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What is Glaucoma?

Glaucoma is actually a group of eye conditions that damage the optic nerve and is a leading cause of blindness. Vision loss happens very gradually and many people do not even notice the vision loss until the disease is a more advanced stage. The incidence of glaucoma increases with age. OMNI Eye Specialists recommends routine eye exams, testing of the peripheral visual fields and measuring of intraocular pressure as important steps in identifying those at risk and in minimizing optic nerve damage resulting in vision loss.

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What Causes Glaucoma?

Increased intraocular pressure (pressure within the eye) caused by a build-up of fluid in the eye is one of the main causes of optic nerve damage. This fluid (aqueous humor) usually exits the eye through a drainage system. But, when this drainage system fails to work properly, the fluid builds up in the eye, causing increased pressure.

Common Types of Glaucoma

Open Angle Glaucoma is the most common form of the condition in the U.S. At OMNI Eye Specialists, we try to identify those at risk before loss of vision occurs. Risk factors include:

  • Race
  • Family history
  • Hypertension
  • Diabetes
  • Appearance of the optic nerve
  • Eye pressure

Therapy for open angle glaucoma usually includes special eye drops, but may also involve specialized glaucoma surgery, including laser eye surgery. Narrow Angle Glaucoma is somewhat uncommon in the United States, but is much more prevalent in Asian countries (this type of the disease may be precipitated by certain over-the-counter cold medicines). Patients complain of eye pain, headache, halos around lights and nausea. Definitive laser treatment is usually helpful in this condition. Angle Recession Glaucoma is associated with severe blunt trauma. This type of glaucoma results in higher intraocular pressure due to damage to the drainage portion of the eye (trabecular meshwork). Patients usually do not experience symptoms and it may take years for the glaucoma to develop.

Other types of glaucoma include pigmentary dispersion, phacomorphic, phacolytic and uveitic. These types of glaucoma are less common, yet can be detected by a thorough eye examination.

Glaucoma Treatment Options

At OMNI Eye Specialists, our focus is on your optimal eye health. Our physicians understand that vision problems and potential vision loss is a cause of anxiety and concern for our patients, which is why our OMNI Eye professionals recommend early detection and regular eye examinations for the successful management of glaucoma. Our priority is the preservation of your vision when it comes to glaucoma and other eye diseases.

Treatment requires monitoring eye pressure and measuring changes in the peripheral field. "Control" of glaucoma usually means that the eye pressure is at an acceptable level and that there has been little or no loss of the visual field, as measured by a visual field analyzer. Control of eye pressure is the mainstay of therapy.

  • Topical Drops: This is usually the first line of treatment. Taken on a daily basis, the drops are typically very effective in controlling eye pressure. Over time, these drops may become less effective and your OMNI doctor may elect to change your medications. Drops either decrease production of intraocular fluid or increase its absorption.
  • Oral Medications: These may also be effective, but have more systemic side effects. If tolerated, medications can be useful adjuncts to other glaucoma treatments.
  • Selective Laser Trabeculoplasty (SLT): This procedure is extremely successful in lowering eye pressure in certain types of glaucoma such as open angle glaucoma, pigment dispersion syndrome and pseudoexfoliation. Treatment is focused on the trabecular meshwork (responsible for fluid drainage from the eye) to increase fluid outflow and thereby reduce eye pressure. This treatment may replace topical drops and can be repeated, if necessary.
  • Laser Iridotomy: This involves the creation of a small hole in the iris (colored portion of eye) to permit an alternate channel or pathway for intraocular fluid to reach the trabecular meshwork and be drained from the eye. This procedure is usually indicated in narrow angle glaucoma.
  • Trabeculectomy: This is a type of surgery whereby intraocular fluid (aqueous humor) is directed to the outside of the eye to increase its absorption. This is commonly performed when medications fail, although some practitioners may recommend this as initial treatment.
  • Seton or shunt placement: This procedure also involves the creation of an alternate pathway for aqueous humor to be absorbed outside the eye. It is not a first line of treatment and may be reserved for very difficult situations.

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DURYSTA™ (Bimatoprost Implant)

DURYSTA™ was recently approved by the FDA. Since March 5th, 2020 we are able to use DURYSTA as an additional method to reduce intraocular pressure. But what is it exactly? How does it work? Are you an ideal candidate for this procedure?

What is DURYSTA?

DURYSTA is also known as bimatoprost implant. It is a drug for ocular hypertension and open-angle glaucoma, and it should be administered through an outpatient therapeutic procedure.

The drug is administered with a sterile applicator after inserting the tip into the anterior chamber of the eye. The bimatoprost implant is released, the needle is removed, and the patient needs to sit for one hour to recover.

Within the eye, the implant releases the drug steadily for a 90-day period. It is a prostaglandin analog that stimulates the outflow of aqueous humor and reduces the intraocular pressure.

The FDA approved the bimatoprost implant because it is really effective. Compared to topical timolol eyedrops, DURYSTA reduced intraocular pressure by 30%, and is only administered once every 3 months instead of twice daily.
But would you prefer applying eyedrops twice a day over a 90-day implant.

According to past experiences with patients, 83% of them said they were likely or very likely to undergo the procedure once again because it is not burdensome and makes their lives easier.

Are you an ideal candidate for DURYSTA?

DURYSTA is useful in cases of open-angle glaucoma and ocular hypertension. However, not everyone is an ideal candidate for DURYSTA. It actually has a few contraindications:

  • Diagnosed or suspected periocular infections
  • Diagnosed or suspected ocular infections
  • Patients who underwent corneal transplantation
  • Patients with corneal endothelial cell dystrophy
  • In case of a rupture or absence of the posterior lens capsule
  • In case of hypersensitivity to the drug or components of the bimatoprost implant

In other words, it should only be used in patients with an open angle, good topical response to bimatoprost, and no underlying issue or infection in the cornea.

For more information read the latest information here. You can also download a patient education sheet here.

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