What is glaucoma and how can treatment help?

Mr Minas Georgopoulos is our new consultant ophthalmologist who specialises in glaucoma and cataract surgery. He is fellowship-trained in the latest advancement in the treatment of glaucoma – minimal invasive surgery. Here he talks about the disease and the treatment options available to patients of Spire Gatwick Park Hospital.

What is glaucoma and how can treatment help?

“Glaucoma is a progressive and irreversible disease usually associated with high pressure in the eye (intraocular pressure, or IOP) which damages the optic nerve. Treatment to lower the IOP - whether that is eye drops, laser treatment or surgery - won’t improve the sight or bring back lost vision, but it will prevent further damage to the optic nerve by stopping the progression of the disease.

However, surgery can improve patients' quality of life. Often they will no longer need to use eye drops, allowing them to become more independent if they currently rely on a partner or carer to administer the drops and they are less anxious that their sight will deteriorate further due to the glaucoma.”

Eye drops

“Twenty years ago, there were only a few eye drops available, but now we have more than a dozen including formulas which combine several medications in one. However, they aim for the same goal and that is to reduce the pressure in the eye. While most people manage well with drops, for some it can cause other health problems such as red eyes, dark skin, eye socket fat atrophy (a shrinking of the skin round the eyes), irregular heartbeat, depression, breathing problems and even erectile dysfunction. Any irritation from the eye drops or side effects should be raised with your eye specialist.”

See here for our top tips on putting in eye drops.

Laser treatment

“If drops are not lowering the eye pressure successfully, stronger drops will be recommended. If this is still not successful, or if the eye drops are causing significant side effects, then the next step can be laser trabeculoplasty. A laser is used to open the drainage tubes within the eye to allow fluid to drain out and reduce the pressure inside. It is carried out while the patient is awake using local anaesthetic drops to numb the eye. Patients may still need to use eye drops after having laser treatment, and its effectiveness may wear off between one and seven years. If this happens, the procedure can be repeated.”

Surgery

“Surgery is recommended when eye drops or laser treatment haven’t been successful. One of the most common procedures is called trabeculectomy which involves creating a 'flap' in the eye to increase the outflow of fluid (called aqueous humour). This allows the fluid to drain and reduce pressure in the eye. During the procedure, anti-scarring medication is also administered. The procedure takes around 50 minutes and recovery time can be up to six weeks.

If you need cataract surgery, this must be done first otherwise the cataract surgery could compromise the result of the trabeculectomy.

Sometimes, a trabeculectomy is not effective, or the eyes may have extensive scarring from previous surgeries, injuries or drops, so a Baerveldt tube shunt is recommended. A plate is sutured onto the sclera and a tube is inserted into the anterior chamber to drain away excess fluid. Surgery, performed under local or general anaesthetic, takes around two hours.” 

Minimally invasive glaucoma surgery (MIGS)

“This has been around for about seven years and it is so rewarding for patients. Procedure times are short, recovery time is much quicker and there is less risk of bleeding, infection and dangerously low eye pressures often associated with traditional glaucoma surgery. And if patients also need cataract surgery it can be done at the same time. MIGS is a big family of procedures using microscopic-sized equipment and tiny incisions and at Spire Gatwick Park I offer the following two:

iStent® - this is a tiny titanium tube, measuring just 0.3mm, so barely a speck to look at. It is inserted via a preloaded injector into the eye to allow the drainage of fluid. It takes just 10 minutes under local anaesthetic, with drops administered to the eye. If it is combined with cataract surgery, the whole procedure takes around 25 minutes.

Xen gel stent - this stent is made from natural gelatine. The stent is inserted into a different space in the eye and mimics the trabeculectomy by opening a passage to drain the fluid without having to create a flap or open up the conjunctiva (fine skin of the eye).

In both procedures recovery time is quick, usually only needing a day or so off work. Patients will be given antibiotics and anti-inflammatory eye drops to use and advised to wear an eye shield at night for a week. The type of MIGS offered will depend on the patient and the target eye pressure. If a patient does contact sports like rugby then the Xen gel shunt is not recommended as it can become dislodged or damaged.”

…And why eye tests are so important

“Everyone should have regular eye tests because conditions such as glaucoma do not show any symptoms until it is at an advanced stage. It is why we call it the 'silent thief of the sight'. We are lucky in this country that the opticians are well trained to check for signs of glaucoma and can refer patients direct to a specialist. Free eye tests are available for the over-60s or, for those with a family history of glaucoma, after the age of 40. I am seeing younger patients with glaucoma. This is because they are being identified early by opticians which gives us the opportunity to be more proactive and protect their sight.”

Advice from Mr Minas Georgopoulos, Consultant Ophthalmologist at Spire Gatwick Park Hospital. If you wish to book a consultation with Mr Georgopoulos, please call on 01293 778 906 to find out more.