Glaucoma Treatment

Treatment for glaucoma depends on the specific type of glaucoma, its severity and how the eye responds to treatment.  The main goal is to lower the eye pressure to a level that stabilizes the disease to prevent further damage/vision loss.  The level of "safe" eye pressure is different for each individual.  Unfortunately, glaucoma treatment does not reverse damage to the optic nerve. 

Lowering eye pressure is accomplished in one of two ways: by decreasing aqueous fluid production (inflow), or increasing aqueous fluid drainage (outflow).  Methods of eye pressure reduction include: medications, glaucoma laser surgery and glaucoma surgery.

Medications in the form of eye drops or pills, or a combination of the two can increase outflow, decrease inflow or a combination of the two.  The prescription drugs can be eyedrops or pills.  Some patients cannot tolerate these medications, and some side effects may outweigh the benefits of the treatments.

Glaucoma Laser Surgery procedures vary in the way that they work.

Laser Trabeculoplasty Laser trabeculoplasty stimulates the trabecular meshwork (drainage angle) to function more efficiently.  This is an in-office procedure.  It is relatively safe with few side effects.  We offer two different types of laser trabeculoplasty: Argon Laser Trabeculoplasty (ALT) and Selective Laser Trabeculoplasty (SLT).

SLT and ALT lower the intra ocular pressure (IOP) by ~20%.  They are about 80% effective in the first year.  However the efficacy may wear off over time: @ 5 years – 50% effective and @ 10 years – 33% effective. These lasers may not need to be repeated at the frequency that many ophthalmologists are performing them.  In a study by Dr. Frenkel, treating 1/3 of the eye is just as effective as treating 1/2 of the eye.  While SLT can be repeated over the same area of the eye, ALT cannot.

	Laser Iridotomy In laser iridotomy, a small hole is created in the iris to improve outflow of aqueous humor into the drainage angle.  This procedure is done for narrow or closed angles.

A Glaucoma consultation will reveal which treatments/procedures are right for your individual situation.

Macular Degeneration Treatment

Dry Macular Degeneration There is no treatment for dry Age-Related Macular Degeneration (Dry AMD), but there are ways to slow the progression for some individuals.  The Age-Related Eye Disease Study (AREDS) showed that people with intermediate stage dry AMD could reduce their risk of progressing to advanced AMD by about 25% by taking a special high-dose formula of supplements, sold without a prescription.

The specific formulation of vitamins  known as the AREDS formula: (Zinc 80 mg, Vitamin C 500 mg, Vitamin E 400 IU, Beta-Carotene 15 mg, and Copper 2 mg) is readily available over-the-counter sold by many manufacturers.  Vitamin supplements are not cures for AMD, nor can they restore vision already lost from AMD.  For dry AMD taking a multivitamin with LUTEIN, eating 3 servings of fruit a day, avoiding snack foods, smoking, and sunlight, and eating fish, spinach, and collard greens has been found helpful.

We strongly encourage you to talk to your doctor about the risks and benefits of these dietary supplements before taking them.  High-dose vitamins, even when sold without a prescription, may present a risk for some people.  

Smokers taking beta-carotene may increase their risk of lung cancer.  High Dose Vitamin E (400 IU) has been linked to 5% higher death rates, bleeding, suppressing the body’s antioxidants and reducing the effect of cholesterol lowering medications.

Wet Macular Degeneration Treating Exudative Macular Degeneration (Wet AMD) has evolved over the years from a destructive treatment that damaged the area it was attempting to treat to a truly revolutionary therapy that for the first time allows ophthalmologists to halt the progression of the disease without damaging the cells of the macula that are responsible for seeing.

In years past, a thermal “hot” laser therapy destroyed abnormal blood vessels by “burning” it with a high-energy laser.  Scar tissue formed where treatment occurred, creating a permanent blind spot that might be noticeable in your vision.

Photodynamic therapy (PDT) “cool” laser came along thereafter and involved the use of a combination of a medication injected into the arm and a lower-power “cool” laser.  The laser activated the drug, which destroyed the abnormal blood vessels. While it was initially accepted as a better option than thermal laser, it still caused scar tissue. 

In December 2004, the first in a new class of medications Anti-VEGF, became available for the treatment of wet AMD.  The first in it's drug was Macugen, followed by Avastin, and now Lucentis.  These are the first non-destructive treatments for wet AMD.  Rather than using a laser, these medications are injected directly into the eye.  In wet AMD, a protein called VEGF (vascular endothelial  growth factor) causes growth of abnormal blood vessels in the eye, which lead to vision loss.  These drugs block VEGF, therefore halting the growth of abnormal blood vessels.

Avastin approved by FDA in Feb 2004 for the treatment of colon cancer, but is used “off-label” in the eye since Nov 2005. 

Lucentis was approved by FDA in July 2006 and has had promising results.  

Study: Aspirin prophylaxis has no effect on AMD development

Prophylactic aspirin therapy appears to have no effect on development of new-onset age-related macular degeneration.

Click here to view the full article!

East Florida Eye Institute currently offers the following to treat Wet AMD:

Intraocular injections

1. Avastin
2. Lucentis
3. Clinical Trial: Genentech Study  -- Harbor

Click here for more information on clinical trials now enrolling for the treatment of Macular Degeneration.

What if AMD cannot be treated?

Normal Amsler Grid	Amsler Grid of Patient with AMD

Diabetic Retinopathy Treatment

Careful observation of the diabetic patient on a regular basis by an eye doctor is crucial in detecting Diabetic changes.  There often is no decrease in vision, though damage from diabetes may be occurring.

As with many diseases, the best treatment is prevention.  Strict control of your blood sugar will significantly reduce the long-term risk of vision loss from diabetic retinopathy.  Laser surgery is often recommended for people with Diabetic Macular Edema, Proliferative Diabetic Retinopathy, and Neovascular Glaucoma.

Laser surgery for Macular Edema

In Laser surgery for Macular Edema, the laser is focused on the damaged retina near the macula to decrease fluid leakage.  Some may see laser spots near the center of their vision following treatment; usually fade with time, but may not disappear.  It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement.  The main goal of treatment is to prevent further loss of vision.

Laser surgery for Proliferative Diabetic Retinopathy

In Laser surgery for Proliferative Diabetic Retinopathy, the laser is focused on all parts of the retina except the macula.  This “pan retinal” photocoagulation treatment causes abnormal new vessels to shrink; often prevents them from growing again.  Treatment decreases the chance that vitreous bleeding or retinal distortion will occur.  Multiple laser treatments over time are sometimes necessary.

Laser panretinal photocoagulation  (PRP)  treatment (arrows show laser spots on the retina)

Vitrectomy Surgery

Vitrectomy Surgery for advanced Proliferative Diabetic Retinopathy is needed when the vitreous (white, gel-like substance in middle of eye) fills with blood.  Performed in the operating room, this microsurgical procedure involves removing the blood-filled vitreous and replacing it with a clear solution.  This invasive surgery often prevents further bleeding by removing abnormal vessels that caused bleeding, by additionally treating the eye with laser treatment.

New Treatments

For certain patients, Anti-VEGF treatment (Avastin and Lucentis) is a new choice in controlling Macular Edema, and Proliferative Daiabetic Retinopathy.  Call our office to find out if this treatment option may be right for you.

Dry Eye Disease Treatment

Treatment is based on the cause and severity of the disease ad is customized on a patient by patient basis.  Treatment is targeted at: supplementing the tears, conserving the tears, preventing evaporation of tears, and increasing production of tears. Artificial Tears lubricate the eyes and help replace the natural moisture layer of the tear film.  They are available without a prescription in several different variations; preserved (in a bottle) – not recommended more than 4x a day, non-preserved (in a vial) - can be used as often as necessary and ointments – used mainly at night and which may cause temporary blurred vision Artificial tears lubricate the eye, but they lack the complex mixture of proteins, mucins, and other factors found in normal health tears and are useful for temporary relief. Punctal plugs conserve your own tears and make artificial tears last longer on the eye so that they do not drain out of the eye through small channels into the nasal cavity.

At East Florida Eye Institute we are currently enrolling patients into a clinical trial investigating a new medication for Moderate to Severe Dry Eyes.  Benefits to you are access to new medications, free study related eye exam and medication and you are able to contribute to the advancement of new treatments.  Click on our Current Research and Clinical Trial page for more information. Above all dry eye should not interfere with your lifestyle.  Don’t suffer from chronic dry eye one more day!  Ask about treatment options right for you available at EFEI.

Cataract Treatment

More than 1.4 million people in the U.S. have cataract surgery each year.  More than 95% of cataract surgeries are performed with no complications and improved vision.   You and your ophthalmologist should decide together when cataract surgery is appropriate for you.  Cataract Surgery is usually an Outpatient procedure, performed with local (a numbing block) or topical anesthesia (eye drops) and some sedation through an IV in your hand or arm.

Cataract Surgery A small incision is made close to the edge of the cornea.  A tiny, high-frequency ultrasound instrument is inserted that breaks up center of the lens.  Broken-up cloudy lens material is removed through the incision. An Intraocular lens (IOL) implant is inserted into your eye to replace the cloudy lens. The IOL is customized for your eye; restores focusing power.  The IOL usually placed behind the iris (posterior chamber lens), but sometimes placed in front of iris (anterior chamber lens).

Most cataract surgical procedures are performed without complications and result in immediate improvement in vision.  You will apply eye drops for several weeks following surgery to reduce the possibility of infection and/or inflammation in the eye.  You may need an eyeglass prescription to obtain your clearest vision following surgery.

In a number of cases, the natural capsule supporting IOL can become cloudy after cataract surgery.  A Posterior Capsulotomy, (laser surgery done in the office) can be performed to open  cloudy capsule and restore clear vision.

Yag Capsulotomy