new type of surgery offers more effective treatment for glaucoma, a leading cause of vision loss that affects more than two million Americans.
The procedure uses a tiny stent, recently approved by the Food and Drug Administration, and is safer and less invasive than earlier types of surgery, with much quicker recovery and less discomfort.
What's more, it can reduce or even eliminate the need for medications.
With glaucoma, pressure from normal fluid in the eye gradually rises, causing damage to the optic nerve and eventually reducing peripheral vision. There are different forms of glaucoma, but the most common type is open-angle glaucoma, affecting 95 percent of those with the disease. The new surgery is designed to treat this exact condition.
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Eye fluid continually flows through the front of the eye, delivering nutrients and removing waste products through a natural drainage system. There is an "open angle" where the iris — the colored part of the eye — meets the cornea, which is a clear dome that covers the iris.
This is the normal exit point for fluid. But with open-angle glaucoma, the angle is blocked, causing fluid buildup and pressure. The breakthrough surgery relieves this blockage by implanting a tiny one-millimeter stent, called the iStent.
"The iStent will radically change the standard for how glaucoma is treated," says Robert Noecker, M.D., an ophthalmologist who is a glaucoma and cataract specialist at Ophthalmic Consultants of Connecticut in Fairfield, Conn., and one of the doctors who tested the device for FDA approval.
Prescription eye drops are the first line of treatment for glaucoma, but many people require more than one type, making the regimen difficult to follow. And there can be side effects, such as stinging, burning, or redness in the eyes, or headaches.
"Every one of my patients would like to get rid of their glaucoma medications," says Dr. Noecker.
"By using the iStent, many of them will be able to go from using several glaucoma meds to fewer, or even from one to none at all."
There are other, older types of surgeries that help fluid to drain. However, says Dr. Noecker, they carry much greater risk of complications and recovery can be painful, sometimes taking a month or more.
Consequently, traditional surgeries are usually done only on patients at high risk of losing their sight.
The iStent surgery, which takes 5-10 minutes, usually requires no stitches and involves much less manipulation of the eye than other surgical treatments.
Although eye drops are prescribed for a few weeks to keep down swelling, patients usually experience no downtime and little if any discomfort.
Because the risk of complications is very low, many patients can benefit.
"This also addresses many of the potentially long-term concerns of my patients," says Dr. Noecker.
"It means they may no longer have to worry about the high cost of glaucoma medications, co-pays, toxicity over time, and med management."
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