The lowdown on glaucoma - part 2

Earlier this week we shared an article on glaucoma to mark World Glaucoma Week.  In this blog we caught up with Ms Choudhary at the end of one of her usually busy clinics. Ms Choudhary has been working as a Consultant Ophthalmologist at St Paul's since 2009 and has a specialist interest in glaucoma.  This is what Ms Choudhary had to say about her work:  

Ms Choudhary, Consultant Ophthalmologist"Glaucoma is a common eye condition where the optic nerve, which connects the eye to the brain, becomes damaged. The symptoms of glaucoma can be subtle at first, such as a slight loss of peripheral (side) vision but if left untreated, glaucoma can lead to a loss of vision. It is not possible to reverse any loss of vision hence early diagnosis and treatment is paramount to maintaining long-term vision. The most common type of glaucoma is called primary open angle glaucoma.

Glaucoma is usually caused by fluid building up in the eye, leading to an increase in the eye pressure. The eyes are constantly producing fluid which provides nourishment to the eye and is essential for healthy eye function. As fluid is produced, it moves throughout the eye and eventually leaves the eye through tiny drainage channels located near the front part of the eye. If these drainage channels become blocked, the fluid in the eye can build up, causing the eye pressure to go up.

The goal of treatment is to lower the eye pressure to prevent or reduce damage to the optic nerve. Treatment is usually eye drops containing drugs that either reduce the production of eye fluid or increase its drainage. Surgical procedures such as trabeculectomy, deep sclerectomy, viscocanalostomy, drainage tubes or some laser procedures are used if indicated. Standard glaucoma surgeries are very often effective at lowering eye pressure and preventing progression of glaucoma, but can occasionally be associated with potential complications, require post-operative interventions and have a long post-operative recovery phase.

Minimally invasive glaucoma surgery (MIGS) is a group of operations that have been developed in recent years to reduce some of the complications of most standard glaucoma surgeries. There are many MIGS devices which work in different ways but have a common principle of being very small in size allowing insertion through tiny incisions using microscopic equipment which allows quicker post-operative recovery. While they reduce the incidence of complications, these procedures might not be as effective in controlling the intraocular pressure as standard procedures hence are usually used in early to moderate glaucoma.

The CyPass Stent is inserted to improve drainageThe CyPass micro-stent is a MIGS device which is designed for use in open angle glaucoma. It is a very small, specially designed plastic tube that works by enhancing one of the natural drainage pathways between the outer and inner layer of the eyes (suprachoroidal space). It allows eye fluid to pass through keeping the pathway open.  It can be implanted in the eye either at the time of cataract surgery or as a standalone procedure. The surgery is done under drops or local anaesthetic and involves visualising the drainage channels using a special lens and inserting the stent using a small incision into the drainage channels from inside the eye.

The mechanism of action is unique to the implant and hence using the procedure does not negatively impact on the outcome of any future glaucoma surgeries if needed. Trials have shown the device to be effective not only in mild but also in more advanced glaucoma with relatively few serious complications and/or requirement for any post-operative interventions. NICE has recently provided guidance on its use and support the use of this device where indicated."