About Glaucoma

Glaucoma is a disease that damages the eye’s optic nerve. This usually happens when fluid builds up in front of the eye that increases the pressure in the eye, damaging the optic nerve.

In a healthy eye, a clear fluid called aqueous humor circulates inside the front of the eye. If patients have glaucoma the aqueous humor will not flow out of the eye properly as it should. Fluid pressure in the eye builds up and eventually by time will cause damage to the optic nerve fibers.

There are several types of glaucoma such as

  • Open Angle Glaucoma – most common type of glaucoma is called primary open angle glaucoma. This occurs when the trabecular meshwork of the eye becomes less efficient at draining the fluid. It causes the eye pressure IOP to rise. Raised eye pressure leads to damage of the optic nerves. Open angle glaucoma has no symptoms in the early stages and the vision will remain normal but as the optic nerve becomes damaged, blank spots will begin to appear in the vision. If all of the optic nerve fibers die, it will result in blindness. Eye pressure is always different it will rise and fall from minute to minute.
  • Normal Tension Glaucoma – is considered as glaucoma, having eye pressure less than 21 mmHg (eye pressure is expressed in millimeters of mercury (mmHg)). Some patients having normal tension or low tension glaucoma with pressure consistently being below 21 mmHg could still have loss of vision. Patients with normal tension glaucoma are treated in the same way as patients with open angle glaucoma.
  • Angle Closure Glaucoma – happens when patients iris is very close to the drainage angle of the eye. When the drainage angle gets completely blocked, the eye pressure will rise very quickly (this is also called an acute attack). An ophthalmologist must be called immediately or blindness can occur. The symptoms of acute attack include
  • Vision is suddenly blurry
  • Severe eye pain
  • Having a headache
  • Feeling sick (nausea)
  • Vomiting
  • Rainbow colored rings or halos around lights are seen

Patients at risk for developing closed angle glaucoma often have no symptoms before the attack.

  • Congenital Glaucoma – a rare type of glaucoma, which is developed in infants and younger children and can be inherited. The condition can result in blindness if not diagnosed and treated early.
  • Secondary Glaucoma – a type of glaucoma, which occurs from another eye condition or disease.
  • Glaucoma Suspect – patients with normal eye pressure but the optic nerve or visual field looks suspicious for glaucoma.

Glaucoma Treatment Procedure

Glaucoma is a permanent disease. It can be prevented with medication or surgery although medication treatment has some side effects like

  • stinging or itching sensation
  • red eyes or red skin around the eye
  • changes in the heartbeat
  • changes in the energy level
  • changes in breathing
  • dry mouth
  • blurred vision
  • eyelash growth
  • changes in the eye color and the skin around the eyes or eyelid appearance

However, for the treatment of glaucoma, surgery is highly recommended. The surgery improves the flow of fluid out of the eye that results in lower eye pressure. There are several types of surgeries such as

Laser Trabeculoplasty – done to treat open angle glaucoma. There are 2 types of trabeculoplasty, ALT (argon laser trabeculoplasty) and SLT (selective laser trabeculoplasty). In an ALT surgery, laser makes a tiny spaced burn in the trabecular meshwork. SLT uses a newer lower energy laser that only treats specific cells in the drainage angle. Even when the surgery is successful some patients are required to use glaucoma medications after the surgery. Laser trabeculoplasty can be used as a first line of treatment for patients who cannot use glaucoma eye drops.

Laser Iridotomy – recommended for treating people with closed angle glaucoma and with very narrow drainage angles. The laser creates a small hole, in the size of a pinhead, going through the iris to improve the flow of aqueous fluid to the drainage angle.

Peripheral Iridectomy – performed when laser iridotomy is unable to stop an acute closed angle glaucoma attack or when other reasons occur. A small piece of the iris is removed giving the aqueous fluid access to the drainage angle.

Trabeculectomy – a small flap is made in the sclera. Filtration bleb or reservoir is created under the conjunctiva. The aqueous humor can go through the flap made in the sclera and collect in the bleb where the fluid will be absorbed into the blood vessels around the eye.

Aqueous Shunt Surgery – in situations where trabeculectomy cannot be performed, aqueous shunt surgery is successful in lowering the eye pressure. An aqueous shunt is a small plastic tube or valve connected to a reservoir. The plate is placed on the outside of the eye under the conjunctiva. Tube is placed into the eye through a little incision and allows aqueous humor to flow through the tube. Fluid is then absorbed into the blood vessels. Once healed the reservoir is not easily seen unless the patient looks upwards and the eyelid is lifted.

Suitable Patients for Glaucoma Surgery

  • Patients over the age of 18
  • Patients at a good health condition and are healthy mentally and physically

Patients which are unsuitable for eye drops or unsuccessful at controlling pressure in the eye

Before Glaucoma surgery

  • Patients must take their usual blood pressure and heart medications and avoid diabetic medication, aspirin and any blood thinners
  • Do not use glaucoma medication on the eye to be operated
  • Patients must not wear any make up before the surgery
  • Patients must make sure they have someone to come with to the surgery and assist them back home
  • Patients must not eat or drink after midnight before the evening of the surgery

After Glaucoma surgery

  • Patients must not remove the eye patch unless told to
  • Patients are not allowed to read but can watch TV
  • Sunglasses can be worn in sunlight to avoid direct light
  • Eye shield must be worn at sleep for 4 to 6 weeks after the surgery
  • Strenuous sexual activity must be avoided for the first 4 to 6 weeks

Risks of Glaucoma surgery

Just like every surgery there are some risks with glaucoma surgery such as

  • Blurred vision
  • Bleeding in the eye
  • Infection
  • High pressure in the eye

Droopy eyelid

Definition

Incision – surgical cut made in the skin during surgery or treatment

Conjunctiva – is inside the eye and covers the sclera

Sclera – the white part of the eye

Aqueous humor – fluid between the cornea and the crystalline lens

Optic nerve – the paired nerve that transmits visual info from the retina to the brain

First day of Glaucoma Surgery

The patient will attend a consultation with the ophthalmologist and will be advised about the procedure and their condition. The patient will then be taken through a couple of tests that are required before the treatment. If desired, patients can spend the day to rest and attend the clinic the next day.

Second day of Glaucoma Surgery

The Glaucoma Surgery will be performed. The surgery will take around an hour to perform. The surgery will be done using an ALT and SLT device and also a laser Iridotomy device and peripheral Iridotomy device will be used depending on the type of surgery performed. Once the surgery ends, an eye patch will be applied to protect the eye. Finally, once the patient is feeling better, they are able to return to their settlement with someone accompanying.

Third day of Glaucoma Surgery

Patients will attend a post surgery check up and consultation. If they are approved to be in a good, healthy condition and the surgery results were all successful; the patients are advised with post treatment care requirements and are ready to go back to their normal routine.

Notes

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What is glaucoma?

Glaucoma is a disease that damages the eye’s optic nerve, which usually happens when fluid builds up in front of the eye that increases the pressure in the eye, damaging the optic nerve.

In a healthy eye, a clear fluid called Aqueous humor circulates inside the front of the eye.

Who are people at higher risk for Glaucoma?

  • African Americans, Africans, Asians and Hispanics
  • Prior eye injury
  • People over 60
  • Steroid users
  • Family history of glaucoma

What are the symptoms of Glaucoma?

Symptoms can vary depending on which type of glaucoma but some of them are:

  • Vision loss
  • Cloudy vision
  • Eye pain
  • Watery eyes
  • Redness
  • Dry eyes
  • Nausea and vomit

How is Glaucoma surgery done?

The treatment for glaucoma can be done with medication or surgery. There are various types of surgery techniques like

  • Laser trabeculoplasty
  • Laser iridotomy
  • Peripheral iridectomy
  • Trabeculectomy
  • Aqueous shunt surgery

How long does Glaucoma surgery take?

The surgery usually takes less than an hour to perform.

How long do I need to stay at hospital?

The surgery is done on an outpatient basis so the patient is sent home a few hours after the surgery.

How long do I need to stay in Turkey?

The recommended stay in Turkey for Glaucoma surgery is 2-3 days including consultation before the surgery and after the surgery.

Who can have Glaucoma surgery?

The surgery is suitable for males and females over the age of 18 and who are mentally and physically healthy.

When can I return to work?

Most patients are able to return to work after a week from the surgery without forcing themselves too much.

Are there any risks of Glaucoma surgery?

Just like every surgery there is a possibility of complications occurring such as

  • Blurred vision
  • Bleeding in the eye
  • Infection
  • High pressure in the eye
  • Droopy eyelid

Devices used in Glaucoma Surgery

Laser Iridotomy Device is used in the Glaucoma Surgery.

Operation Price Stay in hospital Stay in Turkey
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about the pricing.		 The surgery is done on an
outpatient basis		 2-3 Days