Diagnostic Procedures utilized by the doctors of AVC to evaluate disorders of the visual system

Medical, Laser and Surgical Treatments for Glaucoma and Cataract

Laser and Surgical Treatments for Retina and Vitreous Disorders

Diagnostic Procedures

• Visual Acuity Testing
• Pupillary Testing
• Ocular Motility Evaluation
• Color Vision Testing
• Contrast Sensitivity Testing
• Glare Testing
• Stereo acuity Testing
• Potential Acuity Testing
• Slit Lamp Examination
• Intraocular Pressure Measurement
• Gonioscopy
• Binocular Indirect Ophthalmoscopy
• Biomicroscopic examination of the Vitreous and Retina
• Amsler Grid Evaluation
• Visual Field Examination
• Fundus Photography and Fluorescein Angiography
• Retinal Nerve Fiber Photography
• Scanning Laser Ophthalmoscopy
• Ophthalmic Ultrasound Examination
• Ophthalmic Biometry
  

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Medical, Laser and Surgical Treatments for Glaucoma and Cataracts

What is Glaucoma?
Glaucoma is the term given to a variety of diseases that cause weakening of the optic nerve. In most cases the damage is related to an abnormally high fluid pressure in the eye. Glaucoma is actually a number of disorders categorized by whether the drainage channel (angle) in the eye is obstructed (Primary or Secondary Angle Closure Glaucoma) or is not obstructed (Primary or Secondary Open Angle Glaucoma). Treatment with medication, laser or surgery is designed to save vision by reducing the eye pressure.

Medical Treatment of Glaucoma
A large selection of eye drops is available for treating glaucoma. Some are taken as little as once per day while others are used from two to four times per day. The medication chosen may depend on the patient's age, medical conditions, other medications taken, allergy history or other factors. Most patients respond well to one or more of the glaucoma drops. Occasionally medication must be changed or stopped if side effects or allergies develop. The drugs work by decreasing the amount of fluid made by the eye or by increasing the rate at which fluid leaves the eye. Some of the newer medication may also help protect the nerve from damage, independent of any pressure effect (neuroprotection).

Laser Treatment of Glaucoma
Angle Closure Glaucoma, a less common type of glaucoma, is treated with a laser to open the narrow or closed drainage channel in order to improve the flow of fluid within the eye. Typically, a procedure called YAG Laser Iridotomy or Argon Laser Iridotomy is performed. The treatment is done in the office. Anesthetic eyedrops are instilled prior to the procedure that only takes a few minutes. There are no restrictions of activity after the treatment.

Primary Open Angle Glaucoma, the most common type of glaucoma, is treated with laser to stretch open the collapsed pores in the patient's natural drainage channel. A treatment called Argon Laser Trabeculoplasty may be performed once or twice to achieve the desired pressure lowering effect. The treatment is done in the office. Anesthetic eyedrops are instilled prior to the procedure that only takes a few minutes. There are no restrictions of activity after the treatment.

Another kind of laser treatment called Diode Laser Cyclocoagulation may be used in difficult cases of glaucoma as an alternative to, or following surgery. It works by coagulating or cauterizing the glands in the eye that make the eye fluid. Anesthesia is typically achieved by the local injection of anesthetic beneath the eye. A patch is placed on the eye before the patient leaves for home. There are no restrictions of activity after the treatment.

Surgical Treatment of Glaucoma
Surgery for glaucoma involves one of a several of methods to drain fluid out of the eye back into the general circulation (filtration procedures). The most common type of procedure is called Trabeculectomy. Drugs termed antimetabolites (Mitomycin-C, 5-Fluorouracil) may be applied to the eye during the operation to improve the postoperative outcome by slowing the healing response. In certain advanced cases, the insertion of plastic tubes running to a reservoir on the surface of the eye, a procedure called Aqueous Tube Shunt Surgery (Molteno, Krupin, Baerveldt, Ahmed etc.) is performed. Glaucoma surgery is done in the outpatient surgery center. It is usually not necessary to put the patient to sleep. Sedation is given and anesthesia is typically achieved by the local injection of anesthetic beneath the eye. When the surgery is completed, a patch is placed on the eye. The patient leaves for home after a short stay in the recovery room.

What are Cataracts?
In most senior adults, cataract (a clouding of the transparent lens of the eye) is a result of the natural aging process and is not an acquired disease. Symptoms of cataract include blurred or distorted vision, dim vision, loss of contrast, decreased color perception and glare. As other eye diseases may cause some of the same symptoms, a careful eye exam must be done to look for other problems. Cataract formation may be increased or caused by exposure to ultraviolet light, some medications, other medical or eye diseases, or injuries. Wearing sunglasses outdoors is helpful in slowing absorption of ultraviolet light. Currently, there is no medical treatment to remove cataracts. Surgery is usually only recommended when the disturbance in vision is causing difficulty in the patient's daily activities. Many patients elect to have surgery when they have trouble reading, driving (particularly at night), performing their jobs or engaging in sports or hobbies.

Laser Treatment of Cataract
Laser is not generally used as a method to remove cataracts. An exception to this is the development of new instruments that have been experimental until recently. The current type of laser for cataract, called YAG Laser Capsulotomy is usually done months or years following the original cataract surgical procedure called Phacoemulsification. A clear membrane (posterior capsule) remains in the eye when cataract surgery is performed. If this membrane eventually becomes cloudy (Secondary cataract), YAG Laser Capsulotomy is done to improve the vision. Anesthetic eyedrops are instilled prior to the procedure that only takes a few minutes. There are no restrictions of activity after the treatment.

Surgical Treatment of Cataract
Cataract surgery is usually performed in an outpatient, ambulatory surgery center. Mild sedation is administered and the patient is not put to sleep. In most cases an injection of anesthetic is no longer necessary. Painless cataract surgery can be done with the application of anesthetic drops directly to the eye at the start of the procedure. This allows surgery on patients taking blood thinners (anticoagulants) without the discontinuation of their medication. The operation, Small Incision Cataract Surgery or No Stitch Cataract Surgery, is done through a small opening in the cornea with a phacoemulsification (high-speed ultrasound) probe. An Intraocular Lens Implant is inserted into the eye. After the brief procedure it is usually not necessary to patch the eye shut. The patient leaves for home after a short stay in the recovery room.

Surgical Treatment of Glaucoma with Cataract
Many patients have both glaucoma and cataract that may require surgery at the same time. Fortunately, the methods describe above can be used together in Combined Trabeculectomy with Small Incision Cataract Surgery. In these cases, one procedure is done to correct both problems.

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Laser and Surgical Treatments for Retina and Vitreous Disorders

• Argon Laser Retinal Photocoagulation
• Krypton Laser Retinal Photocoagulation
• Dye Laser Retinal Photocoagulation
• Diode Laser Retinal Photocoagulation
• YAG Laser Vitreolysis
• Visudyne Laser Treatment for Macular Degeneration
• Cryogenic Retinopexy
• Scleral Buckling Procedure for Retinal Detachment
• Pars Plana Vitrectomy / Membrane Peeling / Gas-Fluid Exchange
• Pars Plana Lensectomy
• Macular Surgical Procedures

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