We all know attending regular eye examinations can be challenging. Not having enough time in the day can make this duty difficult to fulfill which is a primary reason why Dr. Alan Mendelsohn and Dr. Nathan Klein have extended office hours which include appointments early mornings, Monday evenings, and on Sunday mornings. When it comes to your eyesight, you want to be proactive. Every year, thousands of people suffer from an eye disease called glaucoma. Glaucoma, unlike many other eye diseases, does not have symptoms until permanent vision loss occurs. So, what is glaucoma, and what should you be looking out for?
What is Glaucoma?
Glaucoma is a group of ocular diseases characterized by progressive, irreversible damage to the optic nerve in the back of the eye, with over 70 million people worldwide afflicted. Like a sink, the the fluid in the eye, called the aqueous humor, is produced at a consistent rate throughout one’s lifetime, and drains through outflow tracts in the eye. Ideally, aqueous humor should be produced and drained out of the eye at similar rates, maintaining a consistent internal pressure in the eye, referred to as intraocular pressure (IOP). Sometimes, the drain becomes clogged, leading to damage to the optic nerve, resulting in permanent loss of vision.
There are two primary types of this disease, open-angle glaucoma (the most common) and angle-closure glaucoma. Both types of glaucoma have the same root cause: an increase of natural fluids in the eye due to improper or blocked drainage of the eye. This excess fluid builds dangerous pressure in your eye, which can cause irreparable damage to your optic nerve. Open-angle glaucoma can occur gradually, painlessly and often, unnoticed. In fact, many prominent glaucoma researchers believe that as many as 50% of individuals with glaucoma are not diagnosed until there has already been significant, permanent vision loss. Naturally, in almost all cases, this is entirely preventable.
Especially those with one or more of the prevalent risk factors should be exceedingly conscientious in having an annual comprehensive ocular examination to rule out glaucoma or ocular hypertension. The strong risk factors include: diabetes, hypertension, family history of glaucoma, obstructive sleep apnea, taking steroids/corticosteroids for a few weeks or longer, and Black or Hispanic heritage. Once glaucoma does develop, vision loss can become severe and irreversible, which is why a comprehensive annual eye exam with Alan Mendelsohn, MD, FACS, or Nathan Klein, OD, are always recommended, as opposed to a cursory exam at a retail outfit.
In its early stages, open angle glaucoma has no symptoms. However, with a comprehensive eye exam, OCT diagnostic tests of the optic nerve, Optomap, and peripheral visual field evaluation, Drs. Mendelsohn and Klein can detect glaucoma at its very incipient stages, thereby preventing vision loss. Optical Coherence Tomography (OCT) uses light waves to create detailed, high resolution, cross-sectional images of the retina and optic nerve to detect the onset of glaucoma or glaucoma progression at exceedingly early stages. Drs. Mendelsohn and Klein have the most technologically advanced and accurate OCT, the Zeiss Cirrus HD-OCT, at the office because the earliest detection and highest degree of accuracy is of paramount importance to us. In an amazing technological breakthrough, highly magnified digital images are produced by Optomap scanning laser technology of the back of the eye, providing your physicians with an unparalleled view of the optic nerve and retinal nerve fiber layer. The Humphrey Visual Field Analyzers that our physicians utilize are an important tool in the diagnosis and management of glaucoma. It is used to confirm that glaucoma has affected the visual function, to evaluate the severity, and to monitor progression of the disease. The Humphrey Visual Field Analyzer is the recognized standard of care for early diagnosis and management of ocular diseases resulting in visual field loss.
By the time your central vision is noticeably impacted, which could take several years, the disease is far along. You should always see Dr. Mendelsohn, or Dr. Klein at the first sign of any vision changes. Because there are no symptoms in the early stages of glaucoma, those with risk factors need to be conscientious about their annual eye exams. As mentioned six of the more prevalent risk factors include: diabetes, hypertension, family history of glaucoma, obstructive sleep apnea, taking steroids/corticosteroids for a few weeks or longer, and Black or Hispanic heritage.
Angle-Closure Glaucoma / Narrow-Angle Glaucoma
Much like open-angle glaucoma, most people develop angle-closure glaucoma (also referred to as narrow-angle glaucoma) over a long period of time and without realizing it. Unlike open-angle glaucoma, when the symptoms of angle-closure glaucoma do manifest themselves, they do so suddenly and often very painfully. In addition to headaches and eye pain, your vision may suddenly worsen and you may feel sick to your stomach. This is known as acute angle-closure or a narrow-angle glaucoma attack. At this point, the disease is dangerously far along and may be causing irreparable damage to your vision. If this occurs, you should see Dr. Mendelsohn, or Dr. Klein immediately. This is a prime example where ocular preventive care can be eyesight saving. If an eye appears to be at risk or in imminent danger of angle closure, preventatively, a two-minute laser procedure can be performed in the office called a laser PI (peripheral irridotomy). Dr. Mendelsohn played an integral role in developing an innovative technique with this procedure using an argon laser to perform a laser PI (Ophthalmic Surgery)as well as different research guiding ophthalmologists on how to avoid complications performing a laser PI with a YAG laser (Archives of Ophthalmology).
Humphrey Vision Field Testing
OCT (Ocular Coherence Tomography)
Optic Nerve Photo
While there is not yet a permanent cure for glaucoma, there are many ways to successfully treat the disease and prevent further vision loss. If caught early enough, treatment of glaucoma means no significant loss of vision. So, what are some common treatments?
The goal of glaucoma therapy is to halt the progression of disease and prevent continued loss of vision. Medications, laser procedures, and surgery can all be used to treat chronic open angle glaucoma (COAG). The FDA approved Vyzulta in the Fall of 2017 as a potential game-changer in glaucoma medications. Vyzulta has been recently joined by Rocklatan as wonderful, extremely effective, dual action glaucoma drops that simultaneously minimize side effects while also dramatically reducing intraocular pressure. Vyzulta and Rocklatan, very importantly, entail once per day dosing to best fit in to every patient’s lifestyle.
Ultimately, Drs. Mendelsohn and Klein will usually be successful in reducing the pressure in the eye with eyedrops to a safe intraocular pressure (IOP). Please take your glaucoma drops every day as recommended, being conscientious to maintain your schedule. Even on days of scheduled appointments, please take your regularly scheduled glaucoma eyedrops.
Another key pointer: Please keep all of your eyedrops away from other small bottles, such as cyanoacrylate. Dr. Mendelsohn had a patient frantically call him for sudden unexplained blindness in both eyes. As published in Women’s Health, a 60+ year-old glaucoma patient was immersed in building a model. Turns out, she mixed up her glaucoma drops with cyanoacrylate, an extremely fast-acting and an extremely effective adhesive. The glaucoma eye drop bottle and the adhesive bottle are very similar and she was working on building models and inadvertently glued her eyelids shut when she applied one drop to each eye, thinking that it was her glaucoma eyedrops.
Laser Surgery is a more direct approach to ensuring the proper draining of the eye’s fluids. Dr. Alan Mendelsohn is a pioneer in the field, having researched and published enhancements in the two primary procedures:
Trabeculoplasty: This is the procedure used to treat open-angle glaucoma by targeting cells that are blocking the eye’s drainage channels. The laser emits short, low-powered pulses, which remove these obstacles and helps reduce the pressure.
Iridotomy: This procedure is usually performed on patients who have angle-closure glaucoma. In this procedure, the laser is used to create a small hole in the iris, usually in the upper portion so as to remain less visible. Through this hole, fluids can drain more easily and eye pressure is reduced.
Alan Mendelsohn, MD, FACS, performs both of these procedures within the office utilizing top tier Zeiss Argon and/or Zeiss YAG lasers depending on the precise laser treatment that is optimal for your glaucoma condition.
Operating Room Surgery
In the rare event that glaucoma drops and/or laser surgery are unsuccessful, Dr. Mendelsohn can perform a Trabeculectomy, or Filtration Surgery. This will assist with drainage and reduce the harmful eye pressure. Now, there is ground breaking, new minor surgery for glaucoma with unparalled results, namely Minimally Invasive Glaucoma Surgery (MIGS)