Glaucoma

Glaucoma

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Glaucoma is a progressive eye disease that requires early diagnosis and treatment to prevent optic nerve damage and vision loss. Our specialists have advanced training in managing all types of glaucoma, including open-angle glaucoma, narrow-angle (also known as closed-angle) glaucoma, and neovascular glaucoma -- which may affect people with diabetes. 

Duke's glaucoma experts use the latest diagnostic advances and are skilled in advanced laser and surgical procedures to slow glaucoma progression. We routinely provide care for people who are at high risk for glaucoma, have been diagnosed with glaucoma, or haven't had success with glaucoma treatments. Our goal is to lower your eye pressure, minimize the damage to your optic nerve, and preserve your vision.

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Treatments

Medical Management

Several medications may be prescribed as eye drops or medicines you take by mouth. Depending on your needs, we will recommend one or a combination of medications to help you reduce eye pressure, reduce the fluid that builds in the eye and causes increased pressure, and minimize damage to your optic nerve. 

Selective Laser Trabeculoplasty (SLT)

SLT uses a new laser with low levels of energy to target select cells within the eye's 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.

Laser Peripheral Iridotomy

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.

Trabeculectomy

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.

Tube Shunt Surgery

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. 

Laser Cyclophotocoagulation

Laser energy is used to decrease the eye’s ability to make the fluid that 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 to direct the laser energy. The procedure takes minutes and may reduce or eliminate your need for eye drops.

iStent Surgery

A tiny, L-shaped titanium device is implanted in the eye to create a path for fluid to drain. This decreases eye pressure in people with open-angle glaucoma. Often implanted during cataract surgery, this relatively new device may help a subset of people with glaucoma.

Canaloplasty

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.  

Our Locations
Duke Health offers locations throughout the Triangle. Find one near you.

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.

Tonometry

Measures the inner pressure of your eye using a tiny device that applies pressure to the eye.

Perimetry

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. It is used to diagnose and determine the progression of glaucoma.

Gonioscopy

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. The test is used to determine whether the angle is open or narrow.

Optical Coherence Tomography

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 identify during a visual field test. OCT of the front part of the eye may be useful in identifying angle-closure glaucoma and in imaging abnormalities such as iris cysts.

Pachymetry

Ultrasound waves measure the thickness of the cornea. Thinner corneas are a risk factor for developing glaucoma.

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Experts in Comprehensive Glaucoma Care

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 extensive experience and knowledge mean you receive your care from some of the nation’s most respected glaucoma specialists.

Treatment Options for Complex Cases
We use the latest advances to treat people who have
complex glaucoma, whose glaucoma has not responded to medical therapy, or who have had previous glaucoma procedures that 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.

Promising Research
Our scientists are working on new treatments for glaucoma, ways to make medical management easier, and new drug delivery devices. We are also conducting studies that may ultimately
lead to ways to protect the optic nerve. Our goal is 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.

Best Eye Hospital in NC
When it comes to your care, you want the very best. Duke University Hospital’s ophthalmology program is ranked seventh in the nation and best in North Carolina by U.S. News & World Report for 2019–2020.