“Glaucoma is a silent thief of sight as it is symptomless until reaching the dangerous stage.”
This quote is from Dr. Visanee Tantisevi, an ophthalmologist specializing in glaucoma. It reflects her concern over the silent threat posed by glaucoma. Many may develop glaucoma without knowing, and by the time they are aware, their vision is already severely affected.
Glaucoma: Surreptitious Eye disorders with no warning signs
Glaucoma leads to optic neuropathy due to damaged optic nerve fibers, especially around the optic disc, causing gradual visual field loss, which can end in blindness.
“The cause of optic neuropathy is raised intraocular pressure transmitted to the optic disc on the posterior aspect of the eyeball. When the nerve fibers cannot cope with the elevated intraocular pressure, they become damaged and atrophy, affecting the eye and vision.”
“Many are misinformed that glaucoma treatment options are limited to either medications or surgical procedure only. Laser treatments are an alternative approach. Each laser is suitable for a specific type of glaucoma. The laser treatment I will discuss today is selective laser trabeculoplasty for open-angle glaucoma, yielding effective outcomes.”
SLT for open-angle glaucoma
Open-angle glaucoma is the most common type of glaucoma. It occurs when the angle between the cornea and iris comprising the drainage zone remains open despite raised intraocular pressure. This type of glaucoma deteriorates gradually and leads to slow progressive loss of vision. An effective laser treatment for open glaucoma is selective laser trabeculoplasty (SLT). SLT is a laser fine-tuned for appropriate pulse duration, frequency, and energy to eliminate melanin-containing cells selectively in the trabecular meshwork region. The pigmented cells absorb energy from the laser much quicker than other cells in the same drainage region, sparing other cell types from the thermal effect of the laser.
“This laser improves the eye’s trabecular meshwork drainage function, reducing intraocular pressure and alleviating the consequence of open-angle glaucoma.”
“Most patients believe laser or surgical procedures should be on the back burner until the later stages of treatment. They choose to use eye drops exclusively at first. However, the truth is that laser treatment can be an option at the onset of ocular hypertension, even before the need for eye drops. It can be an alternative as a treatment option.”
Since SLT can lower ocular hypertension, which is the primary cause of glaucoma, it can allow patients to reduce or stop using eye drops in the first 1-2 years after SLT.
The limitation of SLT is that it is effective for open-angle glaucoma only. For angle-closure glaucoma, the ophthalmologist may consider another type of laser.
“Since it is an open-angle laser treatment, SLT is not complicated, can be done quickly, and requires no hospital stay, allowing patients to return home and resume their daily life right after the procedure.”
Does SLT provide instant relief?
For SLT, the effect is detectable four weeks after treatment. People on eye drops may need to continue the eye drops early after SLT. However, after 4-6 weeks of follow-up, the ophthalmologist assessing the laser treatment response may recommend stopping the eye drops if the intraocular pressure is in the regular and safe range.
Eye laser treatment is not as dangerous as one thought.
Many people are anxious when needing eye laser treatment. They worried about the potential dangers and side effects of laser treatment on their eyes. Expert ophthalmology specialists always perform eye laser treatment utilizing the most up-to-date technology.
“Before the advent of laser treatment, eye drops were the initial glaucoma treatment, followed by surgery. Laser is now an in-between treatment option. It renders effective outcomes without a surgical procedure. The word laser may frighten people, but this technology has been around for decades with frequent upgrades to improve workflow and facilitate ease of use. Meanwhile, ophthalmologists are gaining more experience and expertise in laser treatment. Therefore, it is not as frightful as one would imagine.”
According to Dr. Visanee, most patients undergoing SLT were satisfied with the result and felt that their lives were better and more convenient. During the procedure, the ophthalmologist applies a drop of anesthetic to keep the patient from feeling pain. The procedure takes less than ten minutes. When intraocular pressure is in the normal range, no eye drops will be required, eliminating the hassles and burdens of applying the eye drops every day.
“If the question is whether laser treatment can cure glaucoma, the straight answer is no because glaucoma is a chronic eye condition. Laser treatment only helps manage and keep the intraocular pressure under control and stabilized at a safe level, preventing optic nerve damage and loss of visual field, returning a good quality of life to patients.”
From her experience in treating open-angle glaucoma with laser, Dr Visanee recounted a successful and effective SLT outcome lasting five years of normal intraocular pressure with no complications. Patients, however, required regular ophthalmology follow-ups.
Prevention is best for glaucoma.
Despite current efficacious treatment modalities, an ounce of prevention is still better than a pound of cure. Dr. Visanee advises on risk factor assessment and self-care to lower the risk of glaucoma.
“Glaucoma is a stealthy disease, dubbed ‘silent thief of sight’ as it exhibits no perceivable symptoms and becomes untreatable once you are aware of it, resulting in delayed treatment.”
"When patients arrive for routine eye examinations and happen to uncover conditions such as ocular hypertension or other ophthalmic disorders. In such instances, the onus falls upon ophthalmologists like myself to elucidate the nature of these ailments and cultivate a profound understanding within our patients. Many individuals harbor an innate bias towards perceived normalcy, dismissing or disregarding these conditions merely because the symptoms are not perceivable."
For this reason, cultivating awareness and imparting knowledge about ocular diseases can empower individuals to confront and prevent conditions that may insidiously manifest without their cognizance.
“The preventable type of glaucoma is angle-closure glaucoma. The narrowed angle between the cornea and iris predisposes to blocked drainage channels. Primary angle closure glaucoma is more common in people with Asian lineage. Laser treatment can help adjust the drainage angle to prevent the progression of narrowing that could lead to ocular hypertension.”
Apart from genetics, ocular anatomic structural predisposition, and ocular hypertension associated with preexisting conditions like diabetes, another factor is aging.
“As your age advances, at 50-60, the risk of glaucoma increasingly creeps higher. I would recommend starting a comprehensive eye checkup at 40. If you have eye symptoms or a family history of eye condition, it is advisable to start eye checkups sooner, given that an eye disorder can begin in younger individuals.”
The future of laser treatment for eye conditions
The lasers employed in the medical field are diverse, comprising a wide range of applications tailored to specific purposes. Notably, the lasers utilized in ophthalmic treatments possess unique characteristics to cater to the intricate demands of eye care.
“Certain lasers are engineered to precisely drill, cut, ablate, or reshape anatomical structures, while others possess the uncanny capacity to stimulate cellular activity within targeted regions, enhancing their functionality. Conversely, some lasers can selectively vaporize specific cells from designated areas. As ophthalmologists, we select the appropriate laser modality tailored to the specific requirement of each ocular condition we encounter.”
When asked if we could improve upon the current eye laser technology or make it more efficient, the doctor responded with a resounding "yes" and provided the following examples:
“There is an existing group of lasers employed to reduce intraocular pressure, distinct from the SLT laser. These lasers selectively target and deactivate certain cells responsible for producing intraocular fluid. Another category of lasers aims to inhibit the proliferation of blood vessels within the eye, mitigating the severity of diabetic retinopathy. Currently, lasers may not have the capability to penetrate and reach every layer of ocular tissue. If such penetration depth were achievable, we could potentially enhance the treatment outcomes.”
“As technology progresses, we can anticipate enhanced treatment efficacy, reduced side effects, and improved quality of life for patients. However, even at our current juncture, we possess highly effective medical lasers capable of delivering satisfactory treatment outcomes. Coupled with the expertise of specialized physicians, we are well-equipped to instill confidence in patients seeking our care.”
Despite providing effective treatments, Dr. Wisinee never fails to emphasize the inherent nature of glaucoma, aiming to cultivate a profound understanding in her patients. She states:
“Many patients mistakenly believe that they are curable after treating glaucoma with medications, undergoing laser procedures, or surgery. However, this is not the case. Glaucoma is a chronic illness akin to kidney disease or diabetes. The treatments provided by ophthalmologists aim to slow the progression of the disease and control the symptoms to a safe level, enabling patients to maintain a high quality of life.”
“However, it is important to note that undergoing treatment does not insinuate a complete cure. Patients must diligently maintain their overall health and attend regular follow-up appointments with their physician to monitor the progression of the disease. As mentioned earlier, while some patients may experience symptom control for up to 5 years after laser treatment, others may only experience relief for 1-2 years. Regardless of the individual circumstances, a vigilant and proactive approach is essential when living with this chronic condition. Complacency should be avoided at all costs, as glaucoma demands ongoing care and management.”
Glaucoma is an insidious condition that progresses silently, with abnormal symptoms often going unnoticed until discovered by an eye examination or the disease has advanced significantly. Our role as healthcare providers is to identify risk factors and encourage patients to adhere to recommended eye examination schedules set forth by ophthalmologists. In so doing, we can facilitate early detection and intervention, making managing this disease simpler and more effective.