Our Summary

This research paper focuses on the challenges of managing glaucoma, a chronic and progressive eye disease that often goes unnoticed and can be costly to treat. Both conventional methods of treatment and surgery can be difficult for patients to accept due to the impact on their quality of life. However, there is now an alternative: Minimally Invasive Glaucoma Surgeries (MIGS), which provide a less disruptive way of transitioning from medical therapy to surgery. However, choosing the right approach from the newly available options requires a good understanding of these methods. This paper reviews these options, considering factors like the patient’s age, the type of glaucoma, their life expectancy, socioeconomic status, expectations, and the presence of other issues like cataract.

FAQs

  1. What is Minimally Invasive Glaucoma Surgery (MIGS) and how is it different from conventional glaucoma surgery?
  2. What factors are considered in the decision-making process for choosing the right glaucoma surgery?
  3. What is the role of patient’s age, type of glaucoma, life expectancy, socioeconomic status, patient expectations, and coexisting cataract in selecting the type of glaucoma surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about glaucoma surgery is to follow all post-operative instructions carefully to ensure a successful recovery. This may include using prescribed eye drops, avoiding strenuous activities, and attending follow-up appointments with the doctor. It is important to communicate any concerns or changes in vision to the doctor promptly.

Suitable For

Patients who are typically recommended glaucoma surgery are those who have been diagnosed with glaucoma and are not responding well to medical therapy, or are unable to tolerate the side effects of their medications. Additionally, patients with advanced or rapidly progressing glaucoma, or those who have already undergone multiple unsuccessful surgeries, may also be candidates for glaucoma surgery. Other factors that may influence the recommendation for surgery include the patient’s age, type of glaucoma, life expectancy, socioeconomic status, patient expectations, and the presence of coexisting cataract. Ultimately, the decision to undergo glaucoma surgery should be made in consultation with a qualified ophthalmologist who can assess the individual patient’s specific circumstances and recommend the most appropriate treatment option.

Timeline

Before glaucoma surgery:

  1. Patient is diagnosed with glaucoma through routine eye exams or after experiencing symptoms such as blurred vision, eye pain, or halos around lights.
  2. Patient undergoes various treatments to control intraocular pressure, such as eye drops, oral medications, or laser therapy.
  3. Despite treatment, the progression of the disease may continue, leading to the need for surgical intervention.
  4. Patient discusses surgical options with their ophthalmologist, weighing the risks and benefits of each procedure.
  5. Preoperative evaluations and tests are conducted to assess the patient’s overall health and determine the best approach for surgery.

After glaucoma surgery:

  1. Patient undergoes the surgical procedure, which may involve the insertion of a glaucoma drainage device, trabeculectomy, or minimally invasive glaucoma surgery (MIGS).
  2. Patient experiences some discomfort and may need to take medications to manage pain and prevent infection.
  3. Follow-up appointments are scheduled to monitor the healing process and ensure that the surgery was successful in reducing intraocular pressure.
  4. Patient may need to make lifestyle changes, such as avoiding heavy lifting or strenuous activities, to promote proper healing.
  5. Over time, the patient’s vision may improve, and the progression of glaucoma may be slowed or halted, leading to better overall eye health and quality of life.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with the specific type of glaucoma surgery being recommended?
  2. How successful is this type of surgery in lowering intraocular pressure and preserving vision?
  3. How long is the recovery period after surgery and what can I expect in terms of post-operative care and follow-up appointments?
  4. Will I still need to use glaucoma medications after surgery, and if so, how soon can I expect to see a reduction in the number of medications required?
  5. Are there any lifestyle changes or restrictions I should be aware of following glaucoma surgery?
  6. What is the expected long-term outcome of this surgery and how often will I need to be monitored for any potential complications or disease progression?
  7. Are there any alternative treatment options to consider before proceeding with surgery?
  8. How experienced is the surgeon in performing this type of glaucoma surgery, and what is their success rate with previous patients?
  9. Will insurance cover the cost of the surgery, and if not, what are the potential out-of-pocket expenses I should be prepared for?
  10. Are there any specific pre-operative tests or evaluations that need to be done before scheduling the surgery?

Reference

Authors: Dhingra D, Bhartiya S. Journal: Rom J Ophthalmol. 2020 Apr-Jun;64(2):85-95. PMID: 32685772