There are several different variations of Glaucoma, but in this article we will mainly focus on Primary Open Angle Glaucoma. This means that there is no specific underlying cause for the Glaucoma like inflammation, trauma or a severe cataract. It also means that the drainage angle where fluid is drained from the inside of the eye into the bloodstream is not narrow or closed.

Closed or Narrow Angle Glaucoma, which will be discussed in another article, is treated differently from Open Angle Glaucoma

In the U.S., Primary Open Angle Glaucoma (POAG) is by far the most common type of Glaucoma we treat.

Glaucoma is a disease where the Optic Nerve in the back of the eye deteriorates over time, and that deterioration has a relationship to the Intraocular Pressure (IOP).  Most - but not all - people diagnosed with Glaucoma have an elevated IOP.  Some people have fairly normal IOP’s but show the characteristic deterioration in the Optic Nerve. Regardless of whether or not the pressure was high initially, our primary treatment is to lower the IOP. We usually are looking to try to get the IOP down by about 25% from the pre-treatment levels.

The two mainstays of initial treatment for POAG in the U.S. are medications or laser treatments. There are other places in the world where Glaucoma is initially treated with surgery. However, while surgery can often lower the pressure to a greater degree than either medications or laser treatments, it comes with a higher rate of complications. Most U.S. eye doctors elect to go with the more conservative approach and utilize either medications - most often in the form of eye drops - or a laser treatment.

Drops

There are several different classes of medications used to treat Glaucoma.

The most common class used are the Prostaglandin Analogues or PGA’s.  The PGA’s available in the U.S. are Xalatan (latanaprost), Travatan (travapost), Lumigan (bimatoprost) and Zioptan (tafluprost).

PGA’s are most doctors’ first line of treatment because they generally lower the IOP better than the other classes; they are reasonably well tolerated by most people; and they are dosed just once a day, while most of the other drugs available have to be used multiple times a day.

The other classes of drugs include beta-blockers that are used once or twice a day; carbonic anhydrase inhibitors (CAI’s ), which come in either a drop or pill form and are used either twice or three times a day; alpha agonists that are used either twice or three times a day; and miotics, which are used three or four times a day. All of these other medications are typically used as either second-line or adjunctive treatment when the PGA’s are not successful in keeping the pressure down as single agents.

There are also several combination drops available in the U.S. that combine two of the second-line agents (Cosopt, Combigan, and Symbrinza).

Laser

The second option as initial treatment is a laser procedure.

The two most common laser treatments for Open Angle Glaucoma are Argon Laser Trabeculoplasty (ALT) or Selective Laser Trabeculoplasty (SLT).  These treatments try and get an area inside the eye called the Trabecular Meshwork - where fluid is drained from the inside of the eye into the venous system - to drain more efficiently.

These treatments tend to lower the pressure to about the same degree as the PGA’s do with over 80% of patients achieving a significant decrease in their eye pressure that lasts at least a year.  Both laser treatments can be repeated if the pressure begins to rise again in the future but the SLT works slightly better as a repeat procedure compared to the ALT.

Article contributed by Dr. Brian Wnorowski, M.D.

Christmas is one of the most joyful times of the year... thoughts of cookies, decorations, family gatherings, and toys abound. Birthday parties for kids add to the list of wonderful memories as well. But there are a few toys that may not make memories so fun because of their potential for ocular harm. The American Optometric Association lists dangerous toys each year to warn buyers of the potential harm to children’s eyes that could occur because of the particular design of that toy.

Here is a sample of that toy list:

• Laser toys and laser pointers, or laser sights on toy guns pose serious threat to the retina, which may result in thermal burns or holes in the retina that can leave permanent injury or blindness. The FDA’s Center for Devices and Radiological Health issues warnings on these devices at Christmas peak buying times.
• Any type of toy or teenage gun that shoots a projectile object. Even if the ammo is soft pellets, or soft tipped it can still pose a threat. Even soft tipped darts are included in this harmful toy list. A direct hit to the eye can be debilitating.
• Any toy that shoots a stream of water at high velocity can cause damage to the front and or back of the eye. The pressure itself, even though its just water, can damage small cells on the front and back of the eye.
• Any toy that shoots string out of an aerosol can can cause a chemical abrasion to the front of the eye, just as bad as getting a chemical sprayed into the eye.
• Toy fishing poles or toys with pointed edges or ends like swords, sabers or toy wands. Most injuries occur in children under 5 without adult supervision and horseplay can end up in a devastating eye injury from puncture.

The point is, that there are so many great toys to buy for children that can sidestep potential visual harm, that it behooves one to be aware of pitfalls of certain dangerous toy designs.

A great resource of information comes from World Against Toys Causing Harm.

For more information and for lists updated yearly see the W.A.T.C.H. website: www.toysafety.org

 

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