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Monday Medical: Gaining ground on glaucoma

Susan Cunningham
For Steamboat Pilot & Today

Glaucoma, a progressive disease that can eventually lead to blindness, comes on slowly. But most people don’t have symptoms until the damage has been done.

“While glaucoma is not the leading cause of blindness, it’s definitely one of the top five causes of blindness in the world and in the United States,” said Dr. Nathan Hamburger, an ophthalmologist in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center.

What is glaucoma?

Glaucoma is an eye disease that causes damage to the optic nerve, which sends signals from the eye to the brain.



“The optic nerve is like a computer cable hooking up the monitor to the computer,” Hamburger said. “If the cable’s damaged, the signal doesn’t get sent to the brain.”

While the cause of glaucoma isn’t clear, it’s associated with high fluid pressure in the eye.



“Presumably, the pressure can get too high for the nerve cells that send signals from the retina to the brain, and some die,” Hamburger said.

Keep in mind that the fluid pressure related to glaucoma is internal and is not related to tears or fluid on the surface of the eye.

What are the symptoms?

There usually aren’t symptoms of glaucoma initially, but eventually, the damage to the optic nerve causes peripheral vision loss.

“It happens so slowly that patients don’t realize it’s happening until they’re left with a very small island of visual field,” Hamburger said. “That’s what makes it important to get your eyes checked regularly. There are signs of glaucoma that eye doctors can see before there are symptoms.”

The main risk factor for glaucoma is a family history of the disease. The disease may also be associated with nearsightedness, diabetes or high blood pressures. Glaucoma typically arises in middle age.

How is it treated?

The first-line treatment for glaucoma is eye drops, which lower the pressure in the eye. Some eye drops slow down fluid production in the eye, while others increase fluid outflow.

Through a procedure known as selective laser trabeculoplasty, lasers can be used to change the eye tissue enough to encourage better drainage of fluid. Effects of the procedure may take a few months to work but then last for one to five years.

In some cases, minimally invasive glaucoma surgery (MIGS) may help. The procedure is quick, and patients typically go home the same day. Often, MIGS surgeries are done simultaneously with cataract surgery.

“It’s convenient to do both at the same time since your ophthalmologist is already working on the eye, and you don’t really add any additional risk to the procedure,” Hamburger said. “If it works to lower the eye pressure, that’s great. But if it doesn’t work, there’s no harm to the patient.”

Through a MIGS surgery, a microscopic stent is placed inside the portion of the eye that drains fluid, or the trabecular meshwork, allowing fluid to drain from the eye more easily.

The stents, which are made of titanium and last for a patient’s lifetime, are incredibly small. Hamburger uses the iStent inject, which is the smallest on the market.

“It looks like a grain of sand,” Hamburger said. “It’s tiny.”

Why should it be treated?

“Any damage from glaucoma is permanent,” Hamburger said. “The point of treatment is to prevent it from getting worse. Early treatment is the name of the game.”

Even if you don’t have eye problems, it is a good idea to begin regular eye checkups in your forties.

“Based on those exams, your provider can customize when your follow-ups should be,” Hamburger said.

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at cunninghamsbc@gmail.com.


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