting-edge procedures that are newly FDA approved, to investigational procedures that may become the next generation of standard interventions.

Procedures

The glaucoma surgeons at the Gavin Herbert Eye Institute have been instrumental in the development and optimization of numerous surgical innovations that have become the new standard for glaucoma surgery worldwide.

Open-Angle glaucoma, which happens when the eye’s drainage system is open, but fluid does not drain adequately for reasons that are unknown.

Angle-Closure glaucoma (acute), which is defined as the acute closure of the eye’s peripheral drainage system that results in a sudden increase in the intraocular pressure.

Angle-Closure glaucoma (chronic), which is caused when the iris over time begins to obstruct the drainage system of the eye.

Pseudoexfoliation glaucoma, which is caused when fibrillary material is deposited in the eye, impeding fluid from draining.

Pigmentary glaucoma, which is caused when pigment is dislodged from the iris of the eye and obstructs fluid from draining.

Angle Recession glaucoma, which is caused when trauma affects the structure of the drainage system and causes elevated intraocular pressure.

Neovascular glaucoma, which is caused when abnormal blood vessels expand and grow on the iris of the eye, then blocking the eye’s drainage channels and structures.

Congenital glaucoma, which is the abnormal formation of the eye’s drainage channels during gestation.

Laser Peripheral Iridotomy (LPI) 

LPI is the standard first-line treatment in angle-closure glaucoma and eyes at risk for this condition. The laser creates a hole in the outer edge of the iris, leading to an opening of the angle in the majority of cases. After the angle is widened from the procedure, the trabecular meshwork is exposed and fluid outflow is enhanced. Here is a video to learn more.

Selective Laser Trabeculoplasty (SLT)

Selective Laser Trabeculoplasty, or SLT, is a form of laser surgery that is used to lower intraocular pressure in glaucoma. It is used when eye drop medications are not lowering the eye pressure enough or are causing significant side effects. It may sometimes be used as an initial treatment in glaucoma as well.

MIGS has been developed in recent years to lower eye pressure and prevent the progression of glaucoma. MIGS procedures are indicated in certain types of glaucoma and work by using microscopic-sized equipment and tiny incisions.

Filtering surgery creates a new passage for fluid drainage. Surgery is usually reserved for cases that cannot be controlled by medication and after appropriate laser treatment.

 

Aqueous shunt devices

These are silicone tubes implanted into the eye to facilitate drainage of the aqueous humor. They are typically used in refractory cases, and can be used in patients who have had multiple prior surgical procedures. There are several different models of these shunts, one of the most frequently used being the Baerveldt Shunt ®. This shunt was developed by Dr. Baerveldt and continues to be the preferred implant among many glaucoma surgeons. The surgeons at the Gavin Herbert Eye Institute are widely considered to be the world’s experts in tube shunt technology. Aside from writing the major book chapters on this technique, our surgeons have written landmark articles on the procedure and are frequent resources for physicians referring complicated cases from around the country.

Trabeculectomy

This is the standard procedure for glaucoma and has been performed for over forty years. This procedure involves surgically creating an alternate drainage pathway for the eye, through the sclera (the white part of the eye). Recent modifications of this procedure include implantation of a miniature glaucoma device, (The Ex-Press®) under the sclera to better control fluid flow. The surgeons at the Gavin Herbert Eye Institute were the first in Orange County to perform this procedure and are considered national experts on this technology. They are routinely called upon to train other surgeons at major national and international meetings.

This procedure was developed at the Gavin Herbert Eye Institute by Dr. George Baerveldt and his colleagues. This is a minimally invasive approach to restore the eye’s own natural drainage system and was FDA approved in 2006. Since then, over 5,000 patients have undergone the procedure in the US, and it is now widely adopted around the world. The surgeons at the Gavin Herbert Eye Institute are considered not only the developers of the technology, but also the foremost authorities in managing complex cases, developing modifications to improve outcomes, and serve as the instructors for all new surgeons performing the procedure. They have published dozens of articles describing the procedure and expected outcomes and have enriched the literature for all glaucoma surgeons worldwide.

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Whether you need a routine eye exam or care for complex vision problems, the internationally respected ophthalmologists at the UCI Gavin Herbert Eye Institute will provide you with the highest quality of care to treat your vision problems. 

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The UCI Gavin Herbert Eye Institute has locations in Orange at the UCI Medical Center, and also in Irvine on the UCI Campus.