Glaucoma is a disease of the optic nerve which, if untreated, can result in permanent damage to the field of vision.
Weill Cornell Medicine ophthalmologists are trained in the most state-of-the-art evaluation and treatment methods for patients with glaucoma. Through advanced imaging technology, our experienced professionals diagnose glaucoma as early as possible and arrest the disease in its earliest stage. In most cases, glaucoma is treated by lowering intraocular pressure (pressure inside the eye). Although glaucoma surgery is avoided whenever possible, our ophthalmic physicians also practice the most sophisticated surgical techniques for the treatment of glaucoma.
As glaucoma may not affect vision until late in the disease process, it has been called the "sneak thief" of vision. Those at risk for glaucoma include anyone with a family history of glaucoma, patients with ocular hypertension, those with myopia (nearsightedness), the elderly and African-Americans. The only way to be sure that you are unaffected by glaucoma is to undergo a comprehensive eye examination. Weill Cornell Medicine ophthalmologists use standard photography, high-resolution optic nerve imaging technology and specialized visual field testing to monitor the optic nerve for changes and detect glaucoma.
Occasionally, elevated intraocular pressure can develop without any signs of damage to the optic nerve. This condition, ocular hypertension, may lead to glaucoma in some individuals. Weill Cornell Medicine patients with ocular hypertension undergo a comprehensive risk assessment based on demographic information and data from ophthalmic examination (including optic nerve appearance, intraocular pressure, central corneal thickness and visual field data). This risk assessment allows us to treat patients who are likely to develop glaucoma (damage to the optic nerve), and to avoid unnecessarily treating patients who are unlikely to develop glaucoma.
Types of Glaucoma
The myriad of glaucoma types are broadly grouped into two categories, based on whether or not the eye's natural fluid drainage system has been physically blocked by the iris. Open-angle glaucoma presents no physical blockage. Closed-angle glaucoma forces the iris in contact with the eye's natural drain, and prevents fluid from leaving the eye.
Primary Open-Angle Glaucoma (POAG) is the most common form of glaucoma and is present in approximately 1 percent of all Americans. Unfortunately, up to one-half of all people with this disease do not yet know that they have it and are therefore untreated. Weill Cornell Medicine ophthalmologists diagnose open-angle glaucoma through advanced evaluation of the optic nerve and visual field, and provide treatment primarily by lowering intraocular pressure to slow or stop the progression of the disease. Intraocular pressure reduction is typically achieved through medication (usually eye drops), lasers (argon laser trabeculoplasty or selective laser trabeculoplasty) or surgery (trabeculectomy, tube placement or other methods).
Closed-angle glaucoma is often preventable. Chronic angle-closure glaucoma scars the iris to the eye's drain after a long period of contact, often years. Acute angle-closure glaucoma closes the eye's drain with the iris very suddenly, causing intraocular pressure to rise quickly, often resulting in an "attack" of pain, eye redness and blurry vision. Before the angle becomes closed, it is often very narrow. If diagnosed when the angle is narrow but not fully closed, laser iridotomy can prevent both acute angle-closure glaucoma attacks as well as the insidious chronic angle-closure glaucoma. Laser iridotomy is a procedure in which a small hole is created in the iris to allow fluid to escape from the eye without pushing the iris against the eye's drain. Not all patients with narrow angles require laser iridotomy; careful evaluation and monitoring are required before performing the procedure. Weill Cornell Medicine ophthalmologists expertly manage narrow angles and angle-closure glaucoma, and often employ highly specialized diagnostic imaging equipment including non-contact slit lamp Optical Coherence Tomography (OCT) units as well as the Artemis Very High Frequency (VHF) ultrasound eye scanner.
Minimally Invasive Glaucoma Surgery (MIGS)
For patients with glaucoma, elevated intraocular pressure can, over time, result in vision loss. Fortunately, for many patients, the daily use of eyedrops will slow or stop the disease. Traditional glaucoma surgeries including trabeculectomy and tube shunt procedures are typically reserved for patients who are at risk of severe vision loss from glaucoma.
However, the daily administration of eye drops can lead to side effects in some patients, and many glaucoma patients would prefer to avoid this treatment method altogether.
Now, an advanced surgery technique known as Minimally Invasive Glaucoma Surgery (MIGS) is available for Weill Cornell Medicine patients. MIGS procedures, including cutting-edge iStent operations, are typically performed during cataract surgery, only slightly increasing the duration of the procedure. Importantly, MIGS procedures do not significantly change the overall (favorable) safety profile of cataract surgery, but often result in additional benefits for patients with glaucoma, including lower intraocular pressure and the need for fewer (or no) glaucoma medications.