Promising Innovations in the Treatment of Glaucoma
Prevention and Treatment There have been incredible advancements in both the medication associated with and the surgical treatment of glaucoma.
As a young ophthalmologist, I was fortunate to have trained under some incredibly talented surgeons. With their support, I was able to accomplish what I thought would be the greatest challenge of my career: learning to perform some of the most complex glaucoma procedures in the world.
Seeing the impact these surgeries have on patients’ lives has inspired me to take on a bigger challenge — to never perform these surgeries again. Instead, I want to help cure glaucoma.
The easiest way to understand glaucoma is to think of it as a plumbing problem. The eye is filled with clear fluids that are constantly replenishing. One function of these fluids is to keep the shape of the eye by maintaining a consistent intraocular pressure (IOP). New fluids come in near the back of the eye, forcing older fluids out through draining channels near the front. Glaucoma occurs when this plumbing system malfunctions and too much fluid remains in the eye. When this happens, the eye cannot expand to compensate and the resulting increase in pressure can cause irreversible damage — most notably to the retina — leading to vision loss.
A continued evolution of care
Currently, there is no way to prevent glaucoma and because increased IOP causes no physical discomfort, it can easily go undetected. The good news is that we have made incredible advancements in both the medication associated with and the surgical treatment of glaucoma.
Some groups are more likely to develop glaucoma, but it can happen to anyone. The best defence we have is regular screenings which can be arranged through a family doctor.
Medication, usually in the form of drops, is used to control increased IOP. In recent years, we have found ways to use these medications much more effectively. Because IOP can vary dramatically over the course of a day, new devices have been developed that allow patients to take multiple IOP measurements by themselves over the course of many days. We also know that the rigid or elastic properties of an eye can affect IOP readings, so testing methods have evolved to determine an individual’s rigidity/elasticity. These insights help doctors better understand patients’ specific needs, so they can design treatment paths that are more customized.
New innovations in the field
Innovations in surgery are even more promising. Once considered a last resort, surgery is evolving to become less reactive and more proactive. A great example that I am proud to have helped develop, is micro-invasive glaucoma surgery (MIGS).
Traditional glaucoma surgery is performed when natural drainage channels are too damaged to function, using two main procedures. The first is a process called shunts where relatively large devices are inserted into the eye. The second procedure is a trabeculectomy where a hole is cut in the eye wall, the sclera, which is covered by a thin trap-door. Both of these procedures create artificial drainage channels and both can be very invasive.
MIGS is similar to heart stents where a tube used to open blocked arteries as an alternative to open-heart surgery. The MIGS process utilizes a micro stent that is inserted into an existing channel to hold it open. It’s a faster and far less invasive procedure that is used as a preventive measure. Rather than waiting for natural channels to fail completely, we can intervene sooner using procedures like this to repair the natural channels. With this channel repaired, the eye is able to maintain normal IOP, often without additional treatment.
When we think about curing disease, we often think about eradication. But as treatments like MIGS and others become available in Canada, we are seeing a different path for curing glaucoma.
Innovations like these have the potential to eliminate the health risks associated with the disease. Through simple, non-invasive, preventative procedures, we could one day see glaucoma reduced to nothing more than a minor inconvenience.