Glaucoma St Louis | Glaucoma Treatment St Louis MO | Pepose

Glaucoma Treatment

Glaucoma is a permanent loss of side vision caused by damage to the optic nerve. It is often caused by pressure buildup in the eye, but can also be triggered by other factors. The Glaucoma Research Foundation estimates that more than 3 million Americans have glaucoma, but only half of these people know they have it. Approximately 120,000 people go blind from glaucoma each year, accounting for 9-12 percent of all new cases of blindness in the United States.

Glaucoma is the second leading cause of blindness and the first leading cause of preventable blindness.

Pepose Vision is well-known as a leader in glaucoma diagnosis and management, both in the Bi-State region and the entire United States.

Image Illustrating How Glaucoma Affects an Eye

How do I know if I have glaucoma?

Glaucoma is a complicated disease in which damage to the optic nerve results in vision loss.

There are several forms of glaucoma; the two most common forms are primary open-angle glaucoma (POAG) and angle-closure glaucoma (ACG). Open-angle glaucoma is often called “the sneak thief of sight” because it has no symptoms until significant vision loss has occurred.

Symptoms of Open-Angle Glaucoma

There are typically no early warning signs or symptoms of open-angle glaucoma. It develops slowly and sometimes without noticeable sight loss for many years.

Most people who have open-angle glaucoma feel fine and do not notice a change in their vision at first because the initial loss of vision is of side or peripheral vision, and the visual acuity or sharpness of vision is maintained until late in the disease.

By the time a patient is aware of vision loss, the disease is usually quite advanced. Vision loss from glaucoma is not reversible with treatment, even with surgery.

Because open-angle glaucoma has few warning signs or symptoms before damage has occurred, it is important to see a doctor for regular eye examinations. If glaucoma is detected during an eye exam, your eye doctor can prescribe a preventative treatment to help protect your vision.

In open-angle glaucoma, the angle in your eye where the iris meets the cornea is as wide and open as it should be, but the eye’s drainage canals become clogged over time, causing an increase in internal eye pressure 

and subsequent damage to the optic nerve. It is the most common type of glaucoma, affecting about four million Americans, many of whom do not know they have the disease.

You are at increased risk of glaucoma if your parents or siblings have the disease, if you are African-American or Latino, and possibly if you are diabetic or have cardiovascular disease. The risk of glaucoma also increases with age.

Symptoms of Angle-Closure Glaucoma

  • Hazy or blurred vision
  • The appearance of rainbow-colored circles around bright lights
  • Severe eye and head pain
  • Nausea or vomiting (accompanying severe eye pain)
  • Sudden sight loss

Angle-closure glaucoma is caused by blocked drainage canals in the eye, resulting in a sudden rise in intraocular pressure. This is a much more rare form of glaucoma, which develops very quickly and demands immediate medical attention.

In contrast with open-angle glaucoma, symptoms of acute angle-closure glaucoma are very noticeable and damage occurs quickly. If you experience any of these symptoms, seek immediate care from an ophthalmologist.

We always provide our patients with compassionate and customized care.

How do you treat glaucoma?

Our goal in glaucoma treatment is to lower pressure in your eye (intraocular pressure).   Pepose Vision utilizes the most advanced care available, including the SLT Laser treatments and Sight Sciences Visco™ 360.  Your doctor will discuss the available treatments after a thorough examination.

Please understand … glaucoma can’t be cured, and damage caused by the disease can’t be reversed, but treatment and regular checkups can prevent vision loss in people with early glaucoma. If vision loss has already occurred, treatment can slow or prevent further vision loss.

The absolute latest glaucoma treatments

Visco 360 Sight Sciences

Visco360 is a surgical device. If we think of the drainage system for the intraocular fluid as a series of internal canals that eventually drain into the veins on the surface of the eye, one reason why the drain can become clogged is if the canals “collapse” and narrow. With Visco 360, a microcannula is used to gain entry into the drainage canal via a micro-incision. A thick fluid is injected into the drainage canal in order to inflate and force open the passageways.

This is a generally painless 5 to 15-minute procedure that can be performed at the same time or separately from cataract surgery. The advantage of Visco 360 is that it can be performed as a stand-alone procedure and does not have to be combined with cataract surgery (unlike iStent which does). Like other glaucoma microsurgeries, Visco 360 is a medical procedure performed in the operating room that is submitted to insurance for coverage and reimbursement.

Glaucoma FAQs

Glaucoma is a permanent loss of side vision caused by damage to the optic nerve. It is often caused by pressure buildup in the eye, but can also be triggered by other factors. The Glaucoma Research Foundation estimates that more than 3 million Americans have glaucoma, but only half of these people know they have it. Approximately 120,000 people go blind from glaucoma each year, accounting for 9-12 percent of all new cases of blindness in the United States.

Glaucoma is the second leading cause of blindness and the first leading cause of preventable blindness. There are two major types of glaucoma: open angle and closed angle. The most common type – open-angle glaucoma – occurs when the eye’s drainage canal becomes clogged over time, leading to a decrease in fluid drainage and an increase in intraocular pressure. It may also be the result of a sustained increase in fluid production.

Consistently high intraocular pressure reduces blood flow to the optic nerve, over time destroying the optic nerve fibers and compromising peripheral (side) vision.

The best way to protect yourself from loss of vision due to glaucoma is to have annual eye exams with an eye care professional who has the most advanced testing technology to detect glaucoma at its earliest stages. Glaucoma usually has no signs or symptoms until serious vision loss occurs. Risk factors for glaucoma include:

  • Diabetes
  • High degree of nearsightedness
  • Family history of glaucoma
  • African-American descent
  • High blood pressure
  • Elevated ocular pressure
  • High degree of farsightedness
  • Previous eye injury
  • Prolonged steroid use

In recognition of the importance of early detection and management of glaucoma, Medicare and most private insurers offer coverage for annual glaucoma screenings. For patients that have been diagnosed with glaucoma, they should schedule an eye exam every 3 to 4 months, since there is no way to determine whether glaucoma is under control based on the way they feel.

The current “gold standard” for detecting increased eye pressure, a known risk factor for the development of glaucoma, uses a device that touches the eye. The pressure required for the tip of this instrument to flatten the cornea is recorded. However, it is known that some patients with apparently normal pressures recorded with this device still go on to develop glaucoma; others with high pressure readings never develop it.

Pepose Vision Institute is one of the few centers in the U.S. chosen to evaluate the Ocular Response Analyzer (ORA), developed by Reichert Instruments, as a potentially more sensitive and accurate approach to measuring eye pressure. Not only does this Analyzer offer a potential breakthrough in detecting glaucoma in those patients with truly elevated eye pressure, but it can likewise save millions of dollars in pharmacy costs for patients that actually have normal eye pressure but have been measured improperly using current measurement techniques.

In addition to the ORA, Pepose Vision Institute uses the innovative NERVE FIBER ANALYZER (NFA) to perform a quick, thorough, noninvasive test for early signs of glaucoma. The NFA can detect nerve fiber loss and early onset glaucoma years before older testing methods. Don’t settle for anything less than an NFA test to monitor the health of your eyes! The NFA test allows for early intervention treatment options, before glaucoma has compromised your vision.

Utilizing a unique combination of polarized light and scanning laser ophthalmoscopy, the NFA rapidly scans the retina and measures the thickness of the nerve fiber layer. The results reveal whether a patient is within/outside normal limits or borderline with respect to clinical indications for early glaucoma. This test does not require the patient’s eyes to be dilated. There are no bright flashes of light, no pain or discomfort. It is recommended for patients with pre-existing early stage glaucoma, or any patient considered at risk for glaucoma.

Research studies, including those performed by the doctors at Pepose Vision Institute, have demonstrated that the measurement of eye pressure not the actual eye pressure itself can be affected by surgery that changes a patient’s corneal thickness. The degree of measurement error will depend upon the technology that is used to measure your eye pressure. PVI is one of the few centers in the U.S. chosen to evaluate the Ocular Response Analyzer (ORA), developed by Reichert Instruments, as a potentially more accurate approach to measuring eye pressure, irrespective of changes in corneal thickness, thereby detecting glaucoma in those patients with truly elevated eye pressure.

If you have had laser vision correction, or have naturally changing corneal thickness due to a chronic condition such as keratoconus, it is crucial that your eye pressure be monitored by a cornea subspecialist who has experience in differentiating between real increases in eye pressure and simple measurement error. PVI is one of only a handful of eye centers in the country that has conducted clinical research related to this measurement issue. Our cornea subspecialty trained physicians have substantial experience dealing with vision correction patients and other patients with corneal conditions in order to accurately measure and monitor true eye pressure.

Generally, eye drops can be prescribed to help lower the pressure in the eye. These drops must be used daily to have optimal effect, and continued for the rest of your life. It is not uncommon to be prescribed more than one type of drop to be used at the same time.

Unfortunately, eye drops that control glaucoma can have such side effects as headaches, effects on the heart, asthma and decreased libido. Moreover, there can be a substantial financial side effect in terms of the cost of these drops if you do not have comprehensive prescription drug insurance coverage and are required to take more than one type of drop.

For patients who are on many drops or do not have an optimal response to the drops, a new “cold laser” in-office treatment (Selective Laser Trabeculoplasty) may be used to decrease the intraocular pressure in patients with chronic open angle glaucoma. Oftentimes, this procedure can eliminate the need for one or more of the eye drop medications. Pepose Vision Institute is one of the first eye practices in the bi-state area to offer SLT to its patients.

The traditional laser treatment for open angle glaucoma (OAG) applied an argon laser to burn tissue to create tiny, evenly spaced openings in the eye’s trabecular meshwork to improve the draining of eye fluid. Unfortunately, the heat generated by this procedure often results in scarring around these openings, limiting its success and/or ability to retreat the eye in the future should the treatment need to be repeated.

Pepose Vision Institute is one of the first eye practices in the bi-state area to offer the advanced, FDA-approved “cold laser” in an in-office procedure referred to as Selective Laser Trabeculoplasty (SLT). Instead of burning tissue, SLT selectively treats only specific cells to stimulate increased fluid drainage. SLT produces equivalent drops in eye pressure as earlier laser methods, yet it results in less tissue damage, thereby avoiding adverse scarring effects. For this reason, SLT can be repeated throughout a patient’s life when clinically indicated. Moreover, it is often found to be successful when traditional laser methods fail to appreciably reduce eye pressure.

Selective Laser Trabeculoplasty (SLT) is performed in our office and only takes about 20-25 minutes. Prior to the procedure, you will be given eye drops that will numb your eye and prepare it for treatment. You should plan to be at our office for two (2) hours on the day of treatment, giving us sufficient time to optimize your treatment plan.

Because SLT does not burn tissue like earlier laser treatments for glaucoma, no tissue scarring results. Temporary complications that have been reported include inflammation and conjunctivitis. Of course, any technology, in inexperienced hands, can result in adverse outcomes. At Pepose Vision Institute, we have had extensive experience performing SLT. Most importantly, we are available 24/7, 365 days a year should you have any concerns prior to, or after, your treatment.

Virtually all health insurance providers, including Medicare, view laser treatment for glaucoma as a functional surgery, meaning that it is necessary to preserve sight. For this reason, SLT is covered in the same fashion as other surgical procedures. The staff of Pepose Vision Institute will work with your insurance company to ensure that you are pre-certified for treatment, should this be a requirement of coverage.

Did you know Pepose Vision is also an advanced research facility?

Why choose Pepose Vision for your glaucoma treatment?

Experience

Pepose Vision Institute is a leader in the use of the most advanced “cold laser” to lower pressure inside the eye. Because the vision damage from glaucoma cannot be reversed, the best approach is early detection and treatment. That’s why it’s important to know that Pepose Vision Institute is one of the nation’s leaders in developing the most precise tools to measure true eye pressure, and is the only bi-state provider to offer these advanced tests to its patients.

Testing

Each patient undergoes a 3 hour state-of-the-art testing process, directly supervised by our surgeons who then create a precise, personalized treatment plan.

Technology

PVI uses numerous diagnostic devices to assess the extent of glaucoma damage and to confirm each test result. We then collaborate with eye technology industry leaders on “next generation” diagnostics. We also offer on-site cold laser treatment which may reduce the need for lifelong use of eye drops and other medications.

Lifetime Commitment

Our surgeons monitor the progress of your eyes for the rest of your life to maintain the very best vision outcome possible.

We recommend that the best way to ensure a successful outcome in treating your glaucoma is to choose a highly experienced surgeon who is involved in developing state-of-the-art treatments to enhance your vision outcome.

Our State-Of-The-Art Technology

At Pepose Vision Institute, we invest in new, early detection glaucoma technologies because we believe sight is a precious gift and glaucoma is the most prevalent “silent thief” of vision among adults. We are one of the first in the nation to offer the latest diagnostic and surgical technologies to our glaucoma patients.

We’ve worked with some of the leading developers of eye technology to perfect state-of the-art diagnostic tests and treatments for glaucoma. These technologies, and our unparalleled experience in interpreting and 

utilizing them, ensure that your procedure is tailored exactly to your needs.

To be sure that your glaucoma is managed in an optimal fashion, we recommend you select an eye care subspecialist who is integrally involved in developing glaucoma technology to maximize your vision outcome. Below are some of the technologies we use to diagnose and treat glaucoma:

Pepose Vision Institute uses the innovative NERVE FIBER ANALYZER (NFA) to perform a quick, thorough, noninvasive test for early signs of glaucoma. The NFA can detect nerve fiber loss and early onset glaucoma years before older testing methods don’t settle for anything less than an NFA test to monitor the health of your eyes! The NFA test allows for early intervention treatment options, before glaucoma has compromised your vision.

Utilizing a unique combination of polarized light and scanning laser ophthalmoscopy, the NFA rapidly scans the retina and measures the thickness of the nerve fiber layer. The results reveal whether a patient is within/outside normal limits or borderline with respect to clinical indications for early glaucoma. This test does not require the patient’s eyes to be dilated. There are no bright flashes of light, no pain or discomfort. It is recommended for patients with pre-existing early stage glaucoma, or any patient considered at risk for glaucoma.

Eye pressure is a known risk factor for the development of glaucoma. Commonly used eye pressure measuring devices, such as the Goldmann tonometer, utilize a technique that involves touching the eye. The pressure required for the tip of the Goldmann tonometer to flatten the cornea is recorded. However, it is known that some patients with apparently normal pressures recorded with this device still go on to develop glaucoma; others with high pressure readings never develop it.

Pepose Vision Institute is one of the few centers in the U.S. chosen to evaluate the Ocular Response Analyzer (ORA), developed by Reichert Instruments, as a potentially more sensitive and accurate approach to measuring eye pressure. Not only does this Analyzer offer a potential breakthrough in detecting glaucoma in those patients with truly elevated eye pressure, but it can likewise save millions of dollars in pharmacy costs for patients that actually have normal eye pressure but have been measured improperly using current measurement techniques.

Errors in measuring ocular pressure have been found to be related to corneal thickness, and will therefore be affected by laser vision correction procedures that change a patient’s corneal thickness. PVI is one of only a handful of eye centers in the country that has conducted clinical research related to this measurement issue. If you have had laser vision correction, or have naturally changing corneal thickness due to a chronic condition such as keratoconus, it is crucial that you select an eye care professional who is well-versed in differentiating between real increases in eye pressure and simple measurement error. Our cornea subspecialty-trained physicians have substantial experience in the diagnostics required to accurately measure true intraocular pressure for vision correction patients and others with corneal conditions, thereby enabling us to determine the optimal treatment to preserve and protect your vision.

Pepose Vision Institute has conducted studies that show that eye pressure measurements with the PASCAL dynamic contour tonometer may be more accurate than the standard tonometer, which flattens and compresses the cornea. In addition, the Pascal instrument appears less sensitive to naturally occurring variations in corneal thickness and rigidity that can affect eye pressure measurement and choice of treatment regimen.

Assessing a patient’s visual field is an important step in evaluating the progression of glaucoma. Pepose Vision Institute uses the Humphrey Field Analyzer (HFA), which uses automated perimetry to measure responses to visual stimuli appearing in central and side vision.sensitive frequency doubling visual field testing device for this purpose. This technology has been shown to be extremely sensitive in detecting early loss of side vision resulting from glaucoma.

For patients who are on many eye drops to control their glaucoma, or do not have an optimal response to the drops, a new “cold laser” in-office treatment (Selective Laser Trabeculoplasty) may be used to decrease the intraocular pressure in patients with chronic open angle glaucoma. Oftentimes, this procedure can eliminate the need for one or more of the eye drop medications. Pepose Vision Institute is one of the first eye practices in the bi-state area to offer FDA-approved SLT to its patients.

Traditional laser treatment for open angle glaucoma (OAG) applied an argon laser to burn tissue to create tiny, evenly spaced openings in the eye’s trabecular meshwork to improve the draining of eye fluid. Unfortunately, the heat generated by this procedure often results in scarring around these openings, limiting its success and/or ability to retreat the eye in the future should the treatment need to be repeated.

The advanced, FDA-approved “cold laser” in an in-office procedure, referred to as Selective Laser Trabeculoplasty, does not treat glaucoma by burning tissue. Instead, SLT selectively treats only specific cells to stimulate increased fluid drainage. SLT produces equivalent drops in eye pressure as earlier laser methods, yet it results in less tissue damage, thereby avoiding adverse scarring effects. For this reason, SLT can be repeated throughout a patient’s life when clinically indicated. Moreover, it is often found to be successful when traditional laser methods fail to appreciably reduce eye pressure.

Implanted during cataract surgery, iStent® can effectively lower IOP, one of the most important risk factors for glaucoma, and may reduce your reliance on glaucoma medication.

What is the glaucoma treatment process?

1) Schedule Your Diagnostic Exam at PVI
Call us today at 636-728-0111 or toll-free, 1-877-862-2020, or click here to contact us online  to schedule your glaucoma diagnostic examination. We will evaluate your eyes using the most precise instruments available. If you have already been diagnosed with glaucoma, we will assess your intraocular pressure, and, if indicated, discuss laser alternatives, including SLT laser treatment. We guarantee that once you have completed our diagnostic exam, you’ll feel confident that we can help you minimize any potential threat to your vision. Be sure to bring someone to drive you home, since we’ll be dilating your eyes as part of the exam.

2) Schedule Your Laser Treatment
If your PVI surgeon believes that this is the safest, most effective method to preserve your sight, we’ll schedule your procedure. Your surgery scheduler will take care of pre-certification, if required by your insurance company. You will be given precise pre- and post- treatment instructions regarding your eye care and use of medications.

3) Arrive for Your Pain-Free Treatment in the Surgery Center in our Building
Each eye will be scheduled on a different day. Please bring a driver on the day of your laser procedure and allow 1 hour for this visit. Your surgeon will answer any questions you still may have about your eye condition or treatment. Your procedure will be totally painless, thanks to topical anesthesia. If you are currently using eye drops to control your glaucoma, you will continue to use them until your post-operative visit approximately 6 weeks later.

What’s your next step?

If you think you might have glaucoma, or any vision issues, please come see us.
Our experienced doctors will use advanced diagnostics to determine exactly how to best help you see your very best, patiently answer your questions and carefully explain all your options.

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