Treatment Options

In order to preserve eyesight, it is critical to decrease and control the elevated intraocular pressure (IOP) associated with glaucoma. Depending on your individual situation, there are several treatment options available:

Mild-Moderate Glaucoma

Medication (eye drops) is the most common form of treatment for glaucoma; however, there are side effects, and medication is not effective for all patients – and you have to remember to take your medication every day. There are a number of different types of eye drops, but all are used to either decrease the amount of fluid (aqueous humor) in the eye or to improve the outflow of this fluid in order to stabilize or reduce IOP. Your doctor will decide which medication is best suited to you based on a number of considerations, including: medical history and current medication regimen. Your doctor may also elect to prescribe a combination of eye drops.

iTrack™ is a minimally invasive glaucoma surgery (MIGS). Unlike other MIGS procedures, which bypass the natural outflow pathway, iTrack™ is unique in that it acts to restore the eye’s natural drainage system. To date, iTrack™ is the only MIGS procedure that successfully addresses all aspects of potential outflow resistance, including the trabecular meshwork, Schlemm’s canal and the collector channel system. By addressing all aspects of outflow resistance iTrack™ is able to deliver an average reduction in eye pressure of 30%. It can also reduce your glaucoma medications by 50%.

How is iTrack™ performed?

First, your doctor will make a small incision in the eye. A microcatheter designed specifically for iTrack™ is then inserted into the eye’s drainage canal. Your doctor will advance the microcatheter 360 degrees around the canal to open up the channel and enlarge it. Once the end of the catheter has circumnavigated to its point of entry, the microcatheter tip is slowly pulled back while sterile, viscoelastic gel is injected into the canal to dilate it to 2 – 3 times its normal size. The microcatheter is then withdrawn from the eye. It is important to note that there are no permanent implants or devices left in the eye.

iTrack™ can be performed during cataract surgery, or as a stand-alone procedure. Your doctor will be able to determine which option is best for you.

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SLT or Selective Laser Trabeculoplasty, is a low-energy laser therapy, which triggers a natural healing response in the eye in order to reduce the IOP associated with glaucoma. SLT effectively lowers eye pressure in the majority of patients, but the length of time that pressure remains low depends on many factors, including: age of the patient, the type of glaucoma, and other medical conditions that may be present. In many cases medication may still be necessary, but in reduced amounts.

Note: Previously, Argon Laser Trabeculoplasty (ALT) was used to treat glaucoma. ALT uses a high-energy laser to open’ the clogged areas of the trabecular meshwork (the eye’s drainage system), allowing fluid to bypass this drainage system and flow out of the eye. However, unlike SLT, ALT causes permanent coagulative damage to the eye and cannot be repeated.

Advanced Glaucoma

Canaloplasty is an advanced treatment for your glaucoma. It uses breakthrough microcatheter technology, similar to angioplasty, to enlarge your eye’s natural drainage system. Importantly, Canaloplasty is less invasive than traditional surgical treatments.

How is canaloplasty performed?

First, your doctor will make a small incision in the eye. The advanced Canaloplasty microcatheter will be inserted into the eye’s drainage system canal. Using the microcatheter, your doctor will circle the canal and enlarge it via visco-dilation, which will help the aqueous fluid drain properly. The microcatheter is then removed and a suture is placed within the canal to keep it open. By restoring your eye’s natural drainage system, the pressure inside your eye is usually lowered. Canaloplasty can also be performed when other surgeries have failed (even those offered for late-stage disease) and with a very good success rate.

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Severe Glaucoma

During the Molteno3® surgery, a small drainage device is implanted in your eye. This device consists of a small plate and a tube. The tube creates a new drainage channel through which the eye’s fluid can flow from the front chamber of the eye to a filtering area called a bleb. The Molteno3® glaucoma drainage device is placed outside the eye but is covered by the skin of the eye and thus it cannot be seen or felt.

Molteno3® surgery is an outpatient procedure and is performed by your ophthalmologist, but may require an overnight stay in hospital. The total procedure takes about 60 – 90 minutes. Postoperatively, you will need to take eye drops and/​or pain medication. Regular follow-up examinations with your ophthalmologist will track the pressure changes in your eye and ensure that the Molteno3® glaucoma drainage device is working correctly. Potential side effects include blurred vision, bleeding in the eye, infection and discomfort.

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During trabeculectomy surgery, your ophthalmologist will cut a flap in the white part of the eye (known as the sclera) and remove a piece of trabecular meshwork, which is the eye’s drainage channel. This creates a new opening through which the eye’s fluid can drain into a space under the skin around the eye (known as the conjunctiva) to form a drainage bleb’. The drainage bleb sits under the upper eyelid. Potential side effects include blurred vision, bleeding in the eye, infection and discomfort.

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