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Glaucoma

Glaucoma Diagram

 

What is Glaucoma?

Glaucoma is a form of damage to the optic nerve in the back of the eye. The optic nerve connects your eye to your brain and transmits the information we need to be able to see. The damage can be caused by excessive pressure inside your eye (intraocular pressure or IOP) and other factors.

What is the Consequence of Glaucoma?

With optic nerve damage, you may begin to lose your peripheral vision. Your peripheral vision is that vision which is outside of your central gaze. Over time, if glaucoma damage is severe, you may begin to lose your central vision as well.

What are the Different Types of Glaucoma?

The primary forms of glaucoma are called open-angle and closed-angle glaucoma.

What is the Angle of the Eye?

The angle refers to space in the very front part of your eye, between the cornea and the iris. It is where the fluid the eye produces exits the eye.

What is Open-Angle Glaucoma?

Open Angle Glaucoma

Your eye produces an internal fluid called aqueous humor. Aqueous humor drainage takes place in a structure called the trabecular meshwork, located in the angle of the eye. In open-angle glaucoma, there is a malfunction to the trabecular meshwork (black box in the picture). We do not know precisely what causes this malfunction. We do know that there are known risk factors, such as age, a family history of glaucoma, history of taking steroid medication or prior trauma. As a consequence of the malfunction, aqueous fluid doesn’t drain quickly enough, causing the IOP to become elevated, leading to optic nerve damage.

What is Closed-Angle Glaucoma?

Closed Angle Glaucoma

As seen in this picture the aqueous fluid has a difficult time passing between the iris and the lens. The pressure of the fluid pushes the iris forward leading to a narrowing of the angle. This, in turn, can lead to optic nerve damage. IOP can be elevated in this form of glaucoma, but not always.

How Can my Glaucoma Specialist Know if I Have Open Vs. Closed-Angle Glaucoma?

Your glaucoma specialist uses a specialized contact lens called a gonioprism to evaluate the angle. This is a painless assessment done during the course of your eye exam.

I Have High Blood Pressure. Is This Causing My High IOP?

No. There is no clear association between elevated blood pressure and IOP. Blood pressure relates to the pressure of blood in your blood vessels. IOP elevation usually relates to a malfunction in the drainage system of the eye, preventing normal aqueous fluid drainage.

My Glaucoma Specialist Told Me That I Am A “Glaucoma Suspect.” What Does This Mean?

This means that your eyes have some risk factors for glaucoma, but there is no clear damage to the optic nerve. Based on the risk factors present, your glaucoma specialist can give you some perspective on the likelihood of you developing glaucoma in the future. We typically monitor glaucoma suspects once or twice a year and recommend treatment if it is felt that the risk of developing glaucoma is increasing.

My Physician Told me That I Have Glaucoma. Am I Going to go Blind?

Fortunately, with proper treatment and follow up, blindness from glaucoma can normally be prevented.

Is There a Cure for Glaucoma?

At present, there is no cure for glaucoma, but proper treatment usually prevents vision loss. Read more about glaucoma treatment options.

The Glaucoma Consultation

What can I expect at my glaucoma consultation visit?

A glaucoma evaluation requires multiple pieces of information. Your glaucoma team will check your vision and IOP and other various features of the eye. Imaging in the form of a very brief picture test often aids your glaucoma specialist in evaluating your optic nerve. Your glaucoma specialist will sit down with you, evaluate your eye and IOP and discuss the findings.

I’ve had my IOP checked at my regular eye doctor’s office. Do I need my IOP checked again?

It is important that your glaucoma specialist do an independent evaluation of your eye and your IOP.

What is the purpose of the visual field test?

The visual field test is a simple office test that evaluates your peripheral vision. This aids your glaucoma specialist in assessing the severity of your glaucoma.

I have great peripheral vision, why do I need to take this test?

No matter how great you think your peripheral vision is, you may still have glaucoma damage which can only be detected by visual field testing.

Glaucoma Research

New Glaucoma Treatments May Reduce Need for Eye Drops

Brian Flowers, MD of Ophthalmology Associates is currently evaluating new treatments for patients with mild to moderate and moderate to severe glaucoma. Amongst these new and innovative treatments, there are procedures known as “MIGS” (MINIMALLY INVASIVE GLAUCOMA SURGERY). “MIGS” are less invasive than traditional glaucoma surgery. “MIGS” are generally performed in conjunction with cataract surgery for treatment of patients with mild to moderate glaucoma. However, we are currently evaluating the effectiveness of “MIGS” as a stand-alone procedure as well as for patients with more advanced glaucoma. There are also other treatment techniques and devices being evaluated in lieu of traditional glaucoma surgery for the patient that needs a more advanced intervention. These procedures are shown to have less post-operative recovery time than traditional glaucoma surgery.

Glaukos iStent Inject

iStent

(photos courtesy of Glaukos, Corp.)

Two iStent inject stents are implanted in the eye during cataract surgery within the natural drainage system and may help reduce or eliminate the need for eye drops in some patients. The stents are designed to reduce intraocular pressure and prevent further vision loss due to glaucoma.
The clinical trials for the iStent Inject and iStent Supra in conjunction with cataract surgery have been completed and is now being evaluated by the FDA for approval.

***There is an ongoing and enrolling trial to evaluate the Glaukos iStent Inject as a stand-alone procedure.

Glaukos iStent Supra

iStent

iStent Supra (photos courtesy of Glaukos, Corp.)

The iStent Supra procedure consists of placing one stent inside your eye, during cataract surgery using the same opening used to take out your cataract. The iStent Supra stent is placed within a drainage pathway of the eye and is implanted with the goal of lowering pressure. This is done by creating a channel into one of the existing drainage systems that allows fluid to flow out.

The clinical trials for the iStent Inject and iStent Supra in conjunction with cataract surgery have been completed and is now being evaluated by the FDA for approval.

Ivantis Hydrus

Hydrus Aqueous Implant

Photo courtesy of Ivantis

The Hydrus Aqueous Implant, roughly the size of an eyelash is being tested to see if it can relieve the high intraocular pressure (IOP) this is common in patients with primary open angle glaucoma (POAG). The tiny Hydrus scaffold is designed to be inserted into the primary fluid canal (called Schlemm’s canal) of the eye and open the channel to flow more freely, thus reducing high IOP. http://www.ivantisinc.com/.

The clinical trial for the Hydrus Microstent in conjunction with cataract surgery has been completed and is now being evaluated by the FDA approval and is expected to be approved late fall 2018.

***There is an ongoing and enrolling trial to evaluate the Hydrus Microstent as a stand-alone procedure.

Transcend Cypass Micro-stent

Micro Stent

Photo courtesy of Transcend Cypass

Transcend Medical has developed micro-stent technology that is designed to be implanted at the time of cataract surgery in patients with primary open-angle glaucoma. The CyPass Micro-Stent is a small device that is implanted just below the surface of the eye.

Acquired February 2016 by Alcon from Transcend Medical and The FDA approved the Cypass procedure in conjunction with Cataract surgery in August of 2016 and is now available to the general public.

Sight Sciences VISCO360 Procedure in Canaloplasty

Many glaucoma surgeries today drain excess eye fluid creating a bulge of fluid under the surface of the white part of the eye. This bulge is called a “bleb” and sometimes involves placing a permanent implant. The Visco360 Procedure is a system intended to be used inside the eye to perform a procedure to aid in lowering your intraocular pressure. The VISCO360 system is designed to help drain excess fluid from the eye without creating a bleb or requiring a permanent implant. The VISCO360 system will be used to inject an approved viscous liquid into a small canal at the front of your eye. This will open the canal with the goal of helping lower your eye pressure and control your glaucoma.

Sight Science Canaloplasty

Photo courtesy of Sight Sciences

InnFocus Inc. MicroShunt®

The InnFocus Microshunt is a minimally invasive stand-alone procedure for mild, moderate, and severe stage open angle glaucoma, with the potential to eliminate eye drop medications in most patients. Unlike many MIGS (micro-invasive glaucoma surgery) technologies, the InnFocus MicroShunt does not require simultaneous removal of the cataract.

InnFocus Micro Shunt

Photo courtesy of InnFocus Inc.

ForSight VISION5/Allergan Ocular Insert

This ocular insert drug delivery system was acquired by Allergan pharmaceuticals in 2016, and is still undergoing clinical trials for efficacy. This is a non-invasive ocular ring insert that rests on the surface of the eye beneath the eyelid, to be inserted by an ophthalmologist or optometrist. The ring releases a glaucoma drug and treats glaucoma over the course of multiple months by reducing pressure in the eye. This type of drug delivery system enables it to be preservative free and helps improve patient compliance since there is no need to administer drops daily.

ForSight VISION5/Allergan Ocular Insert

Photo courtesy of ForSight Vision 5

For a complete list of clinical trials please click here

For more information about whether you are an eligible candidate for a research study, talk to your doctor or call the glaucoma research department at Ophthalmology Associates in Fort Worth at 817-332-2020.

CLINICAL TRIALS

ONGOING CLINICAL TRIALS

Randomized Study of the Safety and Effectiveness of the Sight Sciences VISCO™360 Viscosurgical System Versus SLT in Primary Open Angle Glaucoma (VISCO360 Study) [Protocol SIGHTVISCO-001]
Sponsor: Sight Sciences, Inc.

The Hydrus Microstent for Refractory Open-Angle Glaucoma: A Prospective, Multicenter Clinical Trial [Protocol CP 16-001]
Sponsor: Ivantis, Inc.

A Prospective, Randomized, Controlled, Parallel Groups, Multicenter Clinical Investigation of the Glaukos® Trabecular Micro-Bypass System Model G2-W vs. Selective Laser Trabeculoplasty [GC-004]
Sponsor: Glaukos Corp.

PAST CLINICAL TRIALS

A Prospective, Randomized, Single-Masked, Controlled, Parallel Groups, Multicenter Clinical Investigation of the Glaukos® Suprachoroidal Stent Model G3 in Conjunction with Cataract Surgery [GC-007]
Sponsor: Glaukos Corp.


A Prospective, Randomized, Single-Masked, Controlled, Parallel Groups, Multicenter Clinical Investigation of the Glaukos® Trabecular Micro-Bypass Stent Model GTS400 using the G@-M-IS Injector System in Conjunction with Cataract Surgery [GC-008]
Sponsor: Glaukos Corp.


A Randomized Study Comparing the Safety and Efficacy of the InnFocus MicroShuntTM Glaucoma Drainage System to Standard Trabeculectomy in Subjects with Primary Open Angle Glaucoma [Protocol INN-005]
Sponsor: InnFocus, Inc.


A Prospective, Randomized, Single-Masked, Comparative, Multicenter Clinical Study To Assess the Safety and Effectiveness of the Transcend CyPass Glaucoma Implant in Patients with Open Angle Glaucoma Undergoing Cataract Surgery (COMPASS Study) [TMI-09-01 Extension]
Sponsor: Transcend/Alcon


The Safety and Effectiveness of the Hydrus Aqueous Implant for Lowering Intraocular Pressure in Glaucoma Patients Undergoing Cataract Surgery, A Prospective, Multicenter, Randomized, Controlled Clinical Trial (Hydrus 4 Study) [Protocol CP 11-001]
Sponsor: Ivantis Inc.


A Phase 2 Prospective, Multicenter, Randomized, Double-Masked Clinical Trial to Evaluate the Safety, Efficacy and Dose-Response of the Bimatoprost Ocular Insert (2.2 mg, 13 mg) and Timolol (0.5%) Topical Ophthalmic Solution in Patients with Open-Angle Glaucoma or Ocular Hypertension
Sponsor: ForSight VISION 5, Inc.


A Prospective, Double-Masked, Randomized, Multi-Center, Active Controlled, Parallel Group 12-Month Study Assessing the Safety and Ocular Hypotensive Efficacy of PG324 Ophthalmic Solution Compared to AR-13324 Ophthalmic Solution, 0.02% and Latanoprost Ophthalmic Solution, 0.005% in Subjects with Elevated Intraocular Pressure [Protocol PG324-CS301 Mercury 1]
Sponsor: Aerie Pharmaceuticals, Inc.
Alcon C-00-50 Phase IV Travatan in African Americans
Allergan Mementine Phase III
Alcon C-01-69 Phase III, Travatan/Timolol vs Travatan
Alcon C-01-70 Phase III, Travatan/Timolol vs Travatan
Allergan internet study
Alcon ORA study
Alcon Travalert C-04-69
Pfizer Xalacom US Phase II

For more information about whether you are an eligible candidate for a research study, talk to your doctor or call the glaucoma research department at Ophthalmology Associates in Fort Worth at 817-332-2020.

Specialized Doctors

Brian Flowers, M.D.Brian Flowers, M.D.Unni Nair, M.D.Unni Nair, M.D.

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