Glaucoma is a progressive eye disease of the optic nerve at the back of the eye. The optic nerve is what receives light impulses from the retina, transmits these signals to the brain, and results in what we know as vision. Glaucoma typically occurs when elevated intraocular pressure within the eye cause damage to the optic nerveresulting in loss of peripheral vision, and if not treated, total blindness. The optic nerve is very sensitive to high intraocular pressures within the eye because it contains delicate nerve fibers that are easily damaged. Less commonly, glaucoma can occur with normal intraocular pressures, as a result of inadequate blood flow to the optic nerve.
Normally, aqueous humour (the fluid in the front third of the eye) flows out of the eye through a mesh-like channel. If there is anything that disrupts the outflow of this fluid, then fluid builds up, raising the pressure in the eye (intraocular pressure), and results in glaucoma. Glaucoma occurs most commonly in adults over the age of 40; however, can also occur in all ages, including infants. Often times the direct cause of glaucoma is unknown, although age, family history, diabetes, and certain medications containing steroids increase a person’s risk of glaucoma.
Glaucoma initially does not cause any symptoms, and many people do not recognize any change in vision until loss of peripheral vision becomes profound. Often times glaucoma is diagnosed through regular dilated eye examination with an optometrist or ophthalmologist, who are trained to recognize initial warning signs that can only be seen during a dilated eye examination. Other testing to monitor and diagnose glaucoma includes photographs of the optic nerve and visual field testing.
Treatment for glaucoma typically involves the use of one or more eye drops and occasionally oral medications to control intraocular pressure. If management is not successful through the use of drops or medications alone, then surgical options are considered.
Trabeculectomy: where a new channel is created to drain aqueous fluid, thereby decreasing the intraocular pressure in the eye.
Ahmed Valve: where a medical shunt is implanted and redirects the flow of aqueous humour out through a small hub to a chamber in the valve, and subsequently out of the eye. Ahmed valves are permanent.
Prior to surgery, you will receive your pre-operative instructions from your surgeon’s office, and these typically include not eating or drinking after midnight the night before your procedure. You will be asked to arrive at SAEC at a specified time, which will allow time for you to have your eye dilated for the procedure, and to meet the anaesthesiologist working with your surgeon that day. Your surgeon, anaesthesiologist, and yourself will determine the type of sedation that is necessary. An injection to freeze the eye, or topical drops and gel are most commonly used to numb the eye. In the operating room, there will be two additional nurses there to assist you and your surgeon, and you can expect the surgical procedure to take approximately 20 to 60 minutes. After your procedure, a nurse will go through your postoperative instructions with you, and ensure that you have made arrangements to be transported home with your friend or family member. You can expect to have a patch and shield in place over the eye until your follow up appointment the next day.
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