Glaucoma is a potentially serious eye condition that causes damage to the optic nerve, which without suitable treatment can lead to a loss of vision. Treatment is currently a mix of eye drops, laser procedures and surgical intervention, but the future of glaucoma treatment could transform the lives of glaucoma sufferers. Mr Vik Sharma, a top ophthalmologist, gives us some insight into the innovative ways that glaucoma may one day be dealt with.
How is glaucoma currently treated?
Broadly speaking, there are three different categories of treatment for glaucoma. One treatment is eye drops. Eye drops work very well but they do rely on the patient having to put them in every day. They can give you local and systemic side effects so we do watch out for those and they can also stop working from time to time and occasionally, we need to use combination eye drops to get the pressure down because all of these medications work in slightly different ways by increasing our drainage or decreasing the amount of fluid the eye makes.
The second type of treatment is lasers. Lasers have been around quite a while, but nowadays the newer generation of lasers are very effective and very, very safe, painless and quick. Some of these lasers work by removing the cells that make the fluid in the eye, and other lasers work by increasing the drainage system which is the space within the eye to allow the fluid to drain better and keep your pressure down. These are outpatient procedures with little recovery for the patient afterwards.
Thirdly, surgery is very effective but it is invasive. The gold standard trabeculectomy operation works very well and is still one of the go-to procedures when we really need to get the pressure down and save someone’s sight. There are also newer surgical techniques which work just as well nowadays which are less invasive and quicker and obviously kinder to the eye as well. For example, I can do a trabeculectomy in about 20-30 minutes, but I can do the same thing with the newer microtube XEN procedures which do exactly the same in under 5 minutes with no major cut or stitches to the eye. There are lots and lots of new surgical techniques on the market now and we’re evaluating them all and looking at what is suitable for each individual person.
What are the advancements being made in the treatment of glaucoma?
There are some very new exciting developments in the treatment of glaucoma. First of all, with the traditional eye drops, it has been over 20 years since we have had a new class of drug and there are now a few in the horizon, one of which is the ROCK inhibitors. These show great potential and they should be available in the next few years for our patients. There are also new device implants that we can put in the eyelid or just under the skin of the eyeball which allows the same eye drop to be delivered over a 3-4 month period and the patient can then forget about having to put drops in every day. That will be something exciting for our patients because they won’t have to worry about having to put eye drops in every day.
The newer lasers are kinder, more effective, safer and allow us to do more. The newer lasers that are being developed will allow us to have more tools to get that pressure down safer.
Surgery has now become micro-invasive and is smaller, quicker and kinder. The gold standard trabeculectomy operation is still the gold standard but the newer devices such as the microtube XEN implants do the same thing as a trabeculectomy in less than half the time without the large cuts and stitches.
If you would like to find out more, make an appointment with a specialist.