Mark Packer, M.D

Researchers have discovered that eye drops used to treat elevated pressure inside the eye can be effective in delaying the onset of glaucoma. These results mean that treating people at higher risk for developing glaucoma may delay -- and possibly prevent -- the disease. These findings are reported in the June 2002 issue of Archives of Ophthalmology.

Scientists found that pressure-lowering eye drops reduced by more than 50 percent the development of primary open-angle glaucoma, the most common form of glaucoma and one of the nation's leading causes of vision loss. Researchers noted that 4.4 percent of the study participants who received the eye drops developed glaucoma within five years. By comparison, 9.5 percent of the study participants who did not receive the eye drops developed glaucoma. Additionally, several significant risk factors were found to be associated with the development of glaucoma in study participants. These included personal risk factors, such as older age and African descent, as well as ocular risk factors, such as higher eye pressure, certain characteristics in the anatomy of the optic nerve, and thinness of the cornea.

The study -- called the Ocular Hypertension Treatment Study -- examined 1636 people 40-80 years of age who had elevated eye pressure but no signs of glaucoma. Half were assigned daily eye drops, and the other half were assigned to observation (no medication). In the medication group, treatment reduced eye pressure by approximately 20 percent.

Open-angle glaucoma affects about 2.2 million Americans age 40 and over; another two million may have the disease and don't know it. Glaucoma occurs when the optic nerve is damaged. In most cases, increased pressure in the eye plays an important role in this damage. The damage to the optic nerve causes loss of peripheral (side) vision. As the disease worsens, the field of vision gradually narrows and blindness can result. However, if detected early through a comprehensive eye exam, glaucoma can usually be controlled and serious vision loss prevented. Comprehensive eye examinations are recommended for all people over age 60, and African Americans over age 40.

In the light of this new information from the Ocular Hypertension Treatment Study, we may wish to revisit the decision of whether or not to treat eyes with elevated intraocular pressure but no nerve damage from glaucoma.

Endoscopic cyclophotocoagulation (ECP) represents a new surgical modality in the fight against glaucoma. Peformed during or after cataract surgery, this procedure involves laser treatment of the part of the eye that makes the aqueous humor (watery fluid inside the eye). After treatment, the rate of fluid production is reduced, thus decreasing the intraocular pressure. At the recent meeting of the American Society of Cataract and Refractive Surgeons in Philadelphia, investigators presented a review of one thousand laser procedures, demonstrating an outstanding safety profile and a very high success rate, with an average reduction in pressure by over 50 %.

The most elegant feature of this procedure lies in the technological feat of combining a high resolution endoscope, light source and a laser device within a tiny microsurgical probe. At the time of cataract surgery it takes only a few extra minutes to image and treat the ciliary epithelium that produces the aqueous humor. Investigators found that the treatment allowed glaucoma patients to decrease the number of eye drops they used to control pressure from an average of 3.6 medications to just over 1. Patients who have already had cataract surgery are also eligible for this procedure, which is performed on an outpatient basis under topical anesthesia.

Increasing understanding and options for both medical and surgical treatment of glaucoma are good news for patients who might otherwise continue to lose vision and face eventual blindness. Together we can work to defeat preventable blindness in our lifetime. [ top ]

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Richard S. Hoffman, M.D.

One of the fastest growing forms of refractive surgery in our practice is a procedure termed a refractive lens exchange with a multifocal intraocular lens implant. A refractive lens exchange involves the removal of the human crystalline lens and insertion of an intraocular lens implant to reduce or eliminate the eye's refractive error. By inserting a multifocal lens, the majority of eyes can see at distance and near without the need for glasses. Astigmatism can be addressed at the time of the procedure by placing relaxing incisions in the peripheral cornea or in special instances, a special lens implant with astigmatism correction built into the lens can be inserted and oriented to reduce the refractive astigmatism.

Currently, the only multifocal intraocular lens that is FDA approved for use within the U.S. is the AMO Array. The Array has five concentric zones on its front surface that have all of the desired refractive powers within them and are designed to allow for distance and near viewing.

The surgical procedure is the same technique we utilize with our cataract patients differing only in that the crystalline lens is clear and not cataractous. The procedure is performed under topical anesthesia without injections and without stitches. Patients who are farsighted and presbyopic (unable to see up close or far away) are the best candidates for this procedure, however, we have also performed this technique in nearsighted patients with great success.

Patients interested in learning more about refractive lens exchange should contact Tony Reynolds at 541-687-2110 to receive more information and to schedule a complimentary screening to determine if they are a good candidate for this procedure. [ top ]

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