Duke Glaucoma Research Leads to Vision-Saving Treatment

In 2021, Paige started losing vision in her left eye. She sought care near her home in Whitsett, but said, “I didn't feel comfortable that they had my best interest at heart. I felt like I was on the assembly line. I needed more confidence than that.”

Paige made an appointment with Dr. Herndon at the Duke Eye Center in Durham. After an extensive evaluation, he diagnosed her with a severe stage of glaucoma. This chronic condition occurs when the natural drain in the eye is clogged, and pressure builds up that damages the optic nerve.

“We know from research and personal experience which patients need aggressive eye pressure lowering, and unfortunately Josie was one of them,” Dr. Herndon said.

Paige had already had laser treatment and was on a complex medication regimen, so Dr. Herndon recommended that she have a trabeculectomy. The procedure creates a new drain in the eye that allows the internal fluid to exit, which lowers the eye pressure. “Most of the time it works well enough to get patients off drops, but most importantly, patients keep their sight,” Dr. Herndon explained.

For the next two years, Paige’s pressure stayed within a safe range, but eventually scarring developed in the new drain, which caused the pressure to rise again. In April 2024, Dr. Herndon determined that a second trabeculectomy was her best bet to lower her pressure to low levels. However, more scarring occurred, her pressure rose again, and her visual field began to close.

Fortunately for Paige, Dr. Herndon and his colleagues are among the country’s leading glaucoma experts. They participated in a large clinical trial which showed that placing a glaucoma drainage tube after a failed trabeculectomy was an effective option. “The results of that study were published and are referenced often by glaucoma surgeons around the country,” Dr. Herndon said.

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In February 2025, Dr. Herndon placed a newer version of the small silicone tube -- also known as a shunt -- into Paige’s eye. Herndon and his colleagues had studied the new tube in a randomized controlled study comparing it to the standard-of-care tube. Their published study demonstrated that the new tube lowers the eye pressure more than the standard tube. More than six months later, Dr. Herndon said Paige is doing great. “We’re thrilled with the results. She’s very stable, and her prognosis is excellent. She'll continue to need close follow-up, but she should keep her sight for the rest of her life.”

Paige is excited to be better as well, and grateful that she can continue to drive and read. “Losing your vision is one of the most devastating things that could happen to you. I have confidence that Duke is the best place on the planet,” she said.

Dr. Herndon stressed that Paige’s experience is not uncommon. “It illustrates the frustrations patients and physicians go through trying to get low pressure in patients with severe glaucoma," he said. 

Dr. Herndon said people with glaucoma should feel confident when seeking care at Duke. Because Duke is one of the best eye centers in the country, it has the resources to combine the best minds in glaucoma research and clinical practice to help patients to make informed decisions about the treatment and management of complex eye conditions like glaucoma.

That’s the approach to which he attributes Paige’s successful outcome. “Because of the multicenter trial and the research we published, we know which patients will do well with which procedures.”