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Seeing Clearly- Getting Rid of Glaucoma Meds

A new implant is helping people save their sight.

More than two million Americans have glaucoma, but only half know it.  Untreated, it can cause blindness. In the past glaucoma sufferers either had to undergo risky surgery or use daily eye drops to help manage this incurable disease. Now, a new implant is helping to eliminate the need for either.
“It feels so good,” Lind Sabatini told Ivanhoe.
Linda thought she had seen the last of driving. She was slowly losing her vision from cataracts and glaucoma. Glaucoma is a disease where fluid pressure builds up inside the eye.
“A sustained elevated pressure then causes damage to the optic nerve, the nerve in the back of the eye,” David M. Lubeck, MD, Ophthalmologist, Arbor Centers for EyeCare, told Ivanhoe.
Doctors implanted a tiny titanium device in Linda’s left eye. It's called iStent.  It creates a channel for excess fluid to drain and lower the eye pressure.
“It is minimally invasive. It has little risk compared to other major glaucoma surgeries, and can effectively reduce the pressure in many patients,” Dr. Lubeck said.
The iStent surgery is performed during normal cataract surgery, using the same incisions. The new procedure can reduce or eliminate the need for open angle glaucoma patients to use up to three types of glaucoma medications daily.
In fact, 68 percent of glaucoma patients who received the iStent remained medication free at 12 months.
While Linda’s new lens from the cataract surgery is what enables her to see clearly, it's the iStent that will prevent her from losing vision from glaucoma.
“I can see so clearly,” Linda said.
Even with the iStent surgery, glaucoma is not curable, and vision lost cannot be regained. However, with medication and/or surgery, it is possible to halt further loss of vision.

BACKGROUND: Glaucoma is a complicated disease where damage to the optic nerve leads to progressive, irreversible vision loss. It is the second most common cause of blindness in the United States. Everyone is at risk for glaucoma, there may be no symptoms to warn you, and there is no cure for the disease. It is estimated that over 2.2 million Americans have glaucoma but only half of those know they have it. (Source: http://www.glaucoma.org/glaucoma/glaucoma-facts-and-stats.php)
TYPES:  There are four major types of glaucoma:
* Open-angle (chronic) glaucoma: an increase in eye pressure occurs slowly over time. The pressure pushes on the optic nerve. Unknown cause, tends to run in families
* Angle-closure (acute) glaucoma: occurs when the exit of the aqueous humor fluid is suddenly blocked. This causes a quick, severe, and painful rise in the pressure in the eye. This is an emergency, and if you have had acute glaucoma in one eye, you are at risk for an attack in the second eye.
* Congenital glaucoma: seen in babies and present at birth due to abnormal eye development.
* Secondary glaucoma: caused by drugs like corticosteroids, eye diseases, systemic diseases, or trauma.
* (Source: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002587/)

NEW TECHNOLOGY: A new device called iStent is designed to release some of the fluid buildup associated with open-angle glaucoma. The iStent is the smallest device ever approved by the FDA, and is designed to be inserted into the eye during normal cataract surgery. The device creates a permanent opening to release eye pressure, easing some of the symptoms of glaucoma. Although it can’t bring back sight, the iStent can get patients off daily glaucoma medications. In a trial, 68 percent of patients who had the iStent were medication-free 12 months after the surgery. (Source: http://www.glaukos.com/istent)
FOR MORE INFORMATION, PLEASE CONTACT:

Dodi Wians
Doctor Assistant
Arbor Centers for EyeCare, Chicago, IL
(708) 249-1017
istent@arboreyecare.com



Dr. David Lubeck, Ophthalmologist, Arbor Centers for EyeCare, Chicago, IL, talks about a new treatment for glaucoma.

Can you explain what this new surgery is?
Dr. Lubeck: The eye stent procedure is an operation that we do in combination with regular cataract surgery to place a micro-implant in the eye to reduce pressure and improve the treatment of glaucoma.
How is this treatment different than ones in the past?
Dr. Lubeck: There have been three levels of treatment with glaucoma up until now. There have been drops, there’ve been laser treatments, and then there’s been surgical treatments, most of which were fairly invasive and had high potential complication rates. The eye stent is a micro-trabecular bypass device; so it’s minimally invasive. It has little risk compared to other major glaucoma surgeries and can effectively reduce the pressure in many patients.
What were the risks of the prior surgeries?
Dr. Lubeck: Most glaucoma surgeries require disrupting or cutting through many layers of the eye, they can take a long time to heal, they can become ineffective over time if they scar or fibrose, and often they make the eye more prone to further complications or other problems thereafter.
What are the risks and complications of the eye stent?
Dr. Lubeck: Well the eye stent, because it’s being placed as part of cataract surgery, carries essentially the risks of cataract surgery alone which are usually quite small. The eye stent itself does not add significantly to the risks of cataract surgery itself.
Why does the stent have to be placed in conjunction with cataract surgery?
Dr. Lubeck: The eye stent went through an extensive approval process and it was approved to be used as part of a cataract operation. We utilize the same incisions of the cataract operation, we pass the stent through the incisions that are made for the cataract operation and then use part of the cataract operation to complete the eye stent procedure.
Is cataract surgery more invasive than like the traditional glaucoma surgery?
Dr. Lubeck: Good question, no. Cataract surgery is much less invasive than traditional glaucoma surgery. So it provides a safer opportunity or a safer environment to do the eye stent now. There are other glaucoma procedures that can be done without cataract surgery which are minimally invasive. They have variable effectiveness and are more invasive than the eye stent itself.
How does the eye stent work?
Dr. Lubeck: The eye stent is a beautiful, miniaturized tube or valve. It is passed in the eye on the end of an inserter and then threaded into the area of the eye that has become blocked by the glaucoma. It’s then released from the inserter and it leaves the stent in place, creating a passageway for fluid pressure to go through the wall of the eye and through the trabecular meshwork that had been previously blocked.
You don’t have to use medication once you have the eye stent?
Dr. Lubeck: Our primary goal in treating glaucoma is to lower pressure by whatever means we can. Drops can lower pressure, surgery can lower pressure, laser can lower pressure. Our goal is to lower pressure effectively, efficiently, and hopefully, as low a cost as possible. So by implanting the eye stent we can lower pressure and reduce the need for medication.
How many people in the US have glaucoma?
Dr. Lubeck: It’s estimated that over to 2 million people in the US have glaucoma, probably half of them don’t know they have it.
What are the symptoms of it?
Dr. Lubeck: The majority of patients have no symptoms of their glaucoma often until it’s too late until they’ve lost too much vision to treat it effectively.
So what are the symptoms for people who know that they have it?
Dr. Lubeck: So most of the glaucoma in the US is the open angle type, there are no symptoms of it which is why we encourage everyone over 50 to be screened at least every year or two, or more often and earlier if they have a family history of glaucoma. If elevated pressure or nerve damage is detected, then treatment would be initiated in the absence of any symptoms. Our goal is to prevent vision loss from occurring in these patients.
What is the worst thing glaucoma could cause?
Dr. Lubeck: Untreated glaucoma is a blinding disease and accounts for much of the preventable blindness in the world today.
What causes glaucoma?
Dr. Lubeck: The precise causes of glaucoma aren’t completely known. In a clinical sense glaucoma occurs when the pressure in the eye becomes elevated, the sustained elevated pressure then causes damage to the optic nerve, the nerve in the back of the eye, and it’s this damaged nerve which leads to the loss of vision.
But nobody really knows why?
Dr. Lubeck: The mechanism that causes the pressure to be elevated and the mechanism that causes the nerve to be more vulnerable to damage are being researched, have been researched for a long time and are being better understood. But there are still many things yet to be learned about it.
Do you know what the success rate of the stent is?
Dr. Lubeck: In the clinical trials of eye stent, 68 percent of patients were off of all medications at a year.
Is it covered by insurance?
Dr. Lubeck: Eye stent is covered by Medicare insurance.
How long does the surgery take?
Dr. Lubeck: Typically the cataract surgery takes between eight and ten minutes, and then the eye stent another five to ten minutes beyond that.
What’s the recovery time?
Dr. Lubeck: The recovery profile is the same as with cataract surgery. So patients normally have better vision the next day. We see them in a day, we then see them at a week, and then typically around a month. Some patients will stay on their glaucoma medications right after surgery and others will have an immediate lowering of pressure and can eliminate them or reduce them.




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