Minimally invasive glaucoma surgery: What you should know (particularly if you have cataracts, too)

Major surgeries such as trabeculectomy and shunts aren’t the only options for treating glaucoma when medicines and laser treatments don’t work.

Minimally invasive surgery is at the forefront of newer advances in the management of glaucoma. More than 10 such procedures are currently available and advances are still ongoing.

The goal of any glaucoma treatment is to keep your vision from getting worse, as vision loss from glaucoma is irreversible. Eye pressure is the only known modifiable risk factor, though not everyone with high eye pressure develops glaucoma (it can occur even if you have normal eye pressure). Eye pressure varies by person; what’s normal for you isn’t necessarily considered normal for another person. That is why it’s important to get a dilated eye exam every year.

Glaucoma procedures—both traditional and minimally invasive—are done to lower eye pressure. Some minimally invasive surgeries involve implanting a small device and some don’t.

“There’s no cure for glaucoma, but we can treat it to prevent progression. We like to treat it in a stepwise fashion, doing the least invasive procedure first and moving forward to more invasive procedures if needed,” says Lauren Dhar, M.D., a Krieger Eye Institute ophthalmologist who specializes in glaucoma surgeries.

Benefits of minimally invasive surgery

While no surgery is without risk, and though it doesn’t replace or eliminate the need for traditional surgery altogether, minimally invasive glaucoma surgery can potentially reduce the amount of glaucoma medications you need to take and delay the need for other surgeries. Compared to traditional surgery, it is associated with shorter surgery time as well as reduced rates of dangerously low eye pressure, infection and decreased vision.

Some minimally invasive surgeries are another approach to traditional procedures, and others are completely original solutions for lowering eye pressure. They include procedures for:

• increasing flow through the drain in the eye
• establishing flow through an alternate pathway (other than the drain in the eye)
• decreasing the production of fluid in the eye

Are you a candidate?

You may be a candidate for minimally invasive glaucoma surgery if you have mild to moderate open angle glaucoma (the most common form of glaucoma, caused by the slow clogging of the drainage canals and resulting in increased eye pressure) or glaucoma that’s uncontrolled despite maximum tolerated medical therapy, Dhar says.

What if you have cataracts?

Minimally invasive surgery is also a good option if you have both glaucoma and cataracts, as it can be performed around the time of cataract surgery.

“Some minimally invasive glaucoma surgeries don’t even have to be done at the time of cataract surgery,” Dhar says. “Some people may be wondering, ‘Well, I’ve already had cataract surgery. Can I benefit from this too?’ And the answer is yes. We have a whole new armamentarium we can offer against glaucoma now.”

Many minimally invasive glaucoma surgeries performed at the time of cataract surgery do not significantly increase recovery time.

Speaking with your doctor

Minimally invasive surgery allows doctors to customize treatment to your specific needs. “Once we determine that a patient needs a procedure to lower eye pressure, we will discuss typical outcomes of the procedure and set realistic expectations based on risk factors and status of disease,” Dhar says. “Optimum results are achieved through adherence to medications and follow-up with the surgeon.”

When discussing the risks, benefits and alternatives of minimally invasive surgery with your doctor, you should ask whether or not an implant will be used and, if so, what material the implant is made of.

“For instance, one implant, Hydrus, is made of a nickel-titanium alloy, which is generally considered safe in patients with nickel allergy because the nickel portion is covered by the titanium portion. But patients with a history of nickel allergy may still want to have a discussion with their doctor regarding their options and what to expect,” Dhar says.

It’s also good to ask about recovery time (which can vary) and special instructions for postoperative care, Dhar adds.

For more information about minimally invasive glaucoma surgeries performed at the Krieger Eye Institute, call 410-601-6480. You can also call 410-601-2020 for information about other services or to schedule an appointment.

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