Understanding Open-Angle Glaucoma

Since open-angle glaucoma is often silent until its later stages, the only reliable way to diagnose the condition is through comprehensive eye exams. Here’s what our glaucoma specialist typically looks for during an exam:

• Tonometry: This test measures the intraocular pressure inside your eye to see if it is elevated.
• Gonioscopy: This examination checks the angle where your iris meets the cornea, ensuring the drainage angle is open yet functioning improperly.
• Optic Nerve Evaluation: The nerve carrying visual signals is closely inspected for any signs of damage or change in appearance.
• Visual Field Testing: This test maps out the areas of your vision to detect any blind spots or areas of decreased sensitivity.
• Optical Coherence Tomography (OCT): Detailed images of your optic nerve help in spotting early neuropathy or structural changes.
• Corneal Thickness Measurement: Also known as pachymetry, this test is important because variations in corneal thickness can affect pressure readings.

Often, our glaucoma specialist will monitor these parameters over several appointments to accurately diagnose the progression of open-angle glaucoma.

For most patients, prescription eye drops serve as the first line of defense. Using these medications consistently is crucial, as skipping doses might allow damage to progress subtly without noticeable symptoms. Common types of eye drops include:

• Prostaglandins: These help increase the drainage of aqueous humor, thereby lowering eye pressure. Examples include medications like latanoprost, travoprost, and bimatoprost.
• Beta-Blockers: These reduce the production of aqueous humor, with common choices being timolol and betaxolol.
• Rho-Kinase Inhibitors: By relaxing the trabecular meshwork, these drops help improve fluid flow; netarsudil is one example.
• Carbonic Anhydrase Inhibitors: These medications reduce the amount of fluid produced in the eye, with options such as brinzolamide and dorzolamide.
• Alpha-Adrenergic Agonists: These not only decrease fluid production but also enhance drainage. Brimonidine and apraclonidine are frequently used.

If medications are insufficient or unsuitable, laser treatments offer another way to manage open-angle glaucoma. These procedures are typically quick with minimal downtime, and include:

• Laser Trabeculoplasty: This procedure uses a laser to improve the flow of fluid through the eye’s drainage system by targeting the trabecular meshwork.
• Cyclophotocoagulation: Used in cases where reducing fluid production is necessary, this laser treatment helps to lower intraocular pressure by targeting the regions responsible for fluid production.

There are situations where neither medications nor laser therapy can provide sufficient control over eye pressure. In these cases, surgical intervention may be recommended by our glaucoma specialist. Surgical procedures aim to create a new pathway for fluid to exit the eye, thereby reducing intraocular pressure. Common surgical options include:

• Trabeculectomy: In this procedure, a small flap is created in the sclera (the white part of the eye) to allow fluid to drain more freely, forming a new drainage channel.
• Drainage Implants (Tube Shunt Surgery): Tiny tubes are inserted into the eye to channel fluid from the eye’s interior to an external reservoir, reducing pressure over the long term.
• Minimally Invasive Glaucoma Surgery (MIGS): This newer surgical approach uses smaller incisions and typically offers faster recovery times. Although MIGS might not reduce eye pressure as dramatically as traditional surgeries, it can be a beneficial addition—especially when performed together with cataract surgery.