Published: 29 September 2021

For over 40 years the standard surgical treatment for glaucoma was a procedure called a trabeculectomy. In a trabeculectomy, the ophthalmic surgeon would make a hole in the wall of eye to allow fluid from the inside of the eye to flow out of the eye and then get resorbed by the blood vessels in the conjunctiva (the mucous membrane that covers the white part of the eye). This surgery often resulted in a large decrease in the Intraocular Pressure (IOP). Reducing the IOP is the goal of glaucoma surgery because multiple studies show that if you can reduce the pressure the progression of glaucoma slows. The problem with trabeculectomy is that although it frequently lowers the pressure, it also has a fairly high complication and/or failure rate. This led to some reluctance to perform the procedure unless the glaucoma was severe, or the pressure was very high. As a result of those issues there has been a search during the last 40 years for something that had a lower complication rate and could be more easily deployed earlier in the disease process. Enter Minimally Invasive Glaucoma Surgery, or MIGS. There are now several types of surgeries that fit in the MIGS category and many of them are used in conjunction with cataract surgery. They are utilized much earlier in the disease process and when combined with cataract surgery they can be used to not only help control the pressure over the long term but can often even reduce the burden of eye drops afterward. The biggest advantage to MIGS over the trabeculectomy is that when used in conjunction with cataract surgery, MIGS can lower the eye pressure (although not as much as the trabeculectomy) but often with no higher rate of complications as there is with cataract surgery alone. The lower complication rate is mainly because the MIGS procedures do not create a full-thickness hole in the wall of the eye. Most of them involve putting in some form of stent inside the eye. The stent lets the intraocular fluid get out of the eye more efficiently through its normal internal drain called the trabecular meshwork, rather than having to flow to the outside of the eye as with a trabeculectomy. There are currently several FDA-approved drainage stents with more on the horizon. A stent is not the only way to lower the pressure along with cataract surgery. There is also a laser treatment you can do from the inside of the eye that slows the amount of fluid the eye makes, which also results in a lower pressure. It is called Endocyclophotocoagulation (ECP). Think of a partially clogged drain in a sink with constantly running water. If you don’t want the sink to overflow (or the pressure in the eye to get too high) you either try to unclog the drain (stent) or you turn down the faucet (ECP). MIGS has been a great development over the last several years, enabling the ophthalmic surgeon to intervene surgically at a much earlier stage of glaucoma and with a significantly lower complication rate than the more invasive trabeculectomy. At this point I utilize one of the MIGS procedures in almost all patients who need their cataracts removed and are on one or more glaucoma medications. Even if the glaucoma is fairly well controlled at the time, the MIGS procedure gives us the opportunity to try and get a glaucoma patient off their eye drops, which is both a decreased burden of treatment and lets us keep the eye drops in reserve should the pressure start to increase again later in life. If you have glaucoma and a cataract you should definitely discuss this with your doctor to see if a MIGS procedure along with your cataract surgery could be the right choice for you. Article contributed by Dr. Brian Wnorowski, M.D.

Published: 27 September 2021

Itching, burning, watering, red, irritated, tired eyes... what is a person to do? The symptoms aforementioned are classic sign of Dry Eye Syndrome (DES), which affects millions of adults and children. With increased screen time in all age groups, the symptoms are rising. What causes this? One reason is that when we stare at a computer screen or phone, our blink reflex slows way down. A normal eye blinks 17,000 times per day. When our eye functions normally, the body usually produces enough tears to be symptom free, however, if you live in a geographical area that is dry, or has a high allergy rate, your symptoms could be worse. Dry eye syndrome can be brought on by many factors: aging, geographical location, lid hygiene, contact lens wear, medications, and dehydration. The lacrimal gland in the eye that produces tears, in a person over forty years old, starts slowly losing function. Females with hormonal changes have a higher incidence of DES (dry eye syndrome). Dry, arid climates or areas with high allergy causes lend to higher incidences of DES as well. Blepharities, a condition of the eyelids, can cause a dandruff-like situation for the eye, exacerbating a dry eye condition. Contact lenses can add to DES, so make sure you are in high oxygen contact lens material if you suffer from DES. Certain medications such as antihistamines, cholesterol and blood pressure meds, hormonal and birth control medications, can also cause symptoms of a dry eye. Check with your pharmacist if you are not sure. And finally, overall dehydration can cause DES. Some studies show we need 1/2 our body weight in ounces of water per day. For example, if you weigh 150 lbs, you need approximately 75 ounces of water per day to be fully hydrated. If you are not at that level, it could affect your eyes. Treatment for DES is varied, but the main treatment is a tear supplement to replace the evaporated tears. These come in the form of topical ophthalmic artificial tears. Oral agents that can help are Omega 3 supplements such as fish oil or flax seed oil pills. They supplement the function of meibomian glands located at the lid margin. Ophthalmic gels used at night, as well as humidifiers, can help keep your eyes moisturized. Simply blinking hard more often can cause the lacrimal gland to produce more tears automatically. For stubborn dry eyes, retaining tears on the eye can be aided by punctal plugs. They act like a stopper for a sink, and they are painless and can be inserted by your eye care practitioner in the office. Moisture chamber goggles can also be used in severe cases to hydrate the eyes with their body’s own natural humidity. This may sound far out but it gets the job done. Being aware of the symptoms and treatments for dry eye syndrome can prevent frustration and allow your eyes to work more smoothly and efficiently in your daily routine. If your eyes feel dry as the Sahara or they water too much, know that help is on the way through proven techniques and products. You do not need to suffer needlessly in the case of Dry Eye Syndrome anymore. Make an appointment to talk with your eye doctor about the best treatments for you!