Review of glaucoma by noted ophthalmologist Dr. Michael Duplessie. Covered in much better detail at

1. COME SEE US, THEN SEE THE WORLD
Michael Duplessie,MD
Taiba Hospital
Department of Ophthalmology
Road No 3,
SabahAl Salem
965-25529019
965-25529019
MICHAEL DUPLESSIE
GLAUCOMA
TOPICS OF DISCUSSION:
• What is glaucoma ?
• How is glaucoma treated ?
• When should I be examined ?
• Is my treatment covered by insurance ?
& GLAUCOMA SURGERY

2. PAGE 2
worldwide firsts and
notables
 Organizer of First United States
Lasik Course
 Organizer of Largest LasikWet lab
course in the world
 First textbook chapter written on
the lasik technique
 First textbook chapter written on
hyperopic lasik
 First textbook chapter on Suture-
less CornealTransplantation
 Editor Advances in Refractive &
Corneal Surgery
 Over 10,000 cataract surgeries and
30,000 lasik surgeries performed
treatment is usually performed in the office, takes only
a few minutes, and is normally painless.
Microsurgery-Penetrating Procedure
The third way to treat glaucoma is with microsur-
gery. Studies have consistently revealed that the eye pres-
sure is reduced to a greater degree through surgical
intervention than the use of eye drops, laser or a combina-
tion of these treatments but with an increased risks of
complications.
In the United States, we prefer to begin treating
glaucoma with eye drops and/or laser applications. In
other countries, such as the European nations, surgery is
selected earlier. United States eye care professionals have
generally held this option for later intervention due to
a percentage of patients that have pressures that are too
low following the surgery or develop other complications.
The surgical procedure that has been considered
the “gold standard” for penetrating procedures is
trabeculectomy. In this procedure, a small drainage hole is
created in the eye, usually located in the upper portion of
the eye.This allows fluid to drain out of the eye and into
the circulation behind the eye in the eye socket.This pro-
cedure effectively drains fluid from the eye as long as the
tissues do not scar sufficiently during the healing phase
after the procedure.
Narrow-Angle GlaucomaTreatment
If you are at risk for or have narrow angle glauco-
ma, Dr. Duplessie will recommend a preventive laser
treatment that creates a small opening in the iris or col-
ored part of the eye. Sometimes narrow angle glaucoma is
a chronic condition that is treated with the same
medicines or microsurgery for open angle glaucoma.

3. Open-Angle GlaucomaTreatment
There are several ways to treat this disease.There is a
growing sentiment among eye care professionals that
a healthy lifestyle, cessation from smoking and exercise
may be valuable in reducing eye pressure.
Most commonly, treatment begins with eye drops
that are designed to lower the pressure in the eye.These
drops are used from one to four times daily, depending on
the medication.They are designed to decrease the amount
of fluid produced in the eye, or to increase the amount of
fluid drained from the eye. Like all medications, these eye
drops can have side effects.There are also oral medications
that are available to lower the eye pressure but often with
greater side effects then the eye drops.
Laser treatment
Another method of treating glaucoma is with a laser.
There are currently two different types of lasers used
to increase the amount of fluid drained from the eye:
 Argon Laser-a thermal laser that creates micro-burns
in the trabecular meshwork.
 Selective Laser-a newer non-thermal laser that targets
the pigment cells in the trabecular meshwork.
The applications can be repeated more than once.
Studies and trials with theArgon laser have shown
pressure reduction in Caucasian patients to have a dura-
tion of two to three years with the lower pressures re-
maining a year or two longer in Black patients.
Both lasers may reduce the number of eye drops
used to control the pressure but rarely does the laser
treatment eliminate the need for the drops.The laser
MICHAEL DUPLESSIE PAGE 3
Glaucoma is one of the leading causes of permanent
blindness in the world. It affects two to three millionAmeri-
cans, and more than twelve million people worldwide. Glau-
coma takes away a victim’s sight slowly, but relentlessly, and
in most cases, without any signs or symptoms.Visual damage
from glaucoma is irreversible and permanent. Blindness
from glaucoma, however, can be prevented with proper pre-
ventive eye care.
Who is at Risk?
Glaucoma can strike people of any age, sex, and race.
Certain individuals, however, are at increased risk.
Those at increased risk include persons ofAfrican de-
scent, those with a family history of glaucoma, persons with
diabetes and possibly those with nearsightedness or high
blood pressure.The risk of glaucoma also increases as one
gets older.The risk of glaucoma increases markedly in peo-
ple ofAfrican descent over the age of 35 years, and in people
of Caucasian descent over the age of 50 years. Other risk
factors for glaucoma include a history of trauma to the eye.

4. What is Glaucoma?
Glaucoma is a disease of the optic nerve, which is
the nerve that connects your eye to your brain.This nerve
transmits visual information from the eye to the brain,
thereby allowing you to see. In most cases, glaucoma dam-
age progresses very slowly, over a period of several years.
However, sometimes this damage can progress more rap-
idly.As the damage to the nerve progresses, a person be-
gins to lose vision.This loss of vision begins with the side,
or peripheral, vision.This is vision that you may not be
aware of, but is very important in everyday activities of
mobility such as walking and driving.The loss of this pe-
ripheral vision progresses as long as the disease is not
treated. If treatment is not given or not effective, then the
visual loss can progress until it begins to involve the cen-
tral, or vision used to read and write. It is at this point that
a victim of glaucoma may begin to notice problems with
vision. If treatment is still not given, then all vision
in the eye can be lost.Visual loss from glaucoma is irre-
versible. Because vision lost from glaucoma can never be
restored, it is critical to detect glaucoma before significant
damage has occurred to the nerve and initiate effective
treatment. Even if vision loss has occurred, treatment for
glaucoma can be provided to prevent further loss of vi-
sion.
Causes of Glaucoma
High pressure inside the eye is known to be one of
the factors that cause glaucoma.The normal eye continu-
ously produces and drains fluid (aqueous) internally in or-
der to maintain the normal shape and pressure of the eye.
This pressure balance and shape is necessary for you to see
properly. In glaucoma, there may be a blockage of fluid
wavelength perimetry.
DifferentTypes of Glaucoma
The most common type of glaucoma is open-angle glauco-
ma. Open-angle glaucoma means that there is no
visible obstruction to the aqueous (fluid) drainage area
inside the eye. It is thought that there may be an invisible
obstruction (tissue) to fluid drainage in the trabecular
meshwork, which is the structure in the eye that drains
the fluid.This type of glaucoma typically causes no symp-
toms until the damage and visual loss is very advanced.
Another type of glaucoma is narrow-angle glauco-
ma.This type of glaucoma may cause symptoms of sudden
pain, redness, blurred vision, and colored haloes around
lights.This condition is called acute narrow-angle glauco-
ma, and must be treated immediately. Failure to treat this
condition immediately can cause permanent loss of vision.
Sometimes narrow-angle glaucoma is a chronic condition
that does not cause any symptoms, like open angle glauco-
ma.

5. To test the visual field, you place your head against
a headrest and stare at a target light that is placed directly
in front of the eye being tested.
The machine then flashes lights in your peripheral
vision. Some of these lights are bright and easy to see.
Others are so dim that they are impossible to see even if
you have no visual damage. Most lights are somewhere in
between.When you see the light, you press a button and
the machine registers your response.The machine then
prints out a map showing any areas where you cannot see
properly. Dr. Duplessie will repeat this measurement pe-
riodically to determine if the glaucoma treatment has been
effective in stabilizing the damage.
The pressure within the eye or intraocular pressure
has classically been thought of as the “key” measure for
diagnosis of the disease. The eye pressure varies depend-
ing on the time of day that the measurement is obtained.
Stability over time is important.
There are other types of specialized testing that
may also be used including: conofocal scanning laser analy-
sis (HRT II); scanning laser polarimetry (GDx); and short
drainage or an excess of fluid production, which leads to
high pressure inside the eye.
If you have high eye pressure, the increased pres-
sure may damage your optic nerve due to compression or
reduction of the normal blood flow to the critical struc-
tures of the optic nerve. Some people, however, are able
to tolerate higher eye pressures without developing glau-
coma damage to the optic nerve.The reason for this is un-
known.
The target for success in many studies has been eye
pressure below 21mm, whereas new clinical information
reveals that vision is preserved to a much greater degree if
pressures are maintained at 16mm or below.
Some people develop glaucoma even without evi-
dence of increased pressure inside the eye. In fact, recent
studies show that up to 50 percent of people with glauco-
ma may not have high eye pressure measurements.
For example, persons of Japanese descent are more
prone to have glaucoma without elevated eye pressure,
and normal-pressure glaucoma is more common in Japan
than high-pressure glaucoma.

6. The two leading theories are that damage to the
nerve is caused by poor circulation to the nerve, or that
abnormally high concentrations of naturally occurring
chemicals or hormones cause the damage.
Many of these people with normal pressure
glaucoma also have other problems with their circulation,
such as heart disease, poor circulation to their legs and
feet, or hardening of the arteries.
Other scientists have shown increased concentra-
tions of glutamate, nitric oxide and other chemicals in the
eyes of people with glaucoma.These chemicals are natu-
rally produced by the body, scientists still have not discov-
ered why the body produces abnormally high amounts of
these chemicals in eyes with glaucoma nor how to reduce
the concentrations to levels that preserve the nerve.
Glaucoma Diagnosis
Dr. Duplessie can detect glaucoma damage by the
appearance of your optic nerve.A normal healthy nerve
has a small depression in the center.
As damage from glaucoma progresses, this depression or
hole in the center of the nerve becomes deeper, enlarges,
and damages the healthy tissue of the nerve. Dr. Duples-
sie can detect progression of the disease by periodically
examining the appearance of the nerve.
If you are a glaucoma suspect, Dr. Duplessie will
want to examine your optic nerve two or three times a
year, to detect definite glaucoma damage as soon as it oc-
curs.This will allow treatment to begin before the glauco-
ma has a significant effect on your vision.
Another way to diagnose glaucoma is to determine
if peripheral or side vision has been lost and if damage
has occurred to record the current amount of peripheral
loss. Glaucoma does not affect your central reading
vision until the late stages of the disease.At this late stage,
a glaucoma victim may already be partially blind.There-
fore, it is important to measure the peripheral vision in
the early stages of the disease so that proper treatment can
be given to stabilize vision and prevent blindness.This is
accomplished with visual field testing, which is an exami-
nation that measures the amount of peripheral and central
vision lost.