Yale-New Haven ophthalmologists are offering advanced new surgical procedures - safer and more effective than older surgeries - to treat glaucoma. The Yale Eye Center is the only place in Connecticut that offers these new options.
Glaucoma, which is usually associated with elevated pressure in the eye, generally leads to damage of the optic nerve which can result in progressive, irreversible loss of vision and can progress to blindness. With no cure for optic nerve damage available yet, doctors at the Yale Eye Center, under the direction of Nils Loewen, MD, PhD, are offering three new surgical options for glaucoma. The procedures are trabectome, canaloplasty and a suprachoroidal shunt - all outpatient procedures that only require local anesthesia.
"Eyes produce and remove fluid from the eye much like a sink with the faucet always turned on, producing and draining the water," said Dr. Loewen, who is an ophthalmologist at Yale-New Haven Hospital and an assistant professor of ophthalmology at Yale School of Medicine. "If the sink's drain becomes clogged, the water may overflow. But if this sink were a closed system, as is the eye, the pressure in the sink would rise. Likewise, if the drainage system of the eye becomes blocked, the pressure in the eye rises. When the intraocular pressure is too high, vision can be irreversibly lost."
Dr. Loewen's new surgical techniques can be elegantly combined with cataract removal as they use the same incision. That has the advantage of actually improving vision in addition to lowering pressure. Unlike the older glaucoma surgeries - known as trabeculectomy - these three new surgeries do not create a filtering bleb, a fluid bubble on the surface of the eye. This means that there is no life-long risk of infection and even contact lenses can be worn without a problem.
Trabectome removes the glaucoma causing obstructive angle tissue barrier by using a highly focused electro-surgical pulse. There are no permanent holes made in the eye to drain the excess aqueous fluid. Instead, the procedure allows the eye's own natural physiologic outflow system to reestablish itself and the intraocular pressure is rebalanced safely.
Canaloplasty procedure is the insertion of a microcatheter into the main drainage channel and other channels by injecting a sterile, gel-like material. After the drainage channel is made larger, the microcatheter is removed and a suture is placed within the canal and tightened to make sure that it stays open. By opening the canal, it will drain properly, and the pressure inside the eye is relieved.
The suprachoroidal shunt offers hope to patients who have had prior failed surgeries as fluid is drained into a different, internal space.
"We don't have a cure for glaucoma yet," notes Dr. Loewen. "However, the dramatic progress with technology allows us now to offer better glaucoma surgeries that lower pressure more safely to maintain what vision the patient still has. We are excited to be at the forefront at Yale to offer these better options as the only surgical center in the state. It is great that there are new therapeutic options in intractable glaucoma."
The Yale Eye Center, at 40 Temple Street in New Haven, is dedicated to improving and preserving vision through world-class patient-centered care, research, and education. Highly skilled ophthalmologists provide a complete range of services in cornea and external disease, glaucoma and related disorders, neuro-ophthalmology, oculoplastic surgery, ophthalmic pathology, pediatric ophthalmology, uveitis, and medical and surgical management of retina and vitreous disorders. Medical residents and fellows in glaucoma and vitreoretinal surgery study under the close supervision of the senior faculty physicians. Visit the Yale Eye Center