Glaucoma: Diagnosis and Treatment

TIME TO CONSIDER A LASER FOR YOUR GLAUCOMA? By Dr. Lisa Bennett, Ophthalmologist at Madison Medical Eye Care with offices in Mequon & Saukville, Wisconsin

By user-admin
June 17, 2020

Many of you have glaucoma that is managed with eye drops. Generally this works quite well in maintaining your eye pressure and preserving your vision but sometimes either that is not the case or use of the drops is unpleasant due to side effects, expense or difficulty getting the drops in. Should that occur, then maybe it is time to consider a laser to control you glaucoma.

Laser treatments for glaucoma are nothing new, they have been around since the late 1970’s. In the past it was called an ALT (Argon Laser Trabeculoplasty) but more recently a different laser has been employed and it is called a SLT (Selective Laser Trabeculoplasty). The SLT has the advantage of being safer as far as increases in eye pressure while recovering and can be repeated if the effects start to wane.

This is not an operation but a procedure. We meet you at the Testing & Treatment area of Ascension Columbia-St. Mary’s Ozaukee Hospital. You put your head on something that looks like what we use for your eye examination in the office. A lens is placed over the eye that is being treated and we focus the laser in the small crevice behind your clear cornea and colored iris. It takes only minutes and is generally pain free.  We usually do one eye at a time.

It is good to have options for your eye care. If you are fine with your drops and you are not losing vision, stay with what works. If, however, you find using the drops a pain or too expensive or if they cause eye irritation it may be time to consider the SLT laser. We can discuss all your possible treatments at your next eye examination or sooner if you are having problems. We want to find what works best for you.

Dr. Lisa Bennett is an Ophthalmologist (Eye Physician & Surgeon) practicing with Dr. Martha Jay and Dr. James Ivanoski at Madison Medical Eye Care with offices in Mequon & Saukville, Wisconsin. She specializes in medical and surgical eye care such as small incision cataract surgery, blade-free LASIK, glaucoma care, macular degeneration management, dry eye treatment and more.

For additional eye care information, call 262-241-1919 or visit www.MadisonMedical.com.


HAVE GLAUCOMA? GET OUT AND EXERCISE! By Dr. Lisa Bennett, Ophthalmologist at Madison Medical Eye Care with offices in Mequon & Saukville, Wisconsin

By user-admin
February 3, 2020

We all know that exercise is great for your heart but did you know that it may help you retain your vision if you have glaucoma? A recent study published in the medical journal Ophthalmology suggests just that.  The activity level of 141 patients with glaucoma was followed for one week with a step monitor.  The devices measured how vigorous the patient's activities were and how much of each day they were active. They then analyzed the patient's glaucoma progression for over 10 years before and 5 years after the activity assessment.  There was a correlation between increased levels of physical activity and better control of the glaucoma as measured by visual field or side vision testing.

So the take home message is that not only should you be taking your glaucoma drops as recommended and coming for your regularly scheduled appointments but you should also get off the couch and get active! Don't let winter be your excuse, join a gym or walk at the mall.  Most likely the reason exercise appears to aid in glaucoma is probably due to a healthier cardiovascular system which in turn provides more oxygen to your eyes as well as the rest of your body.

Glaucoma is still a major contributor to vision loss in the United States.  Even if you have never been told that you are at risk for glaucoma, you should have regular complete eye examinations at least every one to two years to be sure you have not developed this condition. It is easily treated with eye drops, lasers or surgery. Early diagnosis is key, however, to preserving your vision. And now we know that staying active helps too!

Dr. Lisa is an Ophthalmologist (Eye Physician & Surgeon) specializing in medical and surgical eye care such as small incision cataract surgery and blade-free LASIK. She practices with Drs. Martha Jay and James Ivanoski at Madison Medical Eye Care with offices in Mequon & Saukville, Wisconsin.

For more eye care information, call 262-241-1919 or visit www.MadisonMedicalEyeCare.com.


MORE EVIDENCE FOR THE iSTENT By Dr. Martha Jay, Ophthalmologist at Madison Medical Eye Care with offices in Mequon & Saukville, Wisconsin

By user-admin
August 21, 2019

We have been recommending the iStent at the time of cataract surgery over the last few years for our patients who have both cataracts and glaucoma.  The purpose of the iStent is to increase the flow of fluid out of the eye in order to decrease eye pressure. Glaucoma is a condition where the fluid in the eye is either coming in too fast or leaving too slowly.  The buildup of pressure can cause permanent vision loss so is generally treated with eye drops.

The iStent is a tiny device, in fact it is the smallest implantable device in medicine measuring only 230 microns by 360 microns. As you may remember, there are only 1000 microns in a millimeter so that means it is only around ¼ by 1/3 of a millimeter.  After the cataract is removed and the lens inserted, we have the patient turn their head to one side and then place two of these iStents at the edge of the eye. You cannot see them without special mirrors.

When compared to cataract surgery alone, we know that the iStent does generally result in lower eye pressure. A new study just came out looked at if there was a difference in the number of glaucoma eye drops patients used after cataract surgery and found that those with the iStent had a reduction even if they were using 3 or more drops. In fact, the more the drops used the bigger the drop in the number required. This was reported in the medical journal Ophthalmology in January.  The data came from a managed care network and involved almost 3000 patients.

These results mirror what we have found also with this remarkable device. We can talk about whether the iStent is an option for you at your cataract evaluation.

Dr. Martha Jay is an Eye Physician & Surgeon practicing at Madison Medical Eye Care with offices in Mequon & Saukville, Wisconsin. She specializes in small incision cataract surgery and blade-free LASIK.

For more eye care information, call 262-241-1919 or visit www.MadisonMedicalEyeCare.com.


iSTENT: SURGICAL OPTION FOR GLAUCOMA JUST GOT BETTER By Dr. Martha Jay, Ophthalmologist at Madison Medical Eye Care with offices in Mequon & Saukville, Wisconsin

By user-admin
February 28, 2019

For those with both glaucoma and cataracts, we began using a new surgical option to tackle both at the time of cataract surgery in 2017 with an iStent. This tiny device (1 mm by 0.3 mm) controls eye pressure by increasing the outflow of fluid from the front of the eye. The eye is like a small plumbing system: fluid is constantly entering the eye from behind the pupil and leaving it through a sponge-like meshwork at the edges of the eye in front of the colored iris. The iStent bypasses this meshwork, allowing the fluid to leave more quickly to decrease eye pressure.

The iStent is part of a new type of glaucoma care called Micro-Invasive Glaucoma Surgery or MIGS.   In the past glaucoma was mainly managed with eye drops, lasers or extensive surgery. This new option is less traumatic to the eye than traditional glaucoma surgery but does need to be done at the time of cataract surgery. Once the cataract procedure is completed and the lens implant in place, we then turn the patient’s head to one side and insert the iStent. You cannot see or feel the stent.

What already was a great device recently got even better. The new iStent inject is easier to place and works even better than the original version. A recent study showed a 37% decrease in eye pressure and a 68% reduction in the need for glaucoma eye drops compared to the original model.

Regardless of the treatment for glaucoma, close follow-up is important to be sure this condition is well controlled. That generally means seeing you about twice yearly: One appointment with dilating drops to look in the back of the eye and another with the side vision testing along with a scan of the back of the eye.  See you soon!

Dr. Martha Jay is a board certified ophthalmologist (Eye Physician & Surgeon) specializing in small incision cataract surgery, glaucoma care and blade free LASIK.  For more eye care information, visit www.MadisonMedicalEyeCare.com or call 262-241-1919.

 


DOES YOUR BLOOD PRESSURE AFFECT YOUR EYE PRESSURE? By Dr. Martha Jay, Ophthalmologist at Madison Medical Eye Care with offices in Mequon & Saukville, Wisconsin

By user-admin
October 1, 2018

As far as your health is concerned, the two times you hear about “pressure” is with blood pressure and eye pressure. An abnormally high blood pressure could lead to heart disease or stokes. An abnormally high eye pressure could lead to vision loss from glaucoma.  A logical question is whether or not the two are directly related.

It turns out that the two are related. A 2005 article in the British Journal of Ophthalmology reported on the Beaver Dam study. This is a Wisconsin based long term study following thousands of people in Beaver Dam, Wisconsin. The study looked at diastolic (the low number) blood pressure and systolic (the higher number) blood pressure and compared it to the patient’s eye pressure. The results found that for every 10 mm Hg increase in diastolic blood pressure, there was a corresponding 0.6 mm Hg increase in eye pressure. The effects of systolic blood pressure on eye pressure were less. For every 10 mm Hg increase in systolic blood pressure, there was a 0.3 mm Hg increase in eye pressure.

Is this important? First and foremost you concern should be maintaining a healthy blood pressure. This is something for you and your primary care provider to determine. As for eye pressure, you would have to have a very significant elevation in blood pressure to cause significant vision damage from glaucoma but it could certainly happen.

This is just another reason to keep on top of your general health care as it can affect your eye pressure too. Other potential eye problems from uncontrolled blood pressure include small strokes behind the eye and broken or blocked blood vessels in the eye. Take care of yourself and make your eyes happy too!

Dr. Martha Jay is a Board Certified Eye Physician & Surgeon (Ophthalmologist) practicing at Madison Medical Eye Care with offices in Mequon & Saukville, Wisconsin. She specialized in eye surgery including blade-free LASIK and small incision cataract surgery. For more eye care information, call 262-241-1919 or visit www.MadisonMedicalEyeCare.com.

 


iSTENT: NEW SURGICAL OPTION FOR GLAUCOMA By Dr. Martha Jay, Ophthalmologist at Lakeshore Eye Care Professionals with offices in Mequon & Saukville, Wisconsino,

By user-admin
August 28, 2017

iStent

If you have glaucoma and cataracts, there is a new surgical option to tackle both at the time of your cataract surgery called the iStent. This tiny device (1 mm by 0.3 mm) helps control your eye pressure by increasing the outflow of fluid from the front of the eye. The eye is like a small plumbing system: there is fluid constantly entering the eye from behind the pupil and leaving it through a sponge-like meshwork at the edges of the eye in front of the colored iris. By placing the iStent, we bypass this meshwork, allowing the fluid to leave more quickly and with the goal of decreasing eye pressure.

The iStent is part of a new type of glaucoma care called Micro-Invasive Glaucoma Surgery or MIGS.   In the past glaucoma was mainly managed with eye drops, lasers or extensive surgery. This new option is less traumatic to the eye than traditional glaucoma surgery but does need to be done at the time of cataract surgery. Once the cataract procedure is completed and the lens implant in place, we then turn the patient’s head to one side and insert the iStent. You cannot see or feel the stent.

How do you know if the iStent is an option for you?  We will discuss this in more detail at your next eye examination but generally your glaucoma must be mild or moderate. If you have severe glaucoma, for example taking multiple medications for this or have significant vision loss, then other surgical options will be discussed.  If you have already had cataract surgery or your cataracts are not ready yet for surgery, you also would not be a candidate for the iStent at this time.

Regardless of the treatment for glaucoma, close follow-up is important to be sure this condition is well controlled. That generally means seeing you at least every 6 months: one visit with dilating drops and the other with the side vision test along with the scan of the back of the eye. We look forward to sharing this new innovation in glaucoma care with you in the near future.

Dr. Martha F. Jay

Martha F. Jay, Ph.D., M.D.

Dr. Martha Jay is a Board Certified Ophthalmologist specializing in medical and surgical eye care such as glaucoma care, cataract surgery and blade-free LASIK. For more eye care information, call 262-241-1919 or visit www.LakeShoreVision.com.


New Surgical option for Glaucoma the iStent By Dr. Martha Jay, Ophthalmologist at Lakeshore Eye Care Professionals with offices in Mequon & Saukville, Wisconsin

By user-admin
July 21, 2017

iStent

Do you have glaucoma and cataracts? Perhaps you are a candidate for placement of an iStent at the time of your cataract surgery. Click on the image to the right for an informative video about this new innovation.  This is the smallest implantable device in medicine as you can see with it's comparison to the size of a penny. We can discuss if the iStent is an option for you at your next eye examination.

Dr. Martha Jay is a Board Certified ophthalmologist specializing in medical and surgical eye care including small incision cataract surgery, glaucoma surgery and blade-free LASIK.

For more eye care information, call 262-241-1919 or visit www.LakeShoreVision.com


IT IS TIME TO GET YOUR EYES CHECKED FOR GLAUCOMA By Dr. James Ivanoski, Optometrist at Lakeshore Eye Care Professionals with offices in Mequon & Saukville, Wisconsin

By user-admin
February 28, 2017

Glaucoma is an eye condition that damages the optic nerve.  The optic nerve carries vision information collected by the eye to the brain.  If the optic nerve is damaged, vision loss occurs, and is irreversible.  Most types of glaucoma are characterized by high eye pressure that can damage the optic nerve.  Although there is no cure for glaucoma, vision loss can usually be slowed or halted with prescribed eye drops or surgery.

According to the Archives of Ophthalmology in 2004, it is estimated that over 3 million Americans have glaucoma, and only half of those know they have it.  Glaucoma can often times be virtually symptomless.  There is usually no pain associated with increased eye pressure.  Vision loss with glaucoma typically begins with peripheral or side vision, and significant amounts of vision can be lost before it is noticed.

Everyone is at risk for glaucoma.  The risk increases as we age.  People over age 60 are more at risk to develop glaucoma.  African Americans are more at risk to develop glaucoma than Caucasians.  Hispanic populations tend to have a higher risk to develop glaucoma as they age.  People of Asian descent are more at risk to develop angle closure glaucoma.  Other risk factors for developing glaucoma include:  certain medications like steroids, high nearsightedness, and thin corneas.

The best way to diagnose glaucoma is with a dilated eye examination.  A survey done by the Glaucoma Research Foundation found that less than half of all adults have a dilated eye examination every two years.  Glaucoma is a chronic lifelong condition that requires careful monitoring, and diagnosis is the first step in preserving vision.

Dr. James Ivanoski

Dr. Ivanoski is an Optometrist practicing at Lakeshore Eye Care Professionals with offices in Mequon & Saukville, Wisconsin. He welcomes patients of all ages into his practice and accepts most insurance plans.

For more eye care information, call 262-241-1919 or visit www.LakeShoreVision.com.

 

 


TAKE CARE OF YOUR TEETH FOR BETTER EYE HEALTH By Dr. Martha Jay, Ophthalmologist at Lakeshore Eye Care Professionals with offices in Mequon & Saukville, Wisconsin

By user-admin
February 12, 2017

A recent study in the prestigious medical journal “Ophthalmology” showed a link between poor oral health and glaucoma. The study found that those who had lost a tooth in the last 2 years had a 45% increased risk for developing glaucoma. Even worse numbers were found for those who had lost a tooth in the last 2 years and still had active periodontal disease. Those in that group had an 85% increased risk for developing glaucoma.

What can explain this surprising finding? With poor oral health there is a decrease in the blood flow to the affected area which may also alter the blood flow the eyes, obviously located nearby. With treatment of periodontal disease the blood flow to the jaw area increases back to normal. Then presumably it also does so to the eyes. Treatment for periodontal disease has been shown to decrease glaucoma risk back to the normal incidence of 1% of the population.

Many patients are “doctor avoiders” and I suspect that those same people are also “dentist avoiders.” If this sounds like you or someone you know, bring this important study to their attention. We have long known that poor oral health is associated with heart disease, stroke, respiratory problems, dementia and diabetes. Now you can add eye health to the equation.

The type of glaucoma associated with periodontal disease is the more common “open angle” type which is generally treated with eye drops. It can only be diagnosed with a dilated eye examination. We need to measure your eye pressure and then get a good look at your optic nerve in the back of the eye. If either appear abnormal, then extra testing may be required. The key is early detection because once you lose vision from this condition we can only arrest the loss, not bring back what is gone.

For better health remember to brush, floss and visit both your dentist and eye doctor regularly!

Dr. Martha F. Jay

Martha F. Jay, Ph.D., M.D.

Dr. Martha Jay is a board certified Ophthalmologist (Eye Physician & Surgeon) specializing in medical and surgical eye care such as small incision cataract surgery and LASIK Vision Correction. She practices at Lakeshore Eye Care Professionals with Drs. Mark German and James Ivanoski with offices in Mequon & Saukville, Wisconsin.

For more eye care information, call 262-241-1919 or visit www.LakeShoreVision.com.


WHAT’S NEW IN GLAUCOMA TREATMENT? By Dr. Martha Jay, Ophthalmologist at Lakeshore Eye Care Professionals with offices in Mequon & Saukville, Wisconsin

By user-admin
November 28, 2016

Glaucoma is a leading cause of vision loss and is generally managed with eye drops. Now there is good news for those of you who are contemplating cataract surgery and also have glaucoma: The iStent. This tiny device can be placed in the eye at the time of cataract surgery to better control eye pressure. The eye is like a tiny plumbing system.  There is a small amount of fluid constantly entering the eye from behind the pupil and then leaving it at the edges of the eye, in front of the colored iris. This fluid is called “aqueous humour” and it is completely replenished every one to two hours.

Eye drops are the most common treatment for glaucoma. The eye drops either decrease how fast the fluid enters the eye or increase how quickly it leaves. Common eye drops that decrease the inflow are Timolol, Brimonidine and Dorzolamide. The most commonly prescribed eye drop that increases the outflow is Latanoprost.  The iStent is a tiny tube (measuring only 1 mm by 0.3 mm) that is placed in front of the iris at the edge of the eye to allow the aqueous humour to leave faster. It is the smallest implantable device in medicine.

The iStent can only be placed at the time of cataract surgery so you need to have both cataracts and mild to moderate glaucoma. If your glaucoma is very severe, you might need more extensive surgery than the iStent provides. It is made of titanium and is not magnetic so won’t interfere with your ability to have a MRI later in life.

Dr. Martha F. Jay

Martha F. Jay, Ph.D., M.D.

Sounds confusing? We can talk about this more at your next eye examination. The goal of the iStent is to get you off some or all of your glaucoma medications. In the meantime, keep taking your drops as we have prescribed them and continue to have regular follow-up examinations.

For more eye care information, call 262-241-1919 or visit www.LakeshoreVision.com.


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