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Advances in Treating Glaucoma

Advances in Treating Glaucoma

by Robert Arleo, M.D.

Eighty thousand Americans lose their sight to glaucoma every year, while ten times that number struggle with glaucoma-related vision problems. A disease of the optic nerve, glaucoma is the most prevalent major eye disorder in people over the age of 60.

Glaucoma occurs when pressure inside the eye becomes gradually elevated, causing damage to the optic nerve. Most people have no symptoms until they notice changes in their visual field-typically a decrease in their peripheral vision. Unfortunately, at this point, damage to the optic nerve is well underway. There is no cure for glaucoma, and once diagnosed, it must be treated to prevent blindness.

In most newly diagnosed cases of glaucoma, treatment begins with medication. For years, there have been three classes of medications: beta blockers (Timoptic being one of the most common); miotic agents (such as Pilocarpine); and oral agents, which are carbonic anhydrase inhibitors (like Diamox). Each of these drugs has a range of unpleasant side effects.

Timoptic, which lowers internal eye pressure by decreasing fluid production in the eye, can have an adverse effect on emphysema and asthma. Some people on Timoptic find they are easily fatigued. On the other hand, Pilocarpine, which increases the fluid outflow of the eye, constricts the pupils, resulting in poor night vision. Miotic agents like Pilocarpine also increase the risk of cataracts and retinal detachment, and they irritate the eye surface. And finally, while many of the oral agents like Diamox do lower internal eye pressure by decreasing fluid production, they make many people feel generally lousy.

New medications have fewer side effects

Within the past few years, three new drugs have been approved for treating glaucoma. They are more easily tolerated by patients and have fewer side effects.

The first is a whole new class of medication, which is basically "an eye-drop form" of the oral agents. Most people know this drug by the name Trusopt. The second medication on the market is an alpha agonist called Alphagan. This also comes as an eye drop, and has no known side effects other than eye irritation and chronic redness. The last of these newer medications is a very powerful agent that both decreases production of fluid in the eye and increases fluid outflow. This is a prostaglandin inhibitor called Xalatan. Its side effects are a bit odd: green-eyed people may find their eye color gradually changing to brown and their eye lashes growing thicker and longer. Xalatan users also experience general ocular inflammation, but other unpleasant side effects are absent.

In addition to these new classes of drugs, there are more user-friendly formulations of the older drugs. For example, Cosopt-a new combination of Trusopt and Timoptic-needs to be administered fewer times a day and is less irritating to the eye. Researchers are also working on a neuroprotectic agent that is not on the market yet. The goal with this class of medication is to protect the optic nerve from damage.

When medications fail

When a medical approach to glaucoma treatment fails, laser therapy and surgery are additional options to consider. Argon laser trabeculoplasty is a procedure done in the ophthalmologist's office, which increases the fluid outflow of the eye. It is low-risk, has a high rate of success, and patients recover from it rapidly. As a matter of fact, trabeculoplasty is being used more often now as an initial therapy because it can minimize the use of medications, thereby decreasing unpleasant side effects.

In those advanced cases of glaucoma where laser therapy is not effective, an outpatient surgical procedure called trabeculectomy can help to decrease fluid retention in the eye and reduce internal pressure. Improved sutures and new medications injected after the surgery have enhanced the success rate of this procedure, which essentially creates a hole in the eye that acts as a drain. In the most severe cases, a tiny tube with a valve is inserted to regulate fluid retention and keep the hole open.

With new medications and improved laser and surgical intervention, we are able to control glaucoma more aggressively now than ever before. Better visual field testing and optic-nerve imaging also help us track the progression of the disease. The fact remains, however, that early detection is critical. Since you can't feel glaucoma or pick up on symptoms until it has progressed, you should see your eye doctor bi-annually after age 45 for a thorough examination. If you have a family history of glaucoma, see your eye doctor annually.

Dr. Arleo is board certified in ophthalmology and serves on the medical staff of Cayuga Medical Center. He is in practice with Arleo Eye Associates of Ithaca, and performs surgery at the medical center and at Surgicare, located on the Convenient Care Campus. He can be reached at (607) 257-5599, in his office at 100 Uptown Road in Ithaca

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