June 26, 2008 For the first time in Florida, patients with glaucoma have a new treatment option known as the Trabectome. The minimally invasive procedure, which is available at Mayo Clinic and takes about 20 minutes, is designed to decrease pressure within the eye and stabilize the vision.
"The goal of this procedure is to prevent further damage within the eye," says ophthalmologist Rajesh Shetty, M.D. He says that some patients have been able to reduce or eliminate use of daily eye drop medications that regulate intraocular pressure.
Glaucoma, the second leading cause of blindness, is a disease that causes irreversible damage to the optic nerve from increasing pressure within the eye. This occurs because the eye produces a clear fluid that does not drain adequately and raises the eye pressure. The first sign of glaucoma is a loss of peripheral vision that is usually not noticed by the patient until it affects the central vision.
Unfortunately, vision lost to glaucoma can't be restored so treatment aims to reduce eye pressure to prevent further damage.
Traditionally, ophthalmologists first prescribe eye drops to reduce the eye pressure, and if that doesn't work, they can perform a laser procedure (trabeculoplasty) to the existing internal drainage canal around the base of the cornea. A more invasive treatment is trabeculectomy, a surgical technique to create a new drain for the eye.
The Trabectome procedure uses a small probe that opens the eye's drainage system through a tiny incision in the eye's cornea. "It removes a small portion of the eye's natural drainage system so that it functions better," says Dr. Shetty. He says it should be used when eye drops and laser trabeculoplasty fail to reduce pressure and before trabeculectomy is considered. "I see this as another rung in the ladder of treatment for glaucoma," he says.
So far, more than a dozen patients have had the procedure at Mayo Clinic in Florida, although the technique has been available at Mayo Clinic in Rochester for a few years. To date, several thousand procedures have been done nationwide, according to Dr. Shetty.
The procedure requires very little sedation and patients generally recover within a week. "We have been pleased with the results," he says, noting that although lost vision cannot be restored with the procedure, some patients have reported improved vision overall after surgery.
An estimated 4 million Americans are affected by glaucoma. Glaucoma screenings are suggested for anyone over 40 every two to four years. A routine exam can help identify risk for glaucoma and early signs of the disease. Risk factors for glaucoma include: a family history of the disease, African or Hispanic ancestry, diabetes, certain rare eye diseases and having had an eye injury or having used any corticosteroid preparation for a prolonged period.
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