Minimally Invasive Surgery is improving glaucoma treatment


Dr. Robert Arleo, MD
Dr. Robert Arleo, MD

Glaucoma is a disease of the optic nerve that can lead to vision loss and permanent blindness. Without proper treatment, a person with glaucoma loses peripheral vision first, followed by the loss of their central vision.

 Early diagnosis and regular, careful monitoring by an experienced ophthalmologist are important parts of successful treatment. Today, we have advanced treatments to help keep the progression of glaucoma in check. A new, state-of-the-art procedure, Minimally Invasive Glaucoma Surgery (MIGS), improves fluid drainage out of the eye in patients with mild-to-moderate glaucoma. The procedure is frequently performed in combination with cataract surgery for the appropriate patients.

How is the optic nerve damaged in people with glaucoma?

The optic nerve is damaged by elevated intraocular pressure, which occurs when too much fluid builds up inside the eye. Some individuals have glaucoma but do not have increased intraocular pressure, while others have naturally high intraocular pressure and never develop glaucoma. People in the early stages of glaucoma have no symptoms. It is a complex disease and every patient’s case is unique.

Who is at risk for glaucoma?

The most common form of glaucoma is called chronic open-angle glaucoma and the single most important risk factor is elevated intraocular eye pressure. Other significant risk factors include a family history of glaucoma, diabetes, near-sightedness, trauma to the eye and certain physical characteristics of the eye. Being over the age of 45 increases your risk for glaucoma; however, this is not just a disease of the elderly. In my practice, I have several glaucoma patients in their forties.

How is glaucoma diagnosed and monitored?

Glaucoma is diagnosed though a very specific eye examination in the ophthalmologist’s office. We carefully look at the optic nerve in each eye and photograph it, which provides us with a record. In regular follow-up examinations, we can compare these images to determine if there is any change in the optic nerve; ideally, the optic nerve does not change. We test the pressure in the eye and measure the thickness of the cornea, which affects how we interpret the pressure reading. We conduct automated visual field testing and continue to test this sequentially every few months or annually, depending on the stability of the eye’s condition. During the examination, we also assess the areas where fluid drains from the eye.

If a patient has glaucoma or suspected glaucoma, the ophthalmologist sets a safe target range for these various measurements. These parameters, which are different for every person, determine how often to observe the eye and when to treat the eye.

How is glaucoma treated?

When pressure in the eye increases, it is because the drainage within the eye is inadequate. Treatment typically begins with medication and laser treatment. There are different classes of medications to lower eye pressure. We look for the most effective medication for each patient with the least number of side effects and at a cost the patient can afford. In-office laser treatment (trabeculoplasty) and medication both stimulate the eye tissue to drain more efficiently. Both before and during treatment, it is very important to have regular follow-up appointments for glaucoma.

If laser treatment and medications cannot bring the eye pressure into the patient’s safe target range, the next step is outpatient surgery. Locally, glaucoma surgery is performed at Surgicare, where we have the technology and experience to perform a variety of advanced microsurgical glaucoma procedures.

What happens during glaucoma surgery?

The most common procedure is trabeculectomy. This is sensitive microsurgery that creates both a physical opening in the eye wall through which fluid drains and a new channel to carry that fluid from the eye. In more severe cases, we perform tube shunt surgery, during which a microscopic tube is placed in the eye. This tube drains to a reservoir that is positioned in the eye socket, which releases the fluid into the body where it is absorbed.

There are several types of glaucoma, some of which are more difficult to treat and often require surgery. Often, we can tell upon examination if a patient is at risk for glaucoma attack, and we can do surgery to prevent it. Acute closed-angle glaucoma (glaucoma attack) is caused by a sudden blockage in the eye that leads to high intraocular pressure and is a serious emergency. If you experience severe eye pain and headache with blurry vision, seek treatment immediately.


Dr. Arleo is board certified in ophthalmology and serves on the medical staff of the Cayuga Medical Center. He can be reached at Arleo Eye Associates in Ithaca at 607-257-5599.