Glaucoma specialists at New York Eye and Ear Infirmary of Mount Sinai (NYEE) have deep expertise in the medical and surgical treatment of glaucoma. The Service sees thousands of patients every year from the Metropolitan area, affording us the opportunity to treat the most difficult cases. In addition to treating patients, our glaucoma specialists are actively involved in glaucoma research and the advancement of surgical techniques.
Early treatment of glaucoma is critical to halting its progress. Medical management is the first step in that process. Your ophthalmologist will typically prescribe drops to lower pressure in your eye by turning down the fluid production or enhancing fluid drainage within the eye.
Medical Management of Glaucoma
Physicians at NYEE use a wide range of topical and oral medications to treat glaucoma. Glaucoma medicines work by increasing the fluid outflow from the eye and/or reducing the fluid production within the eye. Side effects may include stinging and reddening of the eye, blurred vision, dry mouth and headaches. Preservative-free formulations of some of the commonly used glaucoma eye drops are available and can be helpful in reducing the redness and irritation that some patients experience with these medications.
Major types of medicines we prescribe include:
- Prostaglandins, which include latanoprost, travoprost, bimatoprost, and tafluprost
- Beta blockers, which include timolol maleate and timolol hemihydrate
- Cholinergic agonists and acetylcholinesterase inhibitors, which include pilocarpine and echothiophate iodide
- Alpha-2 Adrenergic receptor agonists, which include brimonidine and apraclonidine (also a weak alpha-1 agonist)
- Carbonic anhydrase inhibitors, which include both oral (acetazolamide, dichlorphenamide, and methazolamide) and topical (dorzolamide and brinzolamide) formulations
- Combination drops, which include:
- Beta –blocker + Carbonic anhydrase inhibitor: dorzolamide-timolol
- Beta-blocker + Alpha-2 agonist: brimonidine-timolol
- Alpha-2 agonist + Carbonic anhydrase inhibitor: brimonidine-brinzolamide
Surgical Care of Glaucoma
If medicines fail to achieve the desired results, surgical treatment is an effective way of reducing intraocular pressure. The type of surgery used by NYEE surgeons to treat glaucoma depends on a variety of factors, including the type and severity of glaucoma, patient age and ethnicity, prior eye surgery, and the presence of other eye conditions, particularly those that may also require surgery.
Common glaucoma surgery includes:
- Laser trabeculoplasty (including argon, selective and MicroPulse® laser trabeculoplasty), where an ophthalmologist applies low-energy laser pulses to the eye’s drainage tissue (trabecular meshwork), prompting chemical and biological changes that enhance the impaired drainage.
- Trabeculectomy, a procedure in which the surgeon lowers the eye pressure by making an opening into the front chamber of the eye which allows fluid to drain to the surface and form a blister, or “filtering bleb,” beneath the eye’s lining skin.
- Glaucoma drainage implants, also known as aqueous tube shunts, in which the surgeon places a small silicone tube in the front or back chamber of the eye to bypass the eye’s damaged outflow system and drain fluid to a reservoir that is positioned on the surface of the eye, beneath the eye’s lining skin.
- Micro-invasive glaucoma surgery (MIGS), describes a group of surgical procedures that use tiny incisions and minimal surgical manipulation to stent or open up the eye’s normal internal drains, or bypass these drains and shunt fluid to the eye’s surface or internal compartments. These procedures minimize disturbance of the delicate eye tissues and allow for quicker healing and postoperative recovery. MIGS procedures are most appropriate for patients with mild to moderate glaucoma and include a new generation of shunts or stents which channel fluids among compartments within the eye to reduce intraocular pressure.
- Laser peripheral iridotomy,a procedure for patients with “narrow angles” who are at risk for or have developed the closed-angle type of glaucoma. The physician uses a laser beam to create a tiny hole in the iris (the colored tissue in the front of the eye) thereby allowing for the passage of fluid from the back chamber of the eye where it is made to the front chamber where it has access to the eye’s drainage channels.