Glaucoma is an optic neuropathy (a disease of the optic nerve) that results from damage due to too much pressure in the eye. As the optic nerve becomes damaged, people gradually lose their sight. There are several subtypes of glaucoma but this disease is most easily understood as either Open or Closed Angle.
While eyedrops have been the mainstay for glaucoma treatment, there are other glaucoma procedures that can be done in the office to manage this disease. Glaucoma procedures and treatments have been modernized, continue reading to learn how the Switch Eye Center approaches glaucoma.
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Micro-Invasive Glaucoma Surgery
Dr. Switch was one of the first Eye Surgeons in the State of Michigan to perform surgery using the iStent Implant outside of clinical trials. This procedure is done at the same time as cataract surgery. There are many other newer micro-invasive glaucoma surgery (MIGS) procedures that are being developed. We plan to offer some of these procedures going forward.
At Switch Eye Center, we focus on offering the latest technology and treatment options for patients, and continue being involved in the research and development of cutting edge eye care technology.
If you are interested in learning more about this groundbreaking technology, call the Switch Eye Center today at (313) 295-3937 to schedule an appointment and find out if MIGS is right for you.
Procedures for Closed Angle Glaucoma
Peripheral Laser Iridotomy (PI)
This treatment is recommended for patients who have been identified as having anatomically narrow or closed angles (drainage ducts) in the eye, which places them at risk of a closed angle glaucoma attack. It is also used for patients who have elevated pressures, which are not well controlled with eye drops.
A Peripheral Iridotomy is a small opening that is created in the iris (the colored part of the eye) that allows excess fluid to drain without resistance and prevents a buildup of pressure. The hole is usually made in the superior portion of the iris where it is hidden under the eyelid. This hole is made using a cold laser, which is applied while the patient is sitting in the exam chair.
As the eye creates fluid (aqueous), the fluid flows around the lens and into the front chamber of the eye in front of the pupil. This fluid is then drained at the base of the iris. In some individuals, this flow of fluid can be blocked off before it reaches the drain. As the pressure builds in the eye, patients are at risk of serious complications and damage to the structures of the eye. The small hole in the iris (PI) allows the fluid to bypass this area of blockage and drain normally, thus preventing an acute glaucoma attack.
Dr. Switch and Dr. Rasansky preforms this office procedure for patients who have been identified being at risk for this condition. The procedure is outlined below.
- Our doctors will instill a drop, which constricts the pupil.
- A numbing eye drop will be placed in the eye, although the procedure is virtually painless, this drop decreases the urge to blink more often during the procedure.
- A special contact lens will be placed on the eye causing a temporary blurring.
- The procedure typically takes less than one minute. During the procedure, Drs. Switch or Rasansky will be focusing a small light in your eye. You will here several “beeps” from the laser as it is applied.
- After the procedure, our doctors will have you wait 15 minutes and then recheck your eye pressure.
- You will be sent home on an anti-inflammatory eye drop to use for four days.
After surgery, you may be light sensitive for the next 4-6 hours. There are no restrictions after this procedure. Typically, the procedure only needs to be done once. In some patients, this small hole can close up, which requires a second procedure. Patients with closed angle glaucoma in one eye have a 50% chance of developing it in their other eye. For this reason, Dr. Switch and Dr. Rasansky may recommend having this procedure in both eyes.
Procedures for Open Angle Glaucoma
SLT (Selective Laser Trabeculoplasty)
Selective laser trabeculoplasty (SLT) is a surgical procedure that is used for multiple types of glaucoma. The goal of this procedure is to decrease the overall pressure of the eye by increasing the drainage of the fluid in the eye (aqueous humor). Often times, patients are able to reduce or stop their glaucoma drops after this procedure.
This procedure is recommended when control of pressure cannot be maintained with drop alone and before more invasive surgery is considered.
The Selective Laser Trabeculoplasty uses low energy light to selectively remove the pigmented cells that block the drainage system, known as the trabecular meshwork, while avoiding damage to other structures. This opens up the drain and allows the fluid to flow out of the eye more efficiently. The eye will continue to make more fluid, but the rate it is drained from the eye will be increased so that that pressure no longer builds as it does in untreated glaucoma.
Dr. Switch and Dr. Rasansky preform this painless office procedure for patients who have been The procedure is outlined below.
- While seated in the exam room chair, the eye is numbed with an eye drop.
- A specialized contact lens is placed on the eye. This lens allows our doctors to focus the laser light. The contact lens also prevents blinking.
- During the procedure, you will here a beeping sound as the doctors apply the laser to the remove the cells that are clogging up the draining meshwork.
- After the procedure, you will remain at the office for at least 15 minutes to have the eye pressure rechecked.
- Once the eye pressure is checked, you will be able to leave without any restrictions.
There will be several follow up appointments to ensure the eye pressure decreases after this procedure.
It is important to understand that this procedure does not improve eyesight. The goal of this procedure is to preserve vision from loss due to damage from elevated eye pressure.
Procedures for Secondary Cataracts
Nd:YAG Laser Capsulotomy (Removal of capsular hazing after cataract surgery)
A cold laser called a Nd:YAG (yttrium-aluminum-garnet) laser is utilized in the office to polish the haze of the posterior capsule. This haze is often referred to as a secondary cataract.
This haze is a thin film that develops along the back portion of the membrane that holds the newly implanted lens in place after cataract surgery.
Often, the symptom that will alert a patient to presence of this secondary cataract is a decrease in vision months to years after cataract surgery. The surgical procedure is a minor outpatient procedure that takes only a few minutes.
- First, your eye will then be dilated with eye drops.
- Next, your eye will be numbed with drops.
- A small laser, which is attached to a lamp that Dr. Switch and Dr. Rasansky use to evaluate your eye, will be brought up to your chair.
- Your doctor will focus the laser on the hazed portion of the secondary cataract. The laser is applied while you are sitting in the chair and is painless.
- You will be sent home with an anti-inflammatory drop to use for four days.
- There is no risk of infection or burn with this cold laser. Typically, patients notice some small “floaters“ in their vision for the next 2-3 days.
- Your doctor will have you come back in one week to reevaluate the eye.
- Once the secondary cataract is removed, it does not come back.