New generation of Glaucoma procedures set to shape the future of patient treatment in the Middle East
20 March 2017 (Dubai – United Arab Emirates): Glaucoma is called ‘the sneak thief of sight’ because there are no symptoms and once vision is lost, it is permanent. As much as 40 per cent of the field of vision can be lost without a person noticing. The World Health Organisation estimates that Glaucoma affects around 60 million people globally. Glaucoma is the second leading cause of blindness worldwide and the number one cause of irreversible blindness. However, the disease is treatable and blindness can be prevented through early diagnosis. According to an expert from Moorfields Eye Hospital Dubai, there is now a new generation of treatment options to combat glaucoma and these will soon be available to patients in the Middle East.
Glaucoma is a group of eye diseases that cause progressive damage of the optic nerve. All glaucoma surgery procedures are designed to decrease the production of intraocular fluid (aqueous humor) or increase the outflow (drainage) of this fluid. Currently the goal of glaucoma surgery and other glaucoma treatment is to reduce or stabilize intraocular pressure (IOP) and when this is accomplished, damage to ocular structures – especially the optic nerve – may be prevented.
Dr. Mohammed Sohaib Mustafa, Consultant Ophthalmologist; Glaucoma, Cataract and Refractive Surgeon at Moorfields Eye Hospital Dubai; and an Honorary Consultant at Moorfields London, explains: “If left untreated, most types of glaucoma result in increasing visual damage and may lead to blindness. There is no simple cure for glaucoma yet, however it can be treated and blindness can be prevented through early diagnosis and acceptance of treatment. Treatment with eye drops or surgery (conventional or laser) can halt or slow-down the disease and prevent further vision loss. Today, we are starting to see a new generation of treatment options that promise to change the patient experience and offer new treatment options between eye drops for life and more invasive surgery.”
For the last 50 years, the treatment for open-angle glaucoma has been based on eye drops, with traditional surgery reserved for more advanced and worsening disease. Recently, there has been increased interest in glaucoma surgery – specifically Minimally Invasive Glaucoma Surgery (MIGS) – which has been shown to deliver excellent results in mild to moderate glaucoma cases.
MIGS or micro surgery is designed to improve the safety of surgery for glaucoma patients and offer an alternative to medical therapy in order to improve the quality-of-life issues with eye drop medications, and as an option to more aggressive traditional surgical options.
Laser treatment is a very viable option in mild to moderate glaucoma. Selective Laser Trabeculoplasty (SLT), a non-invasive eye drainage angle laser treatment, performed in the outpatient clinic with the aim of reducing the eye drop medication burden for patients and also to improve eye pressure control, to reduce progression of glaucoma. There are no long term side effects and patients recover in a few days.
Even at the more invasive surgery end of the treatment spectrum, there are advances being made. Fibrin glue is now used as a sealant to close the wounds and minimise bleeding without stitches during the complex surgical treatment of glaucoma whilst also saving time and making the procedure more comfortable for patients, and reducing post operative complications. The glue is applied by normal medical syringes during the implantation of drainage tubes into the eye of a glaucoma patient, and also for the patching of grafts onto the eye, removing the need for traditional sutures, which can be unpredictable and uncomfortable.
Dr. Mohammed Sohaib Mustafa, who has trained in the UK in this new MIGS technology, adds: “Ultimately, MIGS is all about safety because it is minimally invasive, permitting its use in nonrefractory glaucoma and also much earlier in the treatment process. Physicians and patients have been waiting for a new class of glaucoma interventions to address the gap in therapy. MIGS may help to fill that gap and the first-generation MIGS devices will certainly pave the way for even safer and effective options. The worldwide Glaucoma fraternity goal is 10,10,10 by 2020. We need a procedure that can be done in 10 minutes, give a target pressure of 10mmHg and last for 10 years. MIGS is an answer but perhaps not the complete answer, yet.”