So open-angle glaucoma
Treatment well in this video I get to review the different eye drops for glaucoma and glaucoma surgery. So let's take a look
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Joe Allen here from doctor eye health bringing the best in education about the eyes vision and vision product
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Also, keep in mind this video is part of a complete video series about glaucoma
So if you're new here, that's great
But don't miss out on all the other good videos about glaucoma and I'll hook you up with a link to that in the description
Below as well as in the YouTube card up above otherwise, let's go over open-angle glaucoma
Treatments now when it comes to glaucoma treatment, there are many different treatments out there
however
the same
concept across the board for all those treatments is the same we treat glaucoma by lowering the pressure of the eye and
We can do that with Medicated eyedrops. We can do that with laser surgeries
we can even do that with more intense surgeries in the operating room where we physically make an
Increased drainage canal or we can do implants to again increase the drainage of the eye or we can use a combination
of all those different strategies
So overall the treatment outlook for glaucoma is usually very good
now if you are diagnosed with open-angle glaucoma here in the United States and you're gonna be started on treatment you usually
Started on a medication called a prostaglandin
Analog these eyedrops come with a little kind of Bluegreen almost a teal colored cap
Now I don't have any affiliation with brands or anything. One of the more common ones is called Xalatan
The generic form is called latanoprost now. These drops are excellent
The reason they're prescribed usually first-line is because one they're pretty cheap
the generic form has been out since I think like the mid 90s and
Over all that are pretty cheap for people to take also they're incredibly effective
So just using this drop one time at night every day in both eyes will lower the pressure of the eyes
Anywhere from 25 to 33 percent
That's an excellent decrease in eye pressure. And so for again that the kind of the cost benefit of taking this medication and
a
Significant drop in eye pressure it makes this really the first line for first line treatment for glaucoma now
because this glaucoma medication is
Used so commonly there are some side-effects. I wanted to kind of mention
So if you're taking this medication already, you could notice that these drops make the eyes a little bit red or a hyperemic
That's what we call it in the in the clinic. But usually you're using this drop right before bedtime
So you're going to bed anyway, so it's not really that huge of a deal
Some people will notice their eyelashes grow a lot longer thicker and fuller
Actually a lot of our lady patients who are put on this medication
they don't really mind too much because it's basically like getting a prescription for Latisse the
Medication that can actually grow your eyelashes longer. In fact, they're the same classification of medication. They're both prostaglandin analogues
now
Beyond just that this medication is known for helping change the eye color
Now no one really prescribes this for this reason, but as a side effect people with lighter colored eyes
Like myself I have blue eyes
if I was to start taking this medication and I took it for a long time a couple eight years then the pigment of my
eye you could actually maybe notice it start to get darker and
Eventually, some people even can do that kind of light brown eyes from taking this medication
One of the more lesser common known side effects of a prostaglandin analog is it changes the fat deposition.
around the eyes
So usually we don't prescribe a prostaglandin analog in just one eye by themselves
but
Occasionally if somebody is using it in just one eye and not the other that one I could start to look like it's sunken back
Deeper inside the skull and that's this because the fat around the eye is just not kind of depositing
Normally as it would be in the eye that's not taking that medication
Now beyond just using a prostaglandin analog if your doctor feels that that medication either isn't right for you
Or maybe it's not being effective enough
Maybe you need your eye pressure lowered even more they'll consider adding another medication now
It's always up to your doctor which medication they choose for you
next and which one's the best for you based on your health and make a shion's you're taking but
Often times here in the United States probably the second most commonly prescribed
I drop for glaucoma. It fits into a classification called beta blockers
One of the most famous names is called timolol. There's a couple of different concentrations of timolol. There's either timolol eyedrops
There's tomorrow gel drops. They're a little bit thicker
Usually these drops come in a cat come in the bottle with a yellow cap
And these drops are usually prescribed at least once a day
I've seen a prescribed twice a day, but usually at least once a day and in the mornings
These medications do lower the eye pressure by about
25% and they do that by decreasing the formation of the fluid inside the eye
Prostaglandins actually help decrease the fluid by help actually getting the fluid to drain out of the eye better
So again prostoglandins help drain the fluid out of the eye and then Tim will or beta-blockers will help
Decrease the formation of fluid inside the eye and so if you actually push the doctor was to prescribe these both together
It's a very powerful effect. Now, of course with latanoprost, you know, we have to watch about some of those
Complications those contraindications or side effects with timolol the few side effects that can occur
Usually your doctor has to kind of screen to make sure you're not known of a history of asthma
Or a breathing issues like with COPD and there's other type of medications that could interact
So again, those are things your doctor will consider now beyond using either latanoprost again the teal green cap
Or you got timolol the beta blocker that comes with a yellow cap.
Then there's other medications one that comes in an orange cap is called a carbonic anhydrase
inhibitor or CA is and that's either gonna be called a brinzolamide or dorzolamide now these medications
They actually do lower the eye pressure by decreasing the formation of the fluid just like timolol
But on their own they only decrease the eye pressure just a little bit. So usually these ones are used in
combination with something like timolol
And that actually helps amplify the amount of decreased eye pressure by up to about 15 percent
Now again these medications if they're prescribed alone usually are three times a day
But oftentimes they prescribe just twice a day because using it in combination with the other eyedrops
beyond the carbonic anhydrase inhibitors
Then there's a medication that comes in a purple cap, and that one's called an alpha
Agonist and that one is called brimonidine
now bromonidine this alpha agonist not only decreases the formation of fluid inside the eye but it also increases the
Outflow of the fluid inside the eye. So this medication again works pretty well
Oftentimes it is used as an adjunct to either Latanoprost or perhaps timolol
But again, these are all actually the major
Classifications of the different medications the different eye drops for glaucoma now beyond just these drops that we've mentioned again
There are combo drops out there. These are medications that are kind of like having the shampoo and conditioner
Combos that you have in the shower, these medications are basically the mix of the other ones we mentioned
They work fantastic
but they're basically
just put together like that to make it more convenient rather than having like five or six bottles that you got a dump in your
Eye throughout the day. It just makes it more convenient
increases the adherence to the medication
Things like that. There is another medication that just came out maybe about a year ago. I think it finally got FDA approved in
2017 and that one's called Ropressa. That's the brand name
I have no association with that brand but that medication actually helps again drain the fluid out of the eye through the
Trabecular meshwork, that's one and again that ways that the fluid actually drains out of the eye
Being that this medication is newer. It is a bit more expensive
however
It is kind of making its run for its money because it actually has such a good effect at lowering the eye pressure
I think it's also pretty close to that of a prostaglandin analogue
Now again, it's just a newer medication. We want to kind of throw it out there
I don't think too many people are using it yet
But it could be on the rise as a future big name for glaucoma treatment now
I also want to mention that if you are taking any of these eye drops
it is very likely that a lot of people will start off taking these medications and it
because glaucoma has no symptoms people will start taking it and then they'll just stop taking their eye drops or it's easy for them to
Forget but it's really important that if you're taking these drops for any reason for glaucoma
You try not to forget don't stop doing it. Unless your doctor told you to stop taking them
Really, you know damage from glaucoma is permanent
There's no way for us to back the train up and get vision back from this damage
so really taking these eye drops is the only way for your eye doctor to control the pressure and
prevent or delay for their vision loss and if you're somebody who's taking any of these eye drops and you're having
Difficulty getting the drops in I did make another video on how to put eye drops in on your own and I'll hook that up
Here in the YouTube card up above as well as in the description below now beyond taking those medications
There are a couple other treatments and that involves different types of glaucoma
Surgery, the two major forms a surgery that we're gonna cover today is laser trabeculoplasty
And then we're gonna roughly review some of the different
Implants and the different kind of more invasive procedures that can be used for glaucoma now
The first one is laser trabeculoplasty
This actually it I actually really like laser trabeculoplasty
Because this is a way for us to pay much get rid of some of the eye drops if somebody doesn't want to take them
now laser trabeculoplasty
involves putting a special type of
Mirror contact lens on the eye while the patient sits behind a small
Laser device we have in the clinic and then the doctor will activate this laser and they'll actually burn in burn little drainage canals
Into the already existing drainage canal of the eye
So they basically widen the drainage canal to increase the outflow
Now this procedure isn't ideal for everybody with open-angle glaucoma
You basically do need
Some type of pigment in the drainage canal of your eye for this to work if you don't have any pigment
Then you are not an ideal candidate for this procedure
However, by having this done again
We can lower the eye pressure and some people can lower the pressure so much
That they maybe can stop taking all their other eye drops
They don't have to pay for those drops. They don't have to take them throughout the day
however, saying however
Then now that I said that there are sometimes people will get that procedure and then they still have to be on eyedrops
So it's not a panacea. It's not a cure-all
This method this sort of treatment. However is not always first-line
it can actually be done just about at any point throughout the treatment period
The only real big downsides again is that it's not available for everybody and it actually tends to wear off. So after about five years
Of having the benefits of having this procedure it can wear off and has to be repeated again
So this isn't a fantastic option and I do think it's great for some people
But you have to also there's a few other things you have to weigh out with your eye doctor
With the patient to make sure that hey they're a good candidate. Also. This procedure isn't always covered by insurance
And so sometimes this can cost quite a bit of money to have done
I've actually seen it anywhere from four to up to like seven thousand dollars to have this procedure completed here in the United States
so again
If it's something you're interested in if maybe you're having trouble taking medications talk to your doctors about this option of having a laser trabeculoplasty
now beyond just taking
Medications to lower the eye pressure or having the laser procedure to lower the pressure
If for some reason the pressure isn't low enough or the advanced or glaucoma continues to advance then your doctor will recommend more
intensive
More invasive surgeries. Now. These surgeries are always our last line of defense
They're not recommended right away because they are associated with more
complications
Classically we have the trabeculectomy or maybe an external tube shunt such as the ahmed valve these do lower the eye pressure
Considerably. However, they are associated with more complications
So now we're recommending what are called MiG's these are minimally invasive glaucoma surgeries
And these usually involve really tiny implants inside of the eye again to decrease that eye pressure
And what's great is that these can oftentimes be is so be combined with other surgeries such as cataract surgery
So it's kind of like getting a two-for-one. So these are excellent
They're less complication rates and they usually lower the considerable amounts. No if you're gonna have any of these surgeries
Do keep in mind that you are gonna be on several eye drops before the surgery. Probably even more eye drops after the surgery
And sometimes even after surgeries
People are still on I pressure lowering medications
You have to see your doctor several times a year just to keep that pressure low and verify that it's in a safe
Level and if for some reason these surgeries really just don't take well, it doesn't it doesn't go well for you
Sometimes they have to be repeated again
And yeah, that kind of stinks but we have to do whatever we can to preserve vision
All right
So I health question of the day which glaucoma treatments have you heard of which are some of your favorites?
Do you have any other questions, please? Go ahead and comment in the section below. Alright, everyone. Thanks so much for watching
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