Another Treatment Option for People With Glaucoma

A delicate surgery which gives people with glaucoma another treatment option has been performed here for the first time.

Called “glaucoma tube shunt surgery,” the procedure Tuesday at Scott & White-Brenham yielded outstanding results, said Dr. Shawn Khan, a local ophthalmologist who performed the operation.

“She’s doing great,” Khan said of the 67-year-old patient from Bryan. “Her pressure’s back to normal.”

Glaucoma, a disease of the optic nerve that can result in vision loss, is treated by lowering eye pressure.

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“Glaucoma can’t be reversed, but you can stop the progression,” said Khan.

Initial conventional treatment is to use pressure-lowering eyedrops or a laser to treat the drainage angle of the eye.

The laser surgery makes it easier for fluid to flow out of the front part of the eye, decreasing pressure.

But tube shunt surgery is another viable option if the “conventional” methods don’t work, said Khan.

The patient treated Tuesday was using five different eyedrops in an attempt to lower the pressure “and still wasn’t having any success,” he said.

“She was using all these eyedrops ... there’s the expense and hassle of those. And she was using so many drops that the skin around her eyes was getting red and hardened.”

The tube shunt surgery is exactly as it sounds; a tiny flexible tube is inserted in the front of the eye to just behind the cornea, allowing minute amounts of fluid to drain through the back of the eye, said Khan.

A valve ensures that not too much fluid is drained, he added.

Khan said he has performed the surgery many times, but Tuesday was the first time it’s been done locally.

“It’s been around for a while, but there was nobody here with a glaucoma fellowship background,” said Khan.

The outpatient surgery takes about an hour and recovery time is minimal.

“The patient goes home with a patch and a shield,” Khan said. Those were removed Wednesday, and there were not even any restrictions on things like driving.

Khan said he also found it interesting that a patient was Bryan was referred to medical facilities here for treatment.

“Usually it’s the other way around,” he said.

Phacoviscocanalostomy for open-angle glaucoma with concomitant age-related cataract

Phacoviscocanalostomy controls IOP in eyes with pseudoexfoliation glaucoma, POAG

Phacoviscocanalostomy controlled IOP and improved visual acuity in eyes with pseudoexfoliation glaucoma and primary open-angle glaucoma, a study found.

The prospective study included 30 eyes that underwent phacoviscocanalostomy for cataract and pseudoexfoliation glaucoma and 30 eyes that underwent the procedure for cataract and uncontrolled primary open-angle glaucoma (POAG). Mean age was 70.7 years in the pseudoexfoliation glaucoma group and 58.6 years in the POAG group; the difference was statistically significant (P = .001).

Mean follow-up was 19.7 months. Examinations were performed 1 day, 1 week, and 1, 3, 6 and 12 months after surgery.

Both groups had immediate and statistically significant decreases in mean IOP from baseline (P < .0001).

The pseudoexfoliation glaucoma group had significantly lower mean IOP than the POAG group at all follow-up points (P < .01).

Mean IOP reduction was 12.2 mm Hg (49.7%) in the pseudoexfoliation glaucoma group and 6.7 mm Hg (30.9%) in the POAG group at final follow-up.

Also at final follow-up, 25 eyes in the pseudoexfoliation glaucoma group (83.3%) and 16 eyes in the POAG group (53.3%) achieved IOP of 15 mm Hg or lower without medication; the difference was statistically significant (P < .05).

Uncorrected and corrected visual acuity improved significantly in both groups (P < .005) at all follow-up points.

The complication rate was low and did not influence surgical outcomes. No cases of shallowing of the anterior chamber, hypotony, choroidal detachment or endophthalmitis were reported.

Early Detection of Glaucoma

PATIALA:Dr Gursatinder Singh, an eminent eye surgeon working in the Government Rajindra Hospital, here Tuesday said that the damage caused to the eye because of glaucoma was irreversible. However, medication or surgery, traditional or laser, could slow-down any further vision loss. Therefore, early detection was essential to limiting visual impairment and preventing the progression towards blindness.

Speaking at a Continuing Medical Education (CME) programme organized under the aegis of the Patiala Academy of Ophthalmology by Aromed Pharmaceuticals in collaboration with the Patiala Eye Hospital and Lasik Laser Centre, he said that glaucoma caused progressive damage to the optic nerve at the point where it leaves the eye to carry visual information to the brain and if left untreated glaucoma progressed to gradually worsening visual damage and could lead to blindness. He said that once incurred visual damage was mostly irreversible and this had led to glaucoma being described as the “silent blinding disease” or “the sneak thief of sight.”

Dr Singh said intraocular pressure was a "risk factor" for glaucoma together with other factors such as racial ancestry, family history, high myopia and age. There is no clearly established difference in glaucoma incidence between men and women.

Dr Ranjit Singh Dhaliwal, an eye surgeon from Nabha, a pioneer in small invision cataract surgery north india. said that SICS is the surgery for the comman man as it does not cost much,though the surgeon's skill involved has to be good.results were as good as any machine surgery world over.

Dr Balbir Khan, from the Gian Sagar Medical College and Hospital, highlighted the management of retinoplastry during the coming times.A large number of practicing doctors from Patiala and the surrounding areas participated in the deliberations.

The academic session was followed by a karaoke music competition in which Bollywood film songs relating to eyes and eyesight were played. It proved to be an icing on the proceedings of the evening wherein academics were blended with entertainment.

Glaucoma treatment for old patients

About 675 people turned up during the two-day eye check up camp at the Thimphu referral hospital, which was organised by the Druk lions club.

Most patients, who came for the check up had cataract and retina problems, although the camp was for screening glaucoma.

Glaucoma refers to a group of eye conditions that lead to damage of the optic nerve, the nerve that carries visual information from the eye to the brain.

In many cases, damage to the optic nerve is due to increased pressure in the eye, also known as intraocular pressure (IOP).

Secretary of the Druk lions club Duptho Rinzin said there were around 40 patients, who needed immediate treatment for glaucoma.

“We’re now contacting the Siliguri lions hospital for treatment,” he said. “Then we’ll arrange funds for them.”

Treating a glaucoma patient at Siliguri lions hospital costs about Rs 700, he said.

Lions club will be organising a similar eye camp in Trashigang during the moenlam chhenmo in March this year and a blood donation camp in Paro.

“There’ll be more people gathered during the moenlam chhenmo,” he said. “And we can provide services to more people.”

Opthalmologist at Thimphu referral hospital, Dr Nor Tshering Lepcha, said glaucoma is treated at the hospital as well. “Only some complicated cases are referred to eye hospitals in India,” he said. “Most referred patients are children.”

The rapid assessment on avoidable blindness (RAAB) survey 2009 showed 5.9 percent of eye cases in Bhutan are glaucoma-related, while cataract was 68 percent.

Besides the eye camp, the club is also planning to train teachers in counselling in the next two months. “In a way we’d be helping the government to place a counsellor in each school,” said Duptho Rinzin.

Women's Risk of Open-Angle Glaucoma

Obesity may be associated with reduced risk of the eye disease open-angle glaucoma in women, but not in men, a new study suggests.

Open-angle glaucoma is the most common form of glaucoma, a condition that causes damage to the optic nerve.

In the study, researchers in the Netherlands analyzed data from 3,939 participants, aged 55 and older, who took part in the Rotterdam Study and who did not have open-angle glaucoma when the study began between 1991 and 1993.

Over an average follow-up period of nearly 10 years, open-angle glaucoma developed in 108 participants (2.7 percent). The condition was most likely to occur in those who were older, had severe nearsightedness and in men, said Dr. Wishal Ramdas of the Erasmus Medical Center in Rotterdam, and colleagues.

The investigators found that, for women, there was a link between increased body mass index (BMI) and pressure within the eyes (intraocular pressure), which is a risk factor for open-angle glaucoma. However, they discovered that each one-unit increase in BMI was associated with a 7 percent decrease in the risk of developing open-angle glaucoma, but only among women.

Although the high intraocular pressure among obese women should have put them at increased risk for glaucoma, that didn't appear to be the case, the authors noted. "High estrogen levels and hormone therapy might be protective to open-angle glaucoma, and obesity seems to be positively related with postmenopausal plasma estrogen levels," Ramdas and colleagues wrote.

The study was released online Feb. 14 in advance of publication in the May print issue of the journal Archives of Ophthalmology.

The Best Hope for Glaucoma

The cause of glaucoma is still largely a mystery to medical researchers, but the increasingly common eye disease is among the leading causes of blindness all over the world.

These are some of the points that will come into renewed focus next month when Antigua & Barbuda’s ongoing glaucoma awareness gets an annual booster.

A packed programme has been planned for Glaucoma Week, which begins on March 6 and continues until World Glaucoma Day on March 12.

Optometrist and president of Antigua & Barbuda Glaucoma Support Group Dr Jillia Bird is also president of the World Glaucoma Patients Association.

“Glaucoma is the leading cause of blindness in people of African descent,” she told The Daily OBSERVER. “It is silent and therefore you have to be tested in order to be aware if you have it. The statistics in our part of the world are particularly staggering in black Caribbean eyes. It is probably the leading cause of blindness in Antiguans.”

According to Dr Bird, people should be examined for glaucoma “even in childhood.” She said the condition “is really a group of diseases.”

The optometrist stressed that early diagnosis and treatment offer the only hope of preventing loss of sight from the disease.

She adds that this is even more important, given the type of glaucoma that tends to be common in countries such as Antigua.

She expanded further on why the risk should be treated with utmost seriousness. “The problem with the type that affects us black Antiguans – mainly the open angle glaucoma – is that as doctors we have a patient for one visit at one particular time of the day where the pressure (inside the eye) may be normal or considered normal, and we really have no way of knowing what that pressure is throughout the rest of the day.”

She added that “scientists have worked in the dark for a very long time trying to figure out what is this disease that damages the optic nerve and seems to be related to the intra-ocular pressure, but may not always be.”

Stressing how essential it is to get tested early, Dr Bird noted that “so many people are unaware they have it. It is a silent disease that steals sight slowly, painlessly and you may have well advanced disease before you are even aware that it exists.”

Activities for Glaucoma Week will include a donation of closed circuit TV for visually impaired readers, and glaucoma screenings.

World Glaucoma Day on March 12 will feature a march for sight and a rally.

Comparing glaucoma treatments

It is estimated that around 4,000 people are registered blind or partially sighted in the UK each year because of the eye disorder.

Diagnosing glaucoma can be difficult but new diagnostic tests are available and easy to perform.

However there is a need for robust evidence to guide how best to use these tests which could be potentially very useful, particularly as eye clinicians are already dealing with high numbers of patients.

University of Aberdeen researchers have been commissioned by the National Institute for Health Research Health Technology Assessment programme to compare three new diagnostic technologies - Heidelberg retina tomograph, scanning laser polarimetry and optical coherence tomography.

Augusto Azuara-Blanco, Professor and Honorary Consultant Ophthalmologist at the University’s Health Services Research Unit, is leading the research.

He said: “If one or more of the tests prove to be sufficiently accurate and easy to perform, people would not need to attend lengthy examinations in the hospital eye department in order to establish whether or not they have glaucoma.

“This would give ophthalmologists more time and resources to treat patients who do have eye diseases.

“The majority of people who are referred to hospital by their optometrist do not have glaucoma, however they must be checked out because glaucoma can cause blindness and must be treated early.

“Clinicians in Scotland see 400,000 patients with eye problems a year and glaucoma is a big part of that.

“In the UK the NHS deals with more than one million visits by patients with glaucoma in a year so we are trying to deal with a very large flow of patients.”

The study will involve patients who have been referred by their optometrists with suspected glaucoma or who may be at risk of developing the disease.

The centres involved in the study are Aberdeen Royal Infirmary, St Paul’s Eye Unit in Liverpool, Moorfields Hospital in London and Hinchingbrooke Health Care NHS Trust in Cambridgeshire and patient recruitment will begin in March.

The tests are based on imaging the posterior part (fundus) of the eye where glaucoma damage can be observed. The team will evaluate the performance of these new tests by identifying those who are most likely to have glaucoma and require treatment.

Tiny Device for Tracking Progress of Glaucoma

Scientists at the University of Michigan have developed a pressure monitor device which can be implanted in an individual's eye ball to track the progress of glaucoma. They claim that it is the world's smallest computer system which is just 1 sq mm in size. This device has been developed by Professors Dennis Sylvester, David Blaauw and David Wentzloff. It is yet to be named.

The device contains an ultra low-power microprocessor, a pressure sensor, memory and a thin film battery. It also consists of a solar cell and a wireless radio with an antenna which can transmit data to an external reader device. This radio does not require tuning to find the right frequency and so it can link to wireless network of computers. To charge the battery, the device requires 10 hours of exposure to indoor light or 1.5 hours of sunlight. Information can be stored in the device up to a week. The device takes measurements every 15minutes and consumes an average of 5.3 nanowatts energy.

This device is being seen as the future of the computing industry, though it requires few more years to be available commercially.