Advances In Eye Treatments: Simultaneous Cataract and Glaucoma Treatment by Dr Lim Lei Ai
What is Glaucoma?
Glaucoma is one of the leading causes, of irreversible blindness globally, accounting for 8% of global blindness. This group of conditions leads to damage to the eye’s optic nerve. Fortunately, glaucoma treatment exists however it needs to be administered early.
There is a paucity of up to date prevalence rates especially in Southeast Asia countries such as Malaysia and Singapore. A 2014 systematic review and meta-analysis suggest that the prevalence will increase from 64.3 million to 111.8 million in 2040, is proportionately affecting people in Asia and Africa.
Bilateral blindness from glaucoma is occurring at an alarming rate, increasing from 4.4 million to 6 million between 2010 and 2020.
Blindness From Glaucoma
The most common cause of blindness from glaucoma is late diagnosis. This stems from a combination of lack of public awareness and the absence of robust screening for the condition.
The most common form of glaucoma is Open Angle Glaucoma. The conditions is largely asymptomatic in the earlier stages of the condition, leading to the condition’s other descriptor, ‘the thief of sight,’
Blindness from glaucoma can be prevented with early detection and effective treatment.
It is vital to remember that treatment does not restore lost vision, but can slow or even halt further vision loss.
Risk Factors of Glaucoma
The risk factors for glaucoma are:
- increasing age: 2% at age 40 and 10% at age 70
- having family history can increase your risk four to nine times
- high eye pressure
- high myopia
- diabetes
- steroid medication
- previous eye injury
This makes having regular eye check up especially important to detect glaucoma early, specifically in this group of patients.
Glaucoma Treatment with Micro-Invasive Glaucoma Surgery
Glaucoma treatment comprises different maneuvers to lower eye pressures. Traditionally, incisional surgery such as trabeculectomy and aqueous drainage implant surgery are attempted when maximum tolerated pharmacological therapy and/or laser treatment has been exhausted.
Although traditional surgeries are effective, they are fraught with issues such as frequent follow-ups required after surgery to manage potential longer-term complications.
In the last two decades, there has been progress and innovation in glaucoma treatment, specifically the group of procedures known as micro-invasive glaucoma surgery (MIGS), which has attempted to bridge the gap between traditional medical and surgical therapies.
These procedures carry a much lower risk of serious complications, yet can offer meaningful results, ultimately yielding better control of the condition through lowering of intraocular pressure or reduction of the number of glaucoma medications.
An example of MIGS is the IStent Inject, which belongs to the group of devices that enhance the outflow of aqueous across the trabecular meshwork and through Schlemm’s canal, an area thought to have the greatest resistance to fluid leaving the eye, thereby contributing to raised intraocular pressures in open angle glaucoma.
The Istent Inject is the smallest medical device known to be implanted in the human body, is FDA-, TGA-, and MDA-approved, and can be inserted through the same incision created during cataract surgery, allowing both cataract and glaucoma to be treated at the same setting, as both conditions are common in this age group and frequently co-exist.
The postoperative course and risk profile is not dissimilar to following cataract surgery alone. Furthermore, having this procedure preserves future treatment options.
Having glaucoma means having a lifelong companion that requires different attention at different time points, its management is a journey. Micro-invasive glaucoma surgery has increased the arsenal of tools the glaucoma specialist now possesses to be able to assist on this journey.
Sunway Eye Centre is located strategically in various locations around the Klang Valley such as Kota Damansara, Petaling Jaya, Cheras and Subang Jaya. Make appointment with us for your glaucoma screening today!
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