The eye naturally maintains its own pressure at 10-20mmHg. This is achieved through an equilibrium between the production and drainage of fluid in the front part of the eye. When the eye pressures exceeds this limit, the optic nerve can be damaged. The optic nerve relays information from the eye to the brain and if damaged, our brain is unable to process the visual information captured by our eyes.

The following is the most common risk factors for the development of glaucoma:

• Raised intra ocular pressure.
• Older age, >55years old.
• A 1st or 2nd degree relative with glaucoma.
• African, Asian or Hispanic heritage.
• Associated medical conditions like Diabetes, near-sightedness, far-sightedness
• Associated medication use like corticosteroid (oral/topical/inhalation), sulphanomide, anti-histamines.

The diagnosis of glaucoma is not always that easy. Raised eye pressure is often picked up routinely by your optometrists or during screening.

The next step is a comprehensive eye examination by an ophthalmologist which includes testing your eye pressure and examining your optic nerve head.

At Paarl Eye Centre we use advanced equipment to help us to make a diagnosis.

Our Heidelberg Spectralis OCT, is an eye scanner that analyses the structure of the optic nerves and compares it to a normative data basis for your age. We repeat these scans on future occasions to ensure reproducible results and to establish an accurate baseline.

The next test is a visual field test. During this procedure you will be presented with multiple single lights of different radiances in your central and peripheral vision. This test is performed to evaluate the function of your optic nerve. Glaucoma causes very specific visual field fallouts (blank spots) that can be detected during this procedure. It also serves as a baseline to which we compare future tests to, too ensure that your visual fields are not deteriorating due to the condition.

The good news is that glaucoma can be effectively treated if diagnosed in time. Unfortunately existing nerve damage cannot be reversed. The treatment of choice is individualised and can broadly be divided into drops, SLT LASER treatment and surgery, including minimally invasive glaucoma surgery (MIGS). All of them aim to lower the eye pressure to a point where damage to the optic nerve no longer occurs.

Eye drops

Drops form the basis of treatment in the majority of patients. There are many different agents, as well as combination drops on the market. We will select the best suited drop for each of our patients. You will have to use your drops daily, for the rest of your life to ensure that your eye pressure stays within the normal range.

SLT LASER

Selective LASER trabeculoplasty (SLT) is widely recognised as part of the 1st line treatment in glaucoma. During this procedure the surgeon targets the outflow area of the eye (trabecular meshwork) with a diode LASER. The LASER doesn’t change the structure of the trabecular meshwork, but the mild inflammation that it causes attracts the body’s natural immune cells (macrophages). These cells helps to open up the drainage spaces in the trabecular meshwork to increase the outflow of aqueous in the eye, which then leads to a decrease in the eye pressure.

SLT is a safe procedure and we offer it to the majority of our glaucoma patients based on international literature. It’s an office based procedure performed in our rooms. The procedure takes 5-10 minutes per eye and is pain-free. Your vision might be slightly decreased for a few hours after the procedure due to the lubricating agent that we use to stabilise the SLT lens. It takes 4-8 weeks for SLT to have it’s optimum pressure lowering effect.

If the eye pressure still exceeds the upper limit despite maximum medical treatment and drops, surgery might be indicated. A trabeculectomy use to be the traditional technique. Today, there are multiple microsurgical glaucoma devices on the market which are safer and less invasive than this procedure. At Paarl Eye Centre we offer MIGS to our glaucoma patients already on maximal treatment that have progressive optic nerve damage. Glaucoma surgery is done at the Cure day theatre in Paarl.

The most frequently used MIGS procedures include PreserFlow, Xen inplant and iSTENT.

PreserFlow Microstent

PreserFlow is a minimally invasive surgical procedure and a very safe option for almost all glaucoma patients. The device is made of biologically inert material, thus accepted well by the eye as a permanent implant. The microstent is implanted on the surface of your eye between the conjunctiva and sclera, directing into your eye’s anterior chamber. This then drains eye fluid from inside the eye into the subconjunctival space around the globe and lowers the intra ocular pressure.

XEN® Glaucoma Treatment System

The XEN device is implanted through a corneal microincision using an ab interno approach, meaning from inside the eye to the outside, into the subconjunctival space. The 6-mm length, 45-micron lumen diameter of the Xen makes implantation minimally invasive and the complication rate very low.

This implant is made of durable, biocompatible, tissue-conforming gelatin that becomes flexible after implantation.

iStent inject

This device is composed of titanium. The iStent inject is 2nd generation stent composed of 2 stents and a specifically designed injector. It is currently the smallest medical device implanted into the human body. The stent is often used in combination with cataract surgery and is placed in the drainage angle of the eye .This allows for increased drainage of eye fuid out of the eye.