The New Tests and Treatments for Glaucoma
Glaucoma, the most preventable cause of vision loss in the developed world, affects millions of Americans, often without any symptoms until vision has been lost. Routine eye examinations and testing for glaucoma could prevent the overwhelming majority of cases of vision loss. Pressure in an eye with glaucoma damages the optic nerve in the back of the eye and, if untreated, can lead to vision loss. Several new tools have recently emerged from ophthalmology research laboratories to become part of the state-of-the-art eye care that doctors at Washington Eye Physicians & Surgeons in Chevy Chase, Maryland, provide.
Dr. Howard Weiss, Dr. Arthur Schwartz, and Dr. Kenneth Schwartz have been investigators in clinical trials sponsored by the National Eye Institute of the National Institutes of Health. These include the Advanced Glaucoma Intervention Study and the Ocular Hypertension Treatment Study.
New Ways to Detect Glaucoma
The new Optic Nerve Imaging device takes a 3-dimensional image of the optic nerve in the back of the eye. This is the nerve that carries vision from the eye to the brain and is the part of the eye damaged in glaucoma. In a matter of seconds, as many as thirty million measurements are made of the optic nerve and its surrounding structures. The remarkable resulting images can be used to identify glaucoma and follow known glaucoma patients.
Corneal Thickness has been shown in an NIH-sponsored study to be of great importance in the care of glaucoma patients. Drs. Schwartz and Weiss and many of their patients at Washington Eye Physicians & Surgeons volunteered to participate in this study. Corneal Pachymetry measures the thickness of the cornea which has been found to influence the accuracy of pressure measurements. Corneal thickness also predicts which patients with high pressure are more likely to have damage to their optic nerves. This painless ultrasound test takes only a few minutes for our ophthalmic technicians to perform. Although Medicare does not cover the cost of corneal pachymetry, we have been able to hold our fee to a minimum to be sure it is affordable for all.
New Glaucoma Treatments
Selective Laser Trabeculoplasty is a new type of laser glaucoma treatment, which was approved by the FDA in 03/2001. Dr. Arthur Schwartz was a pioneer in the development of trabeculoplasty. SLT lowers eye pressure by improving the fluid outflow from the eye. It is sometimes called a “cool laser” because the ultra-short pulses of very low energy generate no heat. Selective Laser Trabeculoplasty appears to have the same benefit as the classic treatment, argon laser trabeculoplasty, in lowering pressure, but without the heat damage and scarring. It is believed that SLT, unlike argon laser trabeculoplasty, may be repeated safely many times and may also be used in patients who have had previous argon laser trabeculoplasty. It has been performed successfully in thousands of ophthalmology patients throughout the world.
Improved eye drops, which are easier to use and may have fewer side effects, are another tool in the treatment of glaucoma. One of these, a once-a-day, highly effective medication called lantanoprost is related to a substance that occurs naturally in the human body and so is well tolerated by most patients.
Dr. Kenneth Schwartz is the expert in the placement of glaucoma drainage tubes for the treatment of advanced glaucoma. These microscopic devices allow fluid to flow from inside the eye to reduce elevated eye pressure in glaucoma.
Drs. Schwartz and Weiss have co-authored a chapter on Laser Treatment of Glaucoma for one of the major textbooks in ophthalmology, and all three teach at Georgetown University and the Washington Hospital Center. In addition, Dr. Weiss is the Civilian Glaucoma Consultant at Walter Reed Military Medical Center.