Issue 46.16
Glaucoma is a growing problem in the United States and around the world. It is growing simply due to the increasing population of elderly citizens. This elderly population growth is driven by two main factors. The first factor is the baby boomer generation is now reaching their late 60’s and early 70’s. This is the age when most glaucoma is initially diagnosed. Second is the increasing age to which individuals are living. This is a wonderful modern advancement and a testament to better health and improved, though not perfect, healthcare. One unfortunate consequence however, is a gradual malfunctioning of the body. Glaucoma specifically, is a disease generally caused by a slow malfunctioning drainage canal within the eye. This failing drainage system causes the fluid to build up inside the eye, causing “high eye pressure”. This pressure eventually squeezes the life out of the optic nerve (the nerve that carries vision signals from the eye to the brain), leading to permanent, partial, or complete vision loss, thankfully the latter event is rare.
In some individuals we know why the drainage system in their eye is failing but in the majority of cases the cause is still unknown. The fact is that regardless of the cause being known or unknown, the treatment of glaucoma is the same…lower the eye pressure. All glaucoma patients know this is the goal. At each visit the eye pressure is measured, recorded, compared, and sometimes graphed, all to determine stability or worsening of the pressure over months and years. If the pressure is determined to be inadequately controlled, then treatment is begun or increased, as needed.
The mainstay of clinical glaucoma treatments has been drops and LASER. In the past surgical options were withheld until absolutely necessary due to their invasive nature but now that is changing. Our ability to treat mild and moderate stages of glaucoma less invasively is growing and expanding thanks to improved technology and innovation. One of the glaucoma treatment advancements is a triple procedure that we affectionately call the ICE procedure. It stands for Istent*, Cataract surgery, and Endocyclophotocoagulation (ECP). Each of these procedures has a known eye pressure lowering effect. Cataract surgery has been performed for many decades and lowers the eye pressure a small amount by allowing fluid a more open path to the drainage canal of the eye. The iStent is a microscopically implanted stent that allows for increased fluid flow in one area of the blocked drainage canal. ECP is a laser that decreases the production of fluid within the eye a small amount therapy decreasing the amount of inner eye fluid that needs to be drained and consequently decreasing the eye pressure as well. Due to governmental and insurance regulations the istent can only be implanted at the time of cataract surgery.
Using all three in combination has a greater likelihood of lowering the pressure of the eye than each procedure alone. It is important to recognize that the amount of pressure lowering is different in each patient. It is impossible to predict the outcome of glaucoma therapy in each patient because of the individualized nature of the human body, but it is rare not to have a benefit from this procedure. By performing all three at the time of cataract surgery we increase the amount of pressure lowing possible.
It is important to note that most glaucoma is a chronic disease, which means that a patient’s eye pressure may increase in the years following a successful pressure lowering procedure. Eye pressure must be continuously monitored. The importance of pressure lowering of the eye cannot be understated as this prevents irreversible damage to the vision.
As with all procedures there are risks and benefits. It is important for each patient to weigh the risks and benefits to determine if this is right for them. There are some physicians who do not perform iSent implantation or ECP due to the possibility of increased inflammation or the possibility of only having a small amount of pressure lowering. However, multiple scientific studies, as well as our own experience, have shown the efficacy and safety of each these procedures alone and even more so when performed simultaneously.
Dr. Marcos Reyes is a board-certified, fellowship-trained ophthalmologist specializing in glaucoma. If you have glaucoma or a family history of glaucoma or if you would like to book an appointment for a general eye exam, call Dixie Ophthalmic Specialists at Zion Eye Institute to be seen at any one of our 4 locations in St. George, Santa Clara, Cedar City or Mesquite (435) 656-2020 or Toll-Free (877) 841-2020.