Glaucoma
Duke glaucoma specialists are experts in advanced treatments to lower eye pressure, and treat all types of glaucoma with the goal of preventing vision loss. We have completed years of advanced, fellowship training in the management of open angle and narrow angle which is also known as closed angle glaucoma. As leading experts in our field, we also provide specialized care to people with secondary forms of glaucoma, including neovascular glaucoma, which may affect people with diabetes. Our goal is to lower your eye pressure, minimize the damage to your optic nerve, and prevent vision loss that can result from this silent disease.
Experts in comprehensive glaucoma care
Glaucoma is a progressive eye disease that requires early diagnosis and treatment to prevent the optic nerve damage and vision loss it can cause. Our glaucoma specialists use the latest diagnostic advances to determine the extent of your glaucoma, and are well versed in the latest therapies available to slow its progression.
We routinely care for people who are at high risk for glaucoma, already diagnosed with glaucoma, and people who have not previously had success with glaucoma treatments. Our specialists are experts in the advanced laser and surgical procedures that may be necessary to drain the fluid that causes increased eye pressure. At the same time, our researchers are busy studying new ways to approach glaucoma treatment, and are designing new delivery systems to make your management of glaucoma easier.
Choose Duke for your glaucoma care because we offer:
- Top-ranked care. U.S News & World Report consistently ranks Duke Eye Center among the nation’s best.
- Respected leaders. Our board-certified fellowship-trained glaucoma specialists travel the country to lecture and teach courses on the latest glaucoma research and treatments. Our vast experience and knowledge means you receive your care from some of the nation’s most respected glaucoma specialists.
- Latest treatment advances. Our glaucoma specialists uses the latest advances to treat glaucoma that does not respond to medical therapy including a newly approved device called iStent, and a surgical approach called canaloplasty which may be useful for some patients. We also have vast experience implanting glaucoma drainage devices, or “tubes” which are useful in people with complex glaucoma, and in situations where multiple previous glaucoma procedures have failed.
- Care for multiple eye concerns. If you have eye concerns, such as cataracts or retinal disease, in addition to glaucoma, we can coordinate your visits and work closely with your corneal surgeon or retinal specialist, if needed. We also have the experience and expertise to combine complicated surgeries to minimize your discomfort, which ensures you receive the most comprehensive care.
- Childhood glaucoma. We are one of only a handful of eye centers with a pediatric glaucoma specialist who diagnoses and treats children with primary congenital glaucoma and other forms of childhood glaucoma.
- Promising research. Our scientists are working on new treatments for glaucoma, ways to make medical management easier, new drug delivery devices, and are conducting studies that may lead to ultimately protect the optic nerve. We want to prevent blindness and minimize the damage caused by glaucoma.
- Compassionate, supportive environment. We offer patient support services, including educational materials and programs, a low vision rehabilitation program, and a dedicated social worker to help you and your loved ones manage your condition and maximize your quality of life.
GLAUCOMA
Treatments
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Several medications may be prescribed as eye drops or orally to lower eye pressure, to reduce the fluid that builds in the eye and increases eye pressure. Depending on your needs, we will recommend one or a combination of medications to help you reduce eye pressure and minimize damage to your optic nerve.
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SLT uses a new laser with low levels of energy to target select cells within the drainage system, while leaving the rest of it intact. This procedure is used to treat open angle glaucoma. Unlike some laser procedures, it may be safely repeated.
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When the angle between the iris and the cornea is too small, a laser is used to make a small hole in the iris, which helps fluid drain and lowers eye pressure.
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Relieves eye pressure by surgically creating a tiny drainage hole near the top of the eye through which fluid can drain. This outpatient surgical procedure is also known as filtration surgery. A shunt may be implanted as part of the trabeculectomy surgery.
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This drainage device is a synthetic tube that is inserted through a tiny hole created in the white portion of the eye. The tube allows fluid from inside the eye to drain into the blood stream. May be recommended if you have previous scarring.
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Laser energy is used to decrease the eye’s ability to make fluid, which causes the increased eye pressure. This procedure may be done with a camera (endoscopic cyclophotocoagulation or ECP), to help view the area of the eye that produces fluid and direct the laser energy. The procedure takes minutes, and may reduce or eliminate your need for eye drops.
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A tiny, L-shaped titanium device is implanted in the eye to create a path for fluid to drain. Decreases eye pressure in people with open-angle glaucoma. Often performed during cataract surgery. This relatively new device may help a subset of people with glaucoma.
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An extremely fine tube is threaded into the collecting drain of the eye - called the Schlem’s Canal - to help drain fluid and relieve eye pressure. This procedure can be helpful to some people with glaucoma.
GLAUCOMA
Tests
Your glaucoma doctor will conduct a thorough examination of your eyes, including structural and functional testing of the optic nerve, using a variety of imaging devices. Additional tests are necessary to measure intraocular pressure, the extent of damage, and possible vision loss.
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Measures the inner pressure of your eye using a tiny device that applies pressure to the eye.
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Measures your peripheral or side visual field in each eye. During the test, you look straight ahead while lights flash at various levels of brightness in your side vision. The test allows doctors to detect defects in your visual field. Used to diagnose and determine the progression of glaucoma.
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A microscope, known as a slit lamp, and a special mirrored lens placed in front of your eye, are used to look at the portion of your eye between your cornea and your iris. This “angle” is where the drain of the eye is located; the fluid drains back into your blood. Used to determine whether the angle is open or narrow.
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OCT is a computer-guided imaging device that creates a 3-D image map of the optic nerve, and the macula of the retina. It detects changes in the thickness of the macula and neural tissue, and looks for small defects that may be difficult to obtain during a visual field test. OCT imaging of the front part of the eye may be useful in identifying angle closure glaucoma and imaging abnormalities such as iris cysts.
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Ultrasound waves measure the thickness of the cornea. Thinner corneas are a risk factor for developing glaucoma.