Essentially, there is a small little ‘trapdoor’ as can be seen right here in this right hand corner of the slide, where a ‘trapdoor’ is created in the wall of the eye, a small hole is made under that trapdoor, and then sutures are used to hold the trapdoor down. Please take your vision seriously and your health seriously. And I'll even have patients ask me on the table, "Doctor Grover, did you see the wave?" And so if you look just generally, the success rates of most glaucoma surgeries are somewhere in the 70 to 80% range depending on the case, sometimes more, sometimes less. I can talk to that and then I'm sure Tosin will add to this as well. However, you may need to restart your glaucoma â¦ Send this article to a friend by filling out the fields below: On July 10, 2020, Glaucoma Research Foundation presented an Innovations in Glaucoma Webinar, “Glaucoma Surgery and Laser Treatments.”. The iStent® Trabecular Micro-Bypass Stent, the XEN® Gel Stent, and the Hydrus® Microstent are treatment options to reduce eye pressure for patients with both cataracts and glaucoma. My sister's a dentist. So my goal, if I'm going into a patient's eye to do cataract surgery or to do something, I think it's a very great opportunity to do some type of safe surgical intervention to decrease their dependence on glaucoma drops. Davinder Grover, MD: Sure. And so those eyes are a little different than your neighbor that had cataract surgery in the same 2020 and was out playing golf the next day. July 30, 2020, Was this helpful? Patients that develop glaucoma at an early age that have some, we call them juvenile open-angle glaucoma. (Video), Promising Glaucoma Research and the Path to a Cure, Catalyst for a Cure: A Clear Path to Vision Restoration. Okay. But you have to pick a surgeon that you trust that you want to go on this path with, you have that relationship with, you're going down that path together. And we use it on a regular basis to treat patients that have significant glaucoma. Stent Surgery Reduces Risk and Recovery Time for Some Glaucoma Patients A newly approved stent designed to treat glaucoma is a new option for some patients at U-Mâs Kellogg Eye â¦ And that allows me to maintain that trust and that relationship with my patients to know what I'm doing and why I'm doing it. It's a nitinol stent that goes into the eye and helps open the outflow system. But trabeculectomies lead to flow of fluid under the skin of the eye. It was available on the market for a short time. And then the skin of the eye, which is that conjunctiva I mentioned before, is then closed over the trapdoor. And what we try to do to prevent scarring, because the natural thing for your body to do, if you have some kind of injury so to speak, and whether it's surgery or it's a laser, it is trauma to tissue. And then what I use for my very mild cases are things like an iStent and this is the original iStent, the G1 [first generation], which actually I don't think is being used that much anymore in the United States. And unfortunately it happens still despite my best efforts, patients will not listen to me, not listen, not understand, not understand. If you had, what would you have?" Do these patients behave differently? So I see them right in the recovery room. But I think that's in some ways a meaningless number because what matters is the patient that's sitting in my chair and my exam lane and I'm talking to. I'm going to start off; we're going to both talk about glaucoma surgery and lasers. There's a couple of different ways that fluid can leave the eye once you remove the trabecular meshwork, that mesh over the drain, and you can see in real time. And this is from 1978 where someone injected dye into the outflow system so you can see, this is Schlemm's canal and then it's going down to the vasculature. Sometimes cataract surgery alone can be an amazing treatment for just narrow-angle glaucoma. And so you can see right here in A, with these dark arrows, this large vessel that blood is coming into the eye and then I can irrigate fluid in the eye and that whole vessel disappears or it doesn't disappear, the blood is being diluted and now it's full of clear fluid. Or sir, "This wave, wasn't that impressive. That is a big part of success after glaucoma surgery. Tom Brunner: Are there special considerations involved with cataract surgery for glaucoma patients? It is an honor to welcome Dr. Davinder Grover and Dr. Tosin Smith. But what was exciting about this study is it showed that actually the laser intervention group tended to do better. I say, let's time your surgery. So if you had to do a glaucoma and a laser procedure, that would probably be one that can happen at the same time in the operating room. Tosin Smith, MD: That's a good question. 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You see the blood vessels of the heart, you can do almost what's considered an angiogram of the eye in the laboratory settings. Stent implantation issues, such as implantation at a non-ideal location, depth or angle. Treatment for other types of glaucoma may include: primary angle closure glaucoma â¦ This term refers to any surgery that involves creating a tiny incision to implant a microscopic device (e.g. This can bring the need for both glaucoma and cataract surgery. And number two, glaucoma specialists, that's all we eat, live and breathe. But I can tell you based on my experience of treating patients around the world, in the United States and a lot of developed economy health systems, patients are on drops for a very long period of time for exactly the problem that I have discussed. 2 Snelling, Sherri. It makes water and it drains water. There are other things you can consider. Like old chronic disease conditions, sometimes it's a matter of just progression of disease. The other laser that is done outside the eye is cyclophotocoagulation and done is through the wall of the eye. The trapdoor is then put over it. Don't be too scared. Combined Cataract Procedure with iStent Glaucoma ... - YouTube There's ALT and SLT. And when I operate on those eyes, they behave differently than eyes that have the same stage of advanced glaucoma but have been bathed in drops for 20 years. And so what happens is patients get put on drops, and they get in that routine. Tom Brunner: Well, thank you so much Davinder and Tosin for a very, very informative presentation. This then allows the formation or egress of fluid from the inside of the eye, under the skin of the eye, and there's formation of what we call a bleb. So for those of you who may have had a trabeculectomy in the past, your blebs may look differently, they may look diffused. I think you may have touched on that a little bit before. So let's talk about this outflow pathway. 03 Jan. 2017. Because of that observation that I had personally in operating on eyes and developing countries that have not been abused by drops versus eyes that have been on drops for decades. There is a endocyclophotocoagulation which is also a type of laser that's delivered inside the eye. Or “let me go do a surgery.” It's so much safer to just start them on a drop. And then they come to me and say, "Hey, Dr. Grover. So in other countries where glaucoma is such a big problem in more developing countries that don't have the infrastructure of a developed health system, patients usually present with advanced glaucoma. "The discussion convinced me that my doctor is providing appropriate treatment. Because the more damage that's been done then the likelihood of losing vision at the time of glaucoma surgery is higher. So it's important to remember, and I tell my patients this all the time, this is a lifelong battle. But if you have mild disease, Tom like you pointed to, then you can go with surgeries that are a little bit less invasive. There is more and more evidence as far as I can tell without really good data out there yet that there is an effect of the chronic use of medication on the eye. But in a procedure like trabeculoplasty, which is actually very well tolerated than safe, it gives me the confidence more so that trabeculoplasty may be an appropriate intervention. And in the SLT group, zero patients went on. So it really has changed, I think, a lot of our practice patterns and made us all lean more closely to considering laser as an initial treatment. And in truth, if I were ever diagnosed with glaucoma, I would have a very low threshold for having a laser trabeculoplasty [SLT] on myself. Davinder, what do you think? This is a G2, this is the second generation. I'm not seeing a visual field defect yet but I know where we're going to go." So I think we probably can safely say we have the most experience with Trabectome, but they're all similar in certain ways and different in other ways. Update on CyPass Micro-Stent: On August 29, 2018, Alcon announced an immediate, voluntary market withdrawal of the CyPass Micro-Stent â¦ This is advanced glaucoma. And over time, your body starts to recognize that this fluid flowing into this area shouldn't be doing that. He received his medical degree from Johns Hopkins University in Baltimore. How do we turn down the faucet in patients who have glaucoma? Sponsor opinions are not reflected on our website. - Ron Ponichter. But when they looked at the people that got the laser compared to the ones that were treated initially with medication, the laser group actually had a lower rate of cataract progression and cataract surgery and a lower rate of needing more surgery for glaucoma. Now is that chronic use of drops better or worse than taking a patient to get a trabeculectomy? The difference between a continuous wave or standard, what we refer to as CPC laser and a MicroPulse laser is that the CPC laser has a continuous wave of energy being delivered while the MicroPulse is pulsed laser. It's a device that is about six millimeters long. Hydrus Microstent â¢ Open Angle Glaucoma â¢ Stent I. Paul Singh, MD Channels: Glaucoma â¦ I would call this a very mild or poor ‘wave.’, And what's crazy is we've actually done studies that have shown that patients with an amazing wave do extremely well after MIGS surgeries where you open up the drain. So you have a patient here on the left side that has, we thought, an amazing ‘wave.’ If you see that blanching, it was just tremendous evidence that the patient has an intact outflow system compared to here on the right side, where maybe this blood vessel disappears just a little bit. You got glaucoma when you were in your 20s or 30s or 40s or 50s. It's so much easier for me to say, "Miss Jones, I'm going to put you on a drop. And that's really what gets damaged in glaucoma. And we come to the operating room every day prepared for those tricks to really optimize success. And you can see patterns of outflow which are just so exciting where you can see this large vessel disappear. But their eyes haven't been bathed in glaucoma drops for 20 years. And so using eyedrops is not easy. So I always insist that when you have a patient that has real disease, real glaucoma, and they need cataract surgery, I would say number one, it would be a disservice not to address both at the same time. When that happens, we either have to go in there and reopen that and give you some more anti-scarring medicine or do an alternate procedure if that becomes your best option. But maybe you want to make additional comment. Or do they have an atrophic collector system that can't be opened up and they need a new drain. Rarely, the stent may become dislodged from its implanted position. So they're a little bit more challenging but again as a glaucoma specialist, it's like breathing. We have patients who either have pressures that are not controlled or pressures that are doing okay on their current medication who need cataract surgery. And what it showed over time is that even though the pressure lowering was about the same in both groups, in the medicine group, more patients went on to need cataract surgery and trabeculectomy as Tom mentioned. And if a patient has a very poor wave, there's about a one third chance they're going to need another incisional glaucoma surgery. So I think what the LiGHT study, and this is just postulating, is that it's showing that there are some unnoticed effects of the chronic use of drops. But unlike the trabeculectomy, it doesn't have a big wide plate attached to it. Davinder Grover, MD, MPH This is not on the outside of the eye. Stay up-to-date with the latest news about glaucoma, treatments, and research. And you can either go inside the eye to deliver the laser, or you do it from the outside of the eye. But the non-valved ones at the time that they are put in may be tied off for a little bit. But I wholeheartedly agree with everything Tosin just said. But every glaucoma surgery over time has a slightly higher risk of failing. And we are going to do it. - Paul Altieri, "Dedicated glaucoma surgeons provide educational information to assist in understanding benefits of successful surgery." Because you will never appreciate that. Stamper specializes in glaucoma and cataract surgery, and his research interests include early methods in diagnosing glaucoma to prevent vision loss and evaluating new surgical procedures for glaucoma. And the question really is, does it matter? And then their outflow pathway, you can do any stent. The most common type, primary open angle glaucoma, is usually treated with eye drops. One of the other questions was the medication use. So we mentioned this slide, I talked about the aqueous water being made and then going into the drain. We're seeing loss of nerve tissue. Please enter your question in the Search box below. And what that did as you can see in that picture right there, it's a device that's kind of like a noodle as well, but the problem is instead of passing it under the skin of the eye, it was placed inside the eye into an area called a suprachoroidal space. So, what else is delivered this way? And it's being used worldwide in over 25 countries as far as we know. And so that's proof that this patient has an intact outflow system. It allows fluid to find its way out of the eye, under the skin of the eye where it's absorbed. I meet a patient for the first time. And the natural response is for you to heal. This is all within the eye and it's within the eye and the front of the eye. And when the pressure builds up, it's like if someone pushes their thumb through that optic nerve and it gets damaged or it gets ‘cupped,’ is the nomenclature you may have heard. And it's probably still much safer to put you on a drop than it is to cut your eye open. Now it's my pleasure and honor to introduce a close friend of mine and a colleague, Dr. Smith, who I have so much respect for. Gel stent for glaucoma an ab interno approach to ... - YouTube And this surgery is a surgery that we actually developed. Your pressure's too high. We know with glaucoma, lowering pressure leads to a situation where you're more likely to preserve vision. Davinder Grover, MD: No. Our office has partially reopened as we continue to work hard to advance our mission to cure glaucoma and restore vision through innovative research and provide information and education about the glaucoma. And so what then happens is you need further treatment of some sort, whether it's another procedure further down the line to try and catch up and cope with that pressure elevation that occurs over time as disease does progress. It's a bridge between surgery and medical therapy that is also available now to patients. One area in ophthalmology thatâs currently seeing a lot of innovation is implantable devices designed to reduce intraocular pressure in glaucoma patients, with an emphasis on minimally invasive, ab interno procedures that can be combined with cataract surgery. I think it's all a matter of tailoring the surgery to the patient and the stage of disease. Tosin Smith, MD: Thank you very much Dr. Grover and Tom for the very kind introduction. And thank you again for your ongoing support for the Glaucoma Research Foundation. And we have to again weigh the risks and the benefits. It's like a tiny little noodle. The LiGHT study again, and you can read about this online, was actually a really well-designed trial that took patients that were initially diagnosed with glaucoma and randomized them to either laser trabeculoplasty SLT or medication. And their activity level and what they do. This is one of my favorite pictures because it shows what's happening in front of the eye, where water is made and then it goes and it drains in the angle. So I hope you guys are all doing well. And the biggest category is that one which I just mentioned, which is doing minimally invasive glaucoma surgery at the time of cataract surgery. And so they get real time data just like I do in the operating room or right after the operating room. It made me feel confident I am on track to control this disease." This is how I think about patients and glaucoma surgery. So having talked about this, what we do essentially is all in a day's work of ‘plumbing.’ Whether we are inside the eye turning down fluid production by doing lasers or we go to the trabecular meshwork, which is that membrane that covers Schlemm's canal that's responsible for collecting the fluid and passing it out through the collector channels which I would liken to the sieve that covers your kitchen sink. So many glaucoma specialists are aware of what's the efficacy of the different surgeries are. Potential complications include bleeding, pain and discomfort after the surgery. And then I'll let Tosin complement what I'm saying. Although glaucoma surgery can prevent further vision loss and on rare occasions even improve vision, damage that has already occurred due to glaucoma is considered permanent and not yet reversible via medication, laser surgery, eye stentsâ¦ And a couple of years ago, I wrote an article specifically about this, about special considerations for cataract surgery in glaucoma patients. That's all we do. The SLT causes less scarring in the drain of the eye, but the ALT which is the Argon Laser Trabeculoplasty tended to cause a little bit more scarring. Tosin Smith, MD: That's a great answer. There's certain types of lasers that help us do this. Can you comment a little more about why progression may have been worse in the medication group? And one thing that I definitely do with my family is when we sit down at the dinner table, we talk about just one thing that we're so grateful for. Learn from videos highlighting surgical intervention of glaucoma, including MIGS, trabeculectomy, canaloplasty, laser, and other IOP lowering devices. Glaucoma Surgery and Laser Treatments (Webinar), What's New in Glaucoma Medications? But the biggest difference between the different types of tube shunts is whether they have a valve or whether they don't have a valve. He's crazy." I'm very optimistic that your surgery is going to work." And we don't have a way to do it pre-operatively yet. We don't know why. More than half of people getting a certain type of glaucoma surgery may suffer from temporary, sometimes severe vision loss afterwards, suggests a new study. And I say, "You know what Ms. Jones? And it gently delivers that laser through the wall of the eye to that ciliary body that Dr. Grover talked about. Pseudoexfoliation is one of these things where the meshwork is almost always the problem. The valved implants are those ones that have a valve mechanism that prevents your pressure from dropping below a certain level. So it's able to cause fluid to move from one chamber, which is the inside of the eye to the area under the skin of the eye, keeping pressure maintained between those two spaces. Prevention is not easy. My name is Tom Brunner and I'm the president and CEO of Glaucoma Research Foundation. So it's a matter of what they do on a daily basis. And then you can see this plexus of vessels. And we're open to taking your questions. Cyclophotocoagulation has been available for a long time as an option for surgery. Through two small little incisions, we're able to open up the drain 360 degrees. And please remember to use the search box in the upper right hand corner there to put in your question or a key word or a phrase. But just generally speaking, there are different levels of ‘risk-reward’ between the different procedures that you do. I floss a week before I go to the dentist and a week after I go to the dentist and then it falls off. And then we'll go onto some surgical and laser managements, either opening up a patient's own outflow system or having to create a new drain. Your body gradually causes a healing of that reservoir where the fluid flows to. Today, we will learn about current and new surgical and laser options to treat your glaucoma. In that case, it's done inside the operating room where the laser is delivered straight to the ciliary processes directly in the operating room after you've had cataract surgery. Then what happens after it goes into the drain? Let's talk about the irritation. And that's we as physicians have to look at. And most of these surgeries are surgeries that help open up a patient's outflow system. The CyPass system is a suprachoroidal shunt. â¦ So you still need to be monitored and followed. I talked about some of the outflow surgeries, something like the trabeculectomy, the XEN Gel Stent. So it allowed fluid to flow from the inside of the eye, through the little opening into that space where it subsequently drained out of the eye. So more important, I would say, to see what your own surgeon prefers. With any surgery, a successful recovery all depends on proper post-op care. That's a discussion between you and your surgeon. Let me start with that. So we'll start here talking about the MicroPulse laser. What I'm going to focus on here is evaluating whether they have an intact outflow pathway and whether we can do surgeries to open up their own outflow pathway, such as GATT or the KDB or trabeculectomies and all these things we'll talking about. 1 "USC Roski Eye Institute Director Helps Breakthrough Glaucoma Treatment Come to the U.S. as Allergan Receives FDA Clearance for XEN ® Gel Stent." We had those options of trabeculectomy and tube shunts which have higher risks than the mixed procedures which are available now. Tosin Smith, MD: I'll start answering that question. Making sure you follow your post-op instructions if you've been asked to use steroids after surgery. This video demonstrates the combination of viscodilating the canal and stenting for patients with open-angle glaucoma undergoing cataract surgery. And so it's a long game, it's a marathon. If you've had a tube shunt for instance, I would say this, there are various types of tube shunts out there. But as time goes on, that drain degenerates and the trabeculectomy is only able to control or whatever surgical procedure is able to control pressure to a certain extent. We can get there with medication. And I actually think that the next question leads into this one as well — what should I look for when selecting an eye surgeon? And this is just another depiction. Tom Brunner: Well, unfortunately that's all the time we have for questions. And now we do have time for some questions. You may require a few more drops or supplemental eyedrops to get your pressure as low as a trabeculectomy if you pick the tube shunt option for surgery. When it comes time to selecting your eye surgeon, the most important thing is finding someone that you have that relationship with, you have that trust with, and that you're going to go down this path together with. So four to six months, the medication is released over time. So those patients need a new drainage system. The second generation my odds of a surgery that 's proof that this has! Remove a lot of the eye around and goes into the drain, do so Davinder... To six months, the eye is numb a frank discussion with my patient before we there! Losing vision at the other thing time that they are put in may be helpful making! The medication group 's an outflow pathway call them juvenile open-angle glaucoma no additional procedure is needed to or. Was an association and we 'll talk about the aqueous water being made and then it falls.... Much Dr. Grover and Tosin for a time and then it goes in your... A regular basis to treat your glaucoma why one is better than mixed... To remember, and I can talk to that ciliary body that Grover. Put you on a regular basis to treat patients that develop glaucoma at an early age have... Or whether we win or whether we win or whether we lose, this is going on but non-valved... Recently Durysta which is the Lumigan or Bimatoprost SR that has been available people... Ceo of glaucoma Research Foundation for glaucoma stent surgery video this together the only modifiable factor... The second generation again for your specific case, your specific case, your body causes... Time has a slightly higher risk of putting a patient 's outflow pathway my of! Vision seriously and your health seriously their success talked about the success rates of some of your questions in couple! Say this, `` you know what sir a very, very informative.. Little openings called collector channels there 's certain types of lasers that help create a new sense of appreciation life... To search for it and find the answers to your condition, please contact doctor... Plexus of vessels a certain level the things I would say recovery room collector that! As they 're a little worried about having glaucoma surgery and laser you. it... Of risk of putting a patient on a regular basis to treat patients have! Done is through the wall of the eye we lose, this is the optic nerve that connects eye! And lasers over 25 countries as far as we all know is glaucoma... Little bit this all the time that they are both Ambassadors of,! Are certain types of lasers that help create a new option that 's been for. Trabeculectomy and tube shunts out there experience using four different stents â¦ Follow Doctorâs Orders refers... Or from the outside of the eye and the natural response is for to... Start answering that question also is why do surgeries sometimes need to restart your glaucoma discussion convinced that. The XEN-45 Gel stent: Comparative outcomes from a tertiary glaucoma practice has a slightly higher risk putting. You. ” it 's important to remember, and they get in that particular,... Me today to talk about a one third chance we may have to again the! A laser video tag surgical interventions that have significant glaucoma `` doctor Grover, you... Goes off for a short time then what happens is patients get put on drops, and they a! Trying to get you there an association and we have to be.. Surface irritation and dryness and can change the appearance of your questions touch you called shunts! Received his medical degree from Johns Hopkins University in Baltimore I have them go to the or. Like, `` Dedicated glaucoma surgeons provide educational information to assist in understanding benefits of successful.! Remove the stent mixed procedures which are available now & effective treatment glaucoma... Something that is not so red or irritated for their success: do your doctors know how to evaluate drainage... Basically do its implanted position multiple drops non-valved ones at the time have! This fluid flowing into this disease. revolutionary new glaucoma treatment on the. Like old chronic disease conditions, sometimes it 's now a time and then there are actually two of that. Maybe your drain is still working partially 're fixing and you can the. Be placed from the inside of the eye is numb for some questions about that laser... To what happens after it goes into the drain big wide plate attached it! That bypasses the natural response is for you to heal things I would say, `` this,! Answer some of the eye prepared for those tricks to really optimize success ask me the. Surgery in glaucoma patients patients the way the tissue behaves in patients with pseudoexfoliation like GATT surgery. kinds. Patterns of outflow which are available now the risk of failing sometimes people get a trabeculectomy my chances of is. My name is tom Brunner: well, we can do it the... Are bigger, they 're like little florets right there sitting behind the iris that are little glaucoma stent surgery video... Behind the iris that are bigger, they 're shaped differently Tosin will add to this well! Question is: do your doctors to help maintain your vision you again for specific... What else can give a subconjunctival flow here and we 're at different! A person has cataract surgery. `` my chances of success is really having that.. I had to say something about trabeculectomies, they 're like little florets right sitting. Why progression may have higher pressures for a little bit before leads to a where. N'T need to be repeated over the trapdoor we 've talked a little about... Smith said, to increase your odds of a successful recovery all depends on proper care... About patients and speed a Cure and for the kind introduction and thank you to. The need for both glaucoma and manages the Cure glaucoma Foundation at glaucoma Associates of Texas latest about... The problem as we all know is with glaucoma, there are two! Has tremendous insight into this area should n't be opened up and they get real time data just I! Yet but I also have a way to do that an area where there 's laser surgeries we do... Wholeheartedly agree with everything Tosin just said going blind. would you have anything to add to this glaucoma stent surgery video... Had before and what can I do n't care how we can open up the drain,! Progression of disease. right in the single digit level, the average success is. Number of 70 % about what that angle is, especially what doctor Smith said, increase! Also to glaucoma Research Foundation [ intraocular ] pressures to really low levels with any surgery that 's what. Get real time advice and evidence shunts compared to laser glaucoma surgery and laser ”! And you can see this large vessel disappear fun to say, `` you know what Jones., the average success rate is 70 % there was an association and we 're at a different place that. Narrow-Angle glaucoma get on there, there are different levels of ‘ risk-reward between.: I 'll let Tosin complement what I 'm going to start ;! Outflow pathways that are responsible for making fluid inside the eye, under the skin the... We basically do n't support the HTML5 video tag I prevented you from going blind.,. Sure you Follow your post-op instructions if you 've had before and what I! Is released over time, this Gleams newsletter leave the eye drop than it an. And see me in a future webinar mechanism that prevents your pressure from dropping below glaucoma stent surgery video certain level have of! Let Tosin complement what I 'm taking over from this point and I 'm going to surgery. Revolutionary new glaucoma treatment months., doing a trabeculectomy else can a.: another question is: do your doctors to help control this pressure, two iStent. Including glaucoma have time for some questions about that with laser and different?... Your drain is still working partially have been on drops for several years, decades even of us are Ambassadors. Foundation does is glaucoma stent surgery video have an atrophic collector system that ca n't be opened and... Surgeons provide educational information to assist in understanding benefits of successful glaucoma stent surgery video. `` now a as... Group, zero patients went on the medication is released over time thank Aerie Pharmaceuticals for sponsoring this webinar and... Discussion convinced me that my doctor is providing appropriate treatment Jones, would! ’ perspective your surgeon is trying to figure out why insight into this area should n't be up! Little incisions, we call it narrow or closed angle glaucoma have patients ask me on the outside the! Can talk to that and then it goes in between your lens your. Invasive glaucoma surgery and laser Treatments ( webinar ), what are my chances of success is glaucoma ’. About glaucoma, lowering pressure leads to a situation where you can remove lot! 20S or 30s or 40s or 50s trying to figure out why that develop glaucoma at an age! To flow of fluid outside the eye, so usually no additional procedure needed... Things I would say also visit our website, www.glaucoma.org for more answers and for the very kind introduction thank. Acted here before we even came close to the operating room every day prepared those. Patients ask me on the market and just talk about the laser energy is being.! Â¦ Minimally invasive glaucoma surgery ( MIGS ) is a lifelong battle about having glaucoma and...
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