Dry Eye ICD 10 - Syndrome ICD 10 Code

Dry Eye ICD 10 - Syndrome ICD 10 Code

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ICD-10 

ICD-10 utilizes another organization, wording and codes. This is what you have to know.

O ne of your patients comes to you with a corneal scraped area she got while traveling. It appears she was modeling for a photograph when the colorful winged creature she was holding abruptly scratched her correct eye. In 2013, utilizing International Classification of Disease – ninth Edition coding, you would basically utilize the code for corneal scraped area.

Beginning October 1, 2014, be that as it may, your training should choose from the accompanying ICD-10 codes: wound of eyelid and periocular zone (S00.1); unspecified damage of right eye and circle (S05.91); scraped spot of eyelid and periocular territory (S00.21); scraped area of right eyelid and periocular region, introductory experience (S00.211A); struck by parrot (W61.02xA); struck by macaw (W61.12xA); struck by different psittacines (W61.22xA); or struck by duck (W61.62xA). Despite the fact that obviously fantastical, the codes are genuine, and San Bernardino, Calif., specialist Kevin Corcoran, a specialist on ophthalmic coding, utilizes this model when showing his seminar on ICD-10, taking note of that it gives experts a vibe for what's coming. (Unexpectedly, S00.211A and W61.22xA are the right answers.)

"ICD-10 requires much more detail from the doctor and the biller than they needed to give previously," he says. It turns out this additional detail is a hint of a greater challenge with regards to understanding ICD-10.

In this article, we'll investigate how ICD-10 necessities will influence how you archive a patient experience, demonstrate how the new coding procedure varies from ICD-9 and decode a portion of the new coding dialect for basic ophthalmic patient introductions, so your training can get straight down to business next October.

ICD-10 Overview 

ICD-10 is a coding standard that underlines specificity in recording a patient's visit, to such an extent that the codes in the new book number roughly 69,000. This is a major jump from the 14,000 codes utilized by ICD-9. "It originates from the way that coding will be more granular and itemized," says Lisa Gallagher, VP of innovation arrangements at the Healthcare Information and Management Systems Society, a non-benefit bunch that looks to enhance medicinal services using PC frameworks.
"With more data, we'll have the capacity to perform better examination as far as the nature of consideration and populace wellbeing. With ICD-10, the patient additionally gets a precise analysis with exact documentation that will prompt appropriate installment for the supplier."

Mr. Corcoran says there are a few key reasons why ICD-9 is headed out. "As a matter of first importance, it's a quite old framework," he says. "It's over 30 years of age. Likewise, a portion of the dialect and terms utilized in ICD-9 aren't utilized any longer—a great measure of medicinal practice has proceeded onward in the previous 30 years. At long last, ICD-9 doesn't offer enough detail."

With respect to why the additional points of interest are critical, Mr. Corcoran offers the accompanying precedent. "Say an elderly woman, 80, comes into your office with a bruised eye, a knock on her head and diminished vision," he says. "She discloses to you that she was driving, taking note of she doesn't see too well any longer, and kept running into the back of the auto before her, making her hit her head on the guiding wheel. Upon examination, you discover she's presently got horrible waterfalls that are frustrating her capacity to perform exercises of every day living, for example, driving, and educate her that she needs medical procedure.

In 2013, you would have taken a gander at her waterfalls, charged Medicare—most likely utilizing 366.16 (atomic waterfall)— and, since you didn't indicate it was coincidental to a car collision, would get paid by the administration wellbeing program. In any case, in ICD-10, there is a code 'V43 (struck via car),' which would state to the payor, 'This was the consequence of an engine vehicle mishap and in this way ought to be secured via accident protection—not Medicare.' ICD-10 transforms specialists into this extraordinary enormous revealing framework, and outsider payors profit by it.

ICD 10 Chapters

"Note that you can just code what's in the restorative record," Mr. Corcoran proceeds. "With ICD-10, the restorative record should be significantly more exact, and likely longer than it's been previously, just to have the capacity to code it. Whenever Australia and New Zealand began executing ICD-10 quite a long while back, the greater part of the diagrams weren't codeable. The reason was that, with the end goal to utilize the ICD-10 coding framework, doctors required more accuracy in their depictions. Along these lines, if a specialist basically composes, 'waterfall,' it can't be coded."

One of the unintended results of this hyper-specificity, and which may hit a few doctors where they live, is that practices will never again have the capacity to utilize the purported superbill after an exam, which a few specialists use as a "cheat sheet" for the codes they require. There are essentially an excessive number of conceivable codes to fit on a sheet of paper. "At this moment, a superbill won't be given [with ICD-10]," says Ms. Gallagher. "The arrangement of codes in totality is excessively huge."

A PC program may enable specialists to locate the correct codes—contingent upon how nitty gritty their documentation is—however, in any event in the underlying time of ICD-10 selection, a program may not give all of you the codes. Thus, ophthalmologists and practices who become more acquainted with the dialect of ICD-10, for example, how it doles out ophthalmic codes to exam notes and the unique terms it utilizes, will discover they have a leg up while recording their patient experiences and ensuring their cases aren't rejected.

Inside ICD-10 

Things being what they are, notwithstanding understanding another coding framework, clients of ICD-10 additionally need to know how to really peruse the book, as it utilizes its very own arrangement of terms that may have unexpected implications in comparison to somebody is utilized to. Here are tips for utilizing the book and finding the correct codes.

ICD 10 Terminology

Dry Eye ICD 10

• Know the terms. "The phrasing traditions utilized in the book impact how you utilize it," says Mr. Corcoran. "Lamentably, you can't utilize the book like a ZIP code index—you need to know how to peruse it."

One term utilized frequently in the book that can possibly confound a client is "avoids," since it has two implications in the ICD-10 world. " 'Bars' in basic English intends to keep from being a piece of a gathering," says Mr. Corcoran. "Notwithstanding, in the ICD-10 book, it's utilized two different ways: Excludes 1 and Excludes 2. In the book, the terms really have altogether different implications. Prohibits 1 implies two codes are inconsistent and can't be utilized together on a case. For instance, you'll see that the code for blepharitis, H01.0, accompanies 'Avoids 1: blepharoconjunctivitis,' which means you can't code them both together.

"Be that as it may, Excludes 2 is extraordinary," Mr. Corcoran proceeds. "It implies that another code is excluded with the specific code you're taking a gander at yet it can exist together in the meantime in a similar patient. So the code for chalazion (H00.1) has the note 'Prohibits 2: tainted meibomian organ,' since it's workable for somebody to have the two conditions simultaneously."

"And" likewise has an unforeseen importance in ICD-10; it signifies "and additionally," which, lamentably, is actually the inverse of the by and large comprehended significance of the word. "Thus, in the event that you just flipped open the book without trying to take in its terminology and development and made a supposition about what the word 'and' implied, you'd not be right," says Mr. Corcoran.

ICD-10 likewise tries determining laterality in its codes, something that was missing in ICD-9. Here's the manner by which it codes laterality:

• 1 is the correct eye;

• 2 is the cleared out;

• 3 demonstrates bilaterality; and

• 9 implies the side is unspecified.

For specific analyses, ICD-10 additionally necessitates that a seventh digit speaking to the seriousness of the condition be coded also, most eminently glaucoma:

• 1 speaks to gentle ailment;

• 2 is moderate;

• 3 is extreme;

• 0 is unspecified; and

• 4 implies it is vague.

• Use every one of the sections. The ICD-10 book has 21 parts versus ICD-9's 17, and doctors must be prepared to utilize any of them for a given patient. "You can't simply take in the eye part—Chapter 7, with codes starting with H—and discard the others," says Mr. Corcoran. "For example, if your patient has a diabetic eye condition you won't discover it in the eye part. Rather, you'll see it in the section on the endocrine framework, Chapter 4. The equivalent with shingles; however shingles has visual ramifications, in the event that you looked at without flinching part you wouldn't discover it. You need to go to Chapter 12: Diseases of the Skin, to code visual entanglements of shingles."


• Dig for GEMs. One of the guides the ICD-10 makers have accommodated finding an appropriate code is known as General Equivalence Mapping records. These are programming based transformation tables that enable you to enter in an ICD-9 code and get a general thought of the coding region in the ICD-10 manual where the proper new code or codes may be.

For example, utilizing the corneal scraped spot model from before, entering the ICD-9 corneal scraped spot code, 918.1, into a GEM converter would give you the ICD-10 code S05.00xA. Here, the letter "S" speaks to the part on damage or harming from outer sources. You will then need to dive further with the end goal to legitimately code the damage. Along these lines, basically, the GEM will get you in the correct neighborhood yet regardless you must locate the correct house. "Is the GEM an ideal match?" asks Mr. Corcoran. "Unfortunately, no. It's superior to nothing, however, and will get you in the region of the correct answer."

Normal Coding Examples 

To help figure out some basic ailments that manifest in the ophthalmologist's office, here are a few precedents given by Mr. Corcoran that are among the numerous he covers in his ICD-10 instructional class:

• Corneal ulcer. A patient presents with a focal ulcer. In ICD-9 you'd take note of that it was a focal ulcer, overlooking laterality, and utilize code 370.03. In ICD-10, in any case, you have these decisions: H16.011 (focal corneal ulcer, right eye); H16.012 (focal corneal ulcer, left); H16.013 (focal corneal ulcer, two-sided); and H16.019 (focal corneal ulcer, unspecified).

• Cataract. At the point when a patient is determined to have an atomic waterfall and the GEM document is utilized, it finds the ICD-10 code H25.819 (joined types of age-related waterfall, unspecified eye). "Might we presumably know more than that about the patient?" muses Mr. Corcoran. "As far as laterality, yes. In any case, now that we're in the ballpark, subsequent to taking a gander at the real segment under H25.819, we see the genuine code will be H25.811, H25.812, or H25.813. It won't really be H25.819 (unspecified)."

D

Dry Eye ICD 10

A training may likewise observe the intermittent Flomax tolerant who needs mechanical expansion of the student amid medical procedure. In the new coding standard, certain medications have their own codes that should be entered in the record for specific determinations. For this situation, the coding would be H25.11 (age-related atomic waterfall, right eye), H21.81 (IFIS) and the code for the medication T44.6x5A (tamsulosin hostile to adrenergic utilize).

• Diabetic eye illness. Now and again, ICD-10 makes only one code where ICD-9 utilized two, for example, on account of proliferative diabetic retinopathy. In ICD-9, the codes would be 250.52 (uncontrolled Type 2 diabetic with ophthalmic appearances) and 362.02 (proliferative diabetic retinopathy). In ICD-10, notwithstanding, you utilize one code for this patient: E11.359 (Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema).

Another new idea in ICD-10 is the need to take note of the patient's utilization of insulin with code Z79.4 (long haul current utilization of insulin). "This is noteworthy on the grounds that the long haul utilization of insulin matters in general wellbeing," clarifies Mr. Corcoran. "In the event that somebody starts taking insulin from the get-go throughout everyday life, they may be a major weight on the medicinal services framework for whatever remains of their lives."

• Glaucoma. Another precedent includes a patient who presents with uncontrolled, endless open-edge glaucoma OU with serious visual field misfortune in the correct eye and moderate field misfortune in the left. In ICD-9, the codes would be 365.11 (POAG, interminable basic glaucoma) and 365.73 (extreme glaucoma).

In ICD-10, the best possible codes would be H40.11x3 (extreme glaucoma, right eye), H40.11x2 (moderate glaucoma, left eye) and the training has the alternative of additionally including H53.40 (unspecified visual field deserts) in the event that it needed to give more data.

• Age-related macular degeneration. A patient you've been following for AMD presents with serious vision misfortune in her correct eye. She confesses to being a smoker. You find exudative AMD in the correct eye and dry AMD in the left. You treat the correct eye that day with an infusion of bevacizumab.

To code this specific patient, you would utilize the codes H35.32 (exudative AMD), H35.31 (non-exudative AMD) and would likewise need to note Z72.0 (tobacco utilize).

In spite of the fact that ICD-10 will present documentation, coding and mechanical difficulties as practices upgrade their frameworks to suit the new framework, one thing is clear: It won't be deferred and will be required for repayment come October 2014. "CMS advises us that we have to strengthen the message that the due date wouldn't change," says HIMSS' Ms. Gallagher. "It's descended from the secretary of the Department of Health and Human Services that it won't be deferred. They're adhering to the due date."

Dry Eye Treatment Types - Symptoms

Dry Eye Treatment Types - Symptoms

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Dry Eye Treatment 

Dry eye disorder (DES or dry eye) is a perpetual absence of adequate grease and dampness on the surface of the eye. Its results extend from minor bothering to the failure to wear contact focal points and an expanded danger of corneal irritation and eye diseases.

Signs and Symptoms of Dry Eye 

Tireless dryness, scratchiness and a consuming sensation on your eyes are regular side effects of dry eye disorder. These side effects alone might be sufficient for your eye specialist to analyze dry eye disorder. Here and there, he or she might need to gauge the measure of tears in your eyes. A thin segment of channel paper set at the edge of the eye, called a Schirmer test, is one method for estimating this.

A few people with dry eyes additionally encounter a "remote body sensation" – the inclination that something is in the eye. What's more, it might appear to be odd, however some of the time dry eye disorder can cause watery eyes, in light of the fact that the unnecessary dryness attempts to overstimulate creation of the watery part of your eye's tears.

E-Eye Treatment

What Causes Dry Eyes? 

In dry eye disorder, the tear organs that saturate the eye don't create enough tears, or the tears have a concoction sythesis that makes them vanish too rapidly.

Dry eye disorder has a few causes. It happens:

• As a piece of the common maturing process, particularly among ladies over age 40. 
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• As a symptom of numerous meds, for example, antihistamines, antidepressants, certain circulatory strain meds, Parkinson's meds and contraception pills. 

Since you live in a dry, dusty or blustery atmosphere with low moistness.

In the event that your home or office has cooling or a dry warming framework, that excessively can dry out your eyes. Another reason is lacking flickering, for example, when you're gazing at a PC screen throughout the day.

Eye Drops

Dry eyes are additionally connected with certain fundamental infections, for example, lupus, rheumatoid joint inflammation, rosacea or Sjogren's Syndrome (a group of three of dry eyes, dry mouth, and rheumatoid joint pain or lupus).

Long haul contact focal point wear, inadequate conclusion of the eyelids, eyelid sickness and an insufficiency of the tear-creating organs are different causes.

Dry eye disorder is more typical in ladies, potentially because of hormone variances. Ongoing examination recommends that smoking, as well, can expand your danger of dry eye disorder. Dry eye has likewise been related with inadequate cover conclusion following blepharoplasty – a prevalent corrective medical procedure to dispose of saggy eyelids.

Treatment for Dry Eye 

Dry eye disorder is a continuous condition that medicines might be not able fix. In any case, the indications of dry eye – including dryness, scratchiness and consuming – can for the most part be effectively overseen.

Your eyecare professional may suggest counterfeit tears, which are greasing up eye drops that may mitigate the dry, scratchy inclination and remote body vibe of dry eye. Medicine eye drops for dry eye go above and beyond: they help increment your tear generation. Sometimes, your specialist may likewise endorse a steroid for more quick here and now help.

Another choice for dry eye treatment includes a modest embed loaded up with a greasing up fixing. The embed is put simply inside the lower eyelid, where it consistently discharges oil for the duration of the day.

On the off chance that you wear contact focal points, know that numerous fake tears can't be utilized amid contact focal point wear. You may need to expel your focal points previously utilizing the drops. Hold up 15 minutes or more (check the name) before reinserting them. For gentle dry eye, contact focal point rewetting drops might be adequate to improve your eyes feel, yet the impact is generally just brief. Changing to another focal point brand could likewise help.

Check the name, yet even better, check with your specialist before purchasing any over-the-counter eye drops. Your eye specialist will know which equations are successful and durable and which are not, and which eye drops will work with your contact focal points.

To decrease the impacts of sun, wind and residue on dry eyes, wear shades when outside. Wraparound styles offer the best security.

Eye Layers

Inside, an air cleaner can sift through residue and different particles from the air, while a humidifier adds dampness to air that is excessively dry in view of cooling or warming.

For more critical instances of dry eye, your eye specialist may prescribe punctal plugs. These little gadgets are embedded in pipes in your tops to moderate the waste of tears from your eyes, along these lines keeping your eyes more sodden.

In the event that your dry eye is caused by meibomian organ brokenness (MGD), your specialist may prescribe warm packs and recommend an in-office technique to clear the blocked organs and reestablish ordinary capacity.

Specialists here and there additionally prescribe extraordinary dietary enhancements containing certain basic unsaturated fats to diminish dry eye side effects. Drinking more water may likewise offer some help.

On the off chance that prescriptions are the reason for dry eyes, stopping the medication for the most part settle the issue. In any case, for this situation, the advantages of the medication must be weighed against the reaction of dry eyes. In some cases changing to an alternate kind of prescription eases the dry eye side effects while keeping the required treatment. Regardless, never switch or cease your prescriptions without counseling with your specialist first.

Treating any hidden eyelid ailment, for example, blepharitis, helps too. This may call for anti-infection or steroid drops, in addition to visit eyelid cleans with an antibacterial cleanser.

On the off chance that you are thinking about LASIK, know that dry eyes may exclude you for the medical procedure, at any rate until the point that your dry eye condition is effectively treated. Dry eyes increment your hazard for poor recuperating after LASIK, so most specialists will need to treat the dry eyes first, to guarantee a decent LASIK result. This goes for different sorts of vision redress medical procedure, also.

Dry Eye Spray - Proof - Usage

Dry Eye Spray - Proof - Usage

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Whitepaper 

Understanding the advantages of liposomal eye splashes for dry eye patients

"At RB, we're focused on supporting network drug stores to guarantee they can give the simple best help and counsel to address the issues of patients. Giving reasonable items, data and alluding patients when suitable, are significant components of essential medicinal services. Accordingly, it's of the highest significance that you approach high caliber, up and coming and proof based preparing that can be utilized as your very own feature proceeding with expert advancement, and to help teach your staff.

We work with specialists, scratch feeling pioneers, and network drug specialists to give instructive material that empowers you to give the most ideal consideration to your patients, and guarantees you are perceived and esteemed as a quality goal for neighborhood social insurance administrations."

Dr Samantha Bradley, Head of Professional Relations and Medical Marketing, RB UK Ltd.

The accompanying article has been dispatched, advised and completely supported by RB.

Liposomal splashes are particularly intended to address evaporative dry eye (EDE) side effects. EDE represents roughly 80 percent of dry eye cases[1], with around 20 percent experiencing watery lacking dry eye[1].

Be that as it may, the method of activity and technique for utilization of liposomal showers are not in every case surely knew, specifically, it very well may be entangled to clarify how a liposomal splash achieves the surface of the eye subsequent to being connected to a shut eyelid.

This article is planned to enable drug specialists to comprehend and pass on the advantages of liposomal splashes to sufferers of dry eye, by considering their method of activity in connection to the adjustment of the tear film.

What are liposomal splashes? 

Liposomal showers, as OptrexTM ActiMistTM, contain soy lecithin, a phospholipid, which is typified inside minuscule circular liposomal vesicles. Soy lecithin is an emulsifier, which because of its bipolar nature empowers the water and oil layers of the eye to cooperate.

How do liposomal splashes function?

In 80 percent of individuals with dry eye, the reason is insufficiency or precariousness of the lipid layer of the tear film[1] which ordinarily goes about as a seal for the watery fluid layer, keeping it from vanishing.

Representation of a cross segment of the tear film demonstrating the three principle layers

Tear Film Layers

Three fundamental layers make up the typical tear film. In 80% of individuals with dry eye, the reason is insufficiency or flimsiness of the lipid layer

The tear film lipid layer is comprised of two stages: a thick external nonpartisan layer in contact with the air, and a more slender polar layer made up for the most part of phospholipids which frames an interface with the tear film watery layer. It is this phospholipid layer which encourages spreading of the external lipid layer. Research has demonstrated that people without a noticeable lipid layer, or with a nonconfluent lipid layer, show a four-overlay higher rate of tear film evaporation.

Nonetheless, an investigation has uncovered that the utilization of liposomal splashes results in a clinically and critical increment in lipid layer thickness and tear film dependability following application, while another infers that treatment with phospholipid liposomes demonstrates factually noteworthy clinical points of interest with better outcomes in the top parallel conjunctival overlay (LIPCOF) test, destroy film break time (BUT), Schirmer-I test, tear meniscus estimation, irritation of the cover edges, and visual sharpness, contrasted with customary counterfeit tears treatment.

The liposomal shower conveys phospholipid to the eye, fixing the lipid layer, in this way tending to the lipid unsteadiness that causes EDE. The splash ought to be connected to the shut eyelid from about 10cm away (see figure 2). The eyelids ought to be kept shut a while later to empower the phospholipid liposomes to settle on the eyelid, where they warm up and begin to move towards the edge of the eyelids. When they achieve the edge of the eyelid, squinting disseminates the liposomes over the watery layer of the tear film, creating moment relief.


Delineation demonstrating how Optrex ActiMist chips away at the surface of the eye

Dry Eye Spray

In the wake of applying the splash to the shut eyelid, flickering disseminates liposomes equally over the watery layer of the tear film

Dry Eye Spray Proof

Investigation into the activity of liposomal showers blended with a fluorescein color arrangement onto shut tops outlines how the splashed on arrangement achieves the top edges and the tear film inside a couple of minutes. After application to shut tops, and just a couple of squints, fluorescein is unmistakable in the tear meniscus.

This is like what happens normally when lipids are discharged from the meibomian organs (see figure 3) on to the top edges where they frame a store. Squinting puts weight on the meibomian organs, bringing about a little measure of oil being communicated onto the top edges, and the lipids that were a piece of the tear film blend by and by with the lipid store on the cover edge. Amid the opening of the tops, a portion of the lipids from this store spread onto the tear film, framing a lipid layer.

Delineation demonstrating the meibomian organ of the eye

 Meibomian organs

In evaporative dry eye, the meibomian organ (imagined inset) neglects to emit enough oil to keep up the lipid layer of the tear film

The showered on phospholipid liposomes achieve the top edges through a similar impact and blend with the endogenous lipids to help fix the tear film lipid layer.

What are the advantages of liposomal showers? 

Dissimilar to liposomal showers, numerous watery fake tear visual oils, which are usually used to treat dry eye manifestations, are not particularly intended to address the disturbed lipid layer in EDE; rather, they briefly bathe the eye creating transient symptomatic alleviation and can require visit application.

Liposomal splashes help balance out the external lipid layer[1] to facilitate the bothering and inconvenience of evaporative dry eye. They give moment help and last to up to four hours[1],[4], which means they should be connected less every now and again than some dry eye items.

Liposomal showers are additionally helpful, as they can be utilized by individuals who wear contact focal points, and as a result of the liposome detailing, they won't smear cosmetics. Besides, they can be valuable for patients with coordination issues, or smoothness issues or for the individuals who simply think that its hard to utilize drops. In contrast to many eye arrangements, when opened, they have an expiry of up to a half year and Optrex ActiMist is bundled in a fixed container with a non-vented pump.

Network drug store job 

Around 40% of network drug stores see no less than one patient a day* who has a worry about their eyes and studies demonstrate that up to 30 percent of the populace beyond 50 a years old dry eye indications on an ordinary basis[5].

In spite of this, a 2016 review of pharmacists*, demonstrated that two out of three respondents were unconscious that there are diverse sorts of dry eye condition, which have distinctive etiology, and hence required diverse administration.

By suggesting liposomal splash for the treatment of EDE, disclosing how to utilize it and critically, how it works when showered on shut eyes, drug specialists can assist contribute with ensuring patients get a treatment that is suitable, worthy and will help mitigate the indications of dry eye.

Glaucoma Wiki - Everthing About Glaucoma Disease

Glaucoma Wiki - Everthing About Glaucoma Disease

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Glaucoma

Glaucoma is the name given to a group of eye diseases in which the optic nerve at the back of the eye is slowly destroyed. In most people this damage is due to an increased pressure inside the eye - a result of blockage of the circulation of aqueous, or its drainage. In other patients the damage may be caused by poor blood supply to the vital optic nerve fibres, a weakness in the structure of the nerve, and/or a problem in the health of the nerve fibres themselves.

Over 300,000 Australians have glaucoma. While it is more common as people age, it can occur at any age. As our population becomes older, the proportion of glaucoma patients is increasing.

Glaucoma Causes & Symptoms

Chronic (primary open-angle) glaucoma is the most common type. It has no symptoms until eye sight is lost at a later stage.

Damage progresses very slowly and destroys vision gradually, starting with the side vision. One eye covers for the other, and the person remains unaware of any problem until a majority of nerve fibres have been destroyed, and a large part of vision has been destroyed. This damage is irreversible. It is progressive and usually relentless. Treatment cannot recover what has been lost. But it can arrest, or at least slow down, the damage process. That is why it is so important to detect the problem as early as possible, to be able to start treatment with as little damage to the vision as possible.

• normal vision
• mild to moderate loss
• severe visual loss

Glaucoma Risks

Although anyone can get glaucoma, some people have a higher risk, i.e. those with:

• a family history of glaucoma;
• diabetes;
• migraine;
• short sightedness (myopia);
• long sightedness (hyperopia);
• eye injuries;
• high blood pressure; or
• past or present use of cortisone drugs (steroids).

People in these groups should have their first eye check no later than the age of 35. For most people, it is recommended to have an eye check for glaucoma by the age of 40.

Glaucoma Types

Chronic (primary open-angle) glaucoma

This is the most common form of this disease. However, other forms occur.

Low-tension or normal tension glaucoma

Occasionally optic nerve damage can occur in people with so-called normal eye pressure. This form of glaucoma is treated in the same manner as open-angle glaucoma.

Acute (angle-closure) glaucoma

Acute glaucoma is when the pressure inside the eye rapidly increases due to the iris blocking the drain. An attack of acute glaucoma is often severe. People suffer pain, nausea, blurred vision and redness of the eye. Immediate medical help should be sought. If treatment is delayed there can be permanent visual damage in a very short time. Usually, laser surgery performed promptly can clear the blockage and protect against visual impairment.

severe visual loss

normal vision

Mild to moderate loss

Congenital glaucoma
This is a rare form of glaucoma caused by an abnormal drainage system. It can exist at birth or develop later. Parents may note that the child is sensitive to light, has enlarged and cloudy eyes, and excessive watering. Surgery is usually needed.

Secondary glaucomas
These glaucomas can develop as a result of other disorders of the eye such as injuries, cataracts, or eye inflammation. The use of steroids (cortisone) has a tendency to raise eye pressure and therefore pressures should be checked frequently when steroids are used.

How is glaucoma detected?
Regular eye examinations are the best way to detect glaucoma early.

A glaucoma test usually includes the following:

• optic nerve check with an ophthalmoscope;
• eye pressure check (tonometry);
• visual field assessment if needed — this tests the sensitivity of the side vision, where glaucoma strikes first.

Can glaucoma be treated?
Although there is no cure for glaucoma it can usually be controlled and further loss of sight either prevented or at least slowed down.

Glaucoma Treatments

Glaucoma Eyedrops - these are the most common form of treatment and must be used regularly. In some cases pills are prescribed. The drops can be varied to best suit the patient and the type of glaucoma.
Laser (laser trabeculoplasty) - this is performed when eyedrops do not stop deterioration in the field of vision. In many cases eyedrops will need to be continued after laser. Laser does not require a hospital stay.
Glaucoma Surgery (trabeculectomy) -  this is performed usually after eyedrops and laser have failed to control the eye pressure. A new channel for the fluid to leave the eye is created.


Treatment can save remaining vision but it does not improve eye sight.

Dry Eye Drops - Treatments Of Dry Eye

Dry Eye Drops - Treatments Of Dry Eye

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Which eye drops are best for dry eyes? 

Dry Eye Drop Types 

There are various potential eye drops to think about while treating side effects of dry eyes. These include:

• Counterfeit tears are the most widely recognized treatment technique and are frequently accessible over the counter or on the web. There are an assortment of brand choices and it might take some experimentation for individuals to locate the counterfeit tears that work best for them.
• 
  
• Cyclosporine is a solution eye drop intended to help treat certain contaminations that reason dry eyes. This prescription causes the eyes to deliver more tears. Regularly, it is connected two times each day.
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• Lifitegrast is a little particle integrin foe that decreases T cell-interceded aggravation. It is just accessible through medicine.
• 
  
• Autologous blood serum drops will be drops produced using a patient's very own blood. These are utilized in serious situations where a patient's dry eyes are not reacting to different drops or treatment. These drops are made by taking an example of the individual's blood, expelling the red platelets, and including a salt arrangement.

Eye drops may not be sufficient to completely treat dry eyes relying upon the reason. Different drugs might be expected to treat basic conditions that reason dry eyes.

Dry eye therapy

Side Effects

Individuals considering eye drops for dry eyes ought to counsel with a specialist before attempting over-the-counter eye drops. There are a few components to mull over while choosing this sort of treatment for dry eyes.

Individuals ought to maintain a strategic distance from eye drops intended to expel red from the eye. These are frequently not intended to solely treat dry eye.

In the event that a man has glaucoma or another eye illness, over-the-counter drug should just be taken if a specialist prescribes it.

Diverse over-the-counter eye drops have distinctive fixings. A few drops may function admirably for a few people and not and in addition well for other people.

There are two sorts of counterfeit tear drops: one that contains additives and one that does not. A few people find that the additives bother their eyes thus they have to utilize an additive free assortment.

• Conceivable symptoms 
• A portion of the potential symptoms of utilizing eye drops to treat dry eye include: 
• expanded affectability of eyes to light 
• obscured vision 
• watering of eyes 
• redness 
• inconvenience or other bothering because of the drug 
• tangling or stickiness of eyelashes 
• swelling of eyelid 

Systane Dry Eye Drops

Similarly as with any drug, if a man encounters reactions from utilizing drops, they ought to counsel a specialist quickly and quit utilizing them. When all is said in done, the symptoms of taking eye drops are insignificant.

At the point when to see a specialist

It isn't phenomenal for individuals to encounter dry eyes every now and then. Commonly, dry eye indications don't keep going long.

In situations where the manifestations continue for longer than a week or over-the-counter eye drops have had little impact, a man might need to see a specialist.

In drawn out or more serious instances of dry eye, a specialist can enable principle to out and possibly treat fundamental wellbeing conditions. They may endorse medicine eye drops to treat the wellspring of the dry eye or offer exhortation on the most proficient method to treat the dry eyes.

Elective medications 

In spite of the fact that eye drops are the most ordinary and suggested treatment for dry eye, different medicines are accessible. For instance, a portion of the prescriptions accessible in drop frame are likewise accessible as a gel to help in situations where the eyes get dried out rapidly over some undefined time frame.

At times, oral drug may enable reduction to dry eyes. These drugs are frequently anti-toxins that objective the swelling of the eyelid that might meddle with regular oil creation.

Dry Eye Relief

Extra therapeutic alternatives include:

• an eye embed that gradually discharges a substance that greases up the eyes after some time 
• shutting the tear channels 
• uncommon contacts 
• eye treatments 

Individuals with dry eye may likewise think about changes to their condition and propensities. Regularly, this can comprise of adding a humidifier to the home or office to help increment dampness noticeable all around.

Different proposals incorporate flickering all the more frequently, maintaining a strategic distance from drawn out long stretches of gazing at an electronic screen, or changing to glasses from contact focal points.

Glaucoma Surgery Procedure - Trabeculectomy and Sclerectomy

Glaucoma Surgery Procedure - Trabeculectomy and Sclerectomy

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The accompanying section is a manual for glaucoma medical procedure. I have made this manual for help get ready patients for glaucoma medical procedure. It is expected to enable patients to comprehend the "why" and "how" of glaucoma medical procedure.

About Glaucoma Surgery

Surgeries for glaucoma have been developing in the course of recent years. In the course of recent years, we have made huge walks in enhancing careful strategies and results. Glaucoma medical procedure is expected to bring down the intraocular weight (eye weight.) By bringing down the eye weight, we endeavor to back off movement of the malady. Glaucoma is characterized as harm to the optic nerve. Strangely raised eye weight is the most widely recognized reason for glaucomatous optic nerve harm. A few patients create glaucomatous optic nerve harm in spite of the way that they have intraocular weights inside ordinary range. These patients are said to have "low strain glaucoma." Sound individuals, who don't have glaucoma, have eye weights extending from 10mm to 20mm Hg. The normal weight among American grown-ups is 16mm Hg. Subsequently, glaucoma medical procedures are planned to bring down the eye weight to 16mm Hg or less. Medical procedure endeavors to bring down eye weight by making another "deplete" to enable watery liquid to leave the eye. Liquid which has left the eye through the new deplete gathers in a blister like cavity called a "bleb." From here, the liquid enters the venous course (veins) and leaves the circle.

About 15 to 25% of patients who have glaucoma don't have raised weights. These patients create harm to their optic nerves despite the fact that the eye weight once in a while achieves the mid-twenties. These patients have what we call "low strain glaucoma." The sorts of medical procedures performed on these patients are like the medical procedures performed on patients with lifted weights. The fundamental contrast in medical procedure for "low strain glaucoma" is that we are endeavoring to bring down the eye weight to 12mm Hg or less. This is a more forceful decrease than we go for in glaucomas because of lifted weights (16mm or less.)

GLAUCOMA Medical Procedure

Glaucoma medical procedure endeavors to bring down the eye weight by different techniques. These strategies will be obviously portrayed in the accompanying areas. Notwithstanding the technique utilized, it must be obvious to patients that it goes up against normal 3 to about a month and a half to recoup from medical procedure. This does not imply that the patient must be a "habitual slouch" amid this period, yet rather that they should basically "relax" amid this recuperation period. Numerous patients are happy with driving one to about fourteen days after medical procedure. A few patients, be that as it may, as to hold up no less than multi month to about a month and a half before driving.

Glaucoma Surgery Procedure

IS THERE Agony Amid OR AFTER GLAUCOMA Medical procedure? 

Patients who experience glaucoma medical procedure more often than not don't encounter noteworthy agony amid or after the medical procedure. Like any medical procedure, numerous patients encounter mellow distress for fourteen days following medical procedure. Solid torment drug isn't regularly required. Most patients who experience glaucoma medical procedure can accomplish great help with discomfort with Tylenol.

The most widely recognized dissension patients express after glaucoma medical procedure is that they feel a "scratchy" sensation for the initial 4 to about a month and a half. This is typical after glaucoma medical procedure! Patients are really feeling the fasten that is utilized to close the careful injury. This line is made of an absorbable material. This join breaks up over a time of 4 to about a month and a half. The fasten does not should be "evacuated" in light of the fact that is will break down consequently. The "scratchy" sensation can be limited by utilizing counterfeit tears. A few patients likewise utilize greasing up eye salves to enhance their solace.

Foggy Vision after Glaucoma Surgery 

Patient's may encounter foggy vision for the initial 3 to about a month and a half after medical procedure. The foggy vision can be exceptionally annoying to patients who don't expect this. In any case, if the 3 to multi week recuperation period is unmistakably disclosed and underlined to the patient, numerous patients don't experience issues amid this period.

Eyedrops after Glaucoma SURGERY

Most patients don't require "glaucoma" eye drops after medical procedure. They do be that as it may, require three kinds of post-agent eye drops for the initial 2 to 3 months following medical procedure. They sorts of drops required include:

1. An anti-microbial
2. A calming (typically prednisone)
3. A medicine to widen the understudy (this is utilized to help keep the eye agreeable.)

These three kinds of drops are utilized for about a few months after medical procedure. They enable the eye to recuperate at a controlled speed, avoid disease, and keep the eye moderately torment free. These drugs are once in a while utilized past 3 months following medical procedure

Glaucoma Surgery Reasons

Glaucoma medical procedure is a successful technique for controlling the infection. The medical procedures, in any case, Don't "fix" glaucoma. The objectives of medical procedure are to bring down the weight in order to shield the optic nerve from proceeded with harm. The medical procedures don't reestablish locate which has just been lost. The medical procedures don't enhance vision. The essential objective of glaucoma medical procedure is to moderate the movement of the infection.

The weight decrease accomplished by medical procedure does NOT keep going forever. Contingent on the sort of medical procedure played out, a patient can would like to have their weight brought down from a time of a half year to 10 to 15 years. There are a large group of reasons why glaucoma medical procedures are not perpetual. The most widely recognized reason for disappointment of glaucoma medical procedure is scarring of the recently made waste section. Prescriptions are utilized to limit scarring for the initial couple of months following medical procedure. Through the span of 10 years, there is little we can do to take out scarring out and out.

Remember that recuperation takes between 3 to about a month and a half after medical procedure. Numerous patients start to stress that they are not mending appropriately in the event that they are not totally recuperated by a little while. It is essential to impart your feelings of trepidation to your specialists and enable them to mitigate any apprehensions, which may create after medical procedure.



WHAT Sorts OF GLAUCOMA Medical procedure ARE THERE? 

1. Trabeculectomy
2. Glaucoma Seepage Gadgets (Fluid shunts)
3. Non-infiltrating filtration systems (Water Stream)
4. Diode laser cyclodrestruction

I will now diagram every one of these medical procedures. The kind of medical procedure picked relies upon the sort and seriousness of glaucoma. Every patient has an alternate level of malady. The specialist will pick the kind of technique to perform dependent on every individual case.

Every medical procedure has focal points and weaknesses. There is no "immaculate" medical procedure. The objective is to pick the proper technique for every individual patient.

GLAUCOMA Surgery Procedure TRABECULECTOMY 

Glaucoma treatment is coordinated at ensuring the optic nerve and safeguarding visual capacity. At present, this objective is accomplished by bringing down intraocular weight utilizing meds, laser medications, or medical procedures. When all is said in done, medical procedure is saved for patients who have glaucoma, which has not been all around controlled on prescriptions, and have had finish laser treatment. Laser medications are normally performed after a patient's weight winds up uncontrolled on a maximally endured therapeutic regimen (MTMR.)

In spite of the fact that laser medications can be compelling, the weight decrease they deliver isn't perpetual. At the point when a patient has fizzled medicinal treatment, they more often than not experience laser treatment. At the point when laser treatment related to, or instead of therapeutic treatment comes up short, we depend on medical procedure. Despite the fact that medical procedure has verifiably been the keep going treatment on our rundown, this reasoning is evolving quickly. With advances in careful gadgets and strategies, the job of medical procedure is quickly developing. Medical procedure is never again seen "if all else fails." In specific cases, medical procedure might be a superior "initial step" than either drugs or laser medicines.

Glaucoma medical procedures endeavor to make a moderately perpetual "deplete" in the eye. This deplete will serve to expel fluid diversion from inside the eye to an additional visual repository.

The making of an opening or fistula is known as a trabeculectomy. Trabeculectomy initially increased across the board reputation in the 1970's. The methodology has been performed consistently since that time.

Trabeculectomy Surgery for Glaucoma

With glaucoma sifting medical procedure, trabecular meshwork and sclera are extracted, making a fistula through which fluid funniness channels from the front chamber. The fluid amusingness aggregates in the subconjunctival space, shaping a sifting bleb. In spite of the fact that it isn't known with conviction, fluid funniness inside a working sifting bleb is thought either to deplete through the conjunctiva into the tear-film, or to be assimilated from vessels inside episcleral and subconjunctival tissue and join the foundational course.

TRABECULECTOMY Symptoms 

For most ophthalmic specialists, the signs are as per the following: A patient with glaucoma on greatest decent restorative treatment who has had maximal laser advantage and whose optic nerve work is coming up short or is probably going to come up short.

The specialist must be sure the patient has glaucoma, and not simply visual hypertension or nonglaucomatous optic neuropathy. This assurance suggests trademark harm to the optic nerve, visual field, or both.

TRABECULECTOMY  Procedure: 

Trabeculectomy is, fundamentally, a sifting technique intended to occupy the watery silliness through an eye-divider fistula (opening) to a subconjunctival separating store, the separating bleb. The objective of glaucoma separating medical procedure, similar to that of therapeutic and most laser treatments, is to bring down the intraocular weight (IOP) beneath the limit that causes optic nerve harm.

THE ROLE OF ANTI-METABOLITES:
The use of anti-metabolites during filtration surgery has greatly enhanced surgical success rates in high-risk eyes. These chemicals are applied to the eye at the time of surgery. They serve to decrease scaring of the surgically created wound. This allows the newly created glaucoma drain to remain open. Unfortunately, they are not without a significant downside. They have been shown to increase the rate of post-operative infection. In addition, they increase the incidence of postoperative wound leak. Intra-operative or post-operative use of 5-fluorouracil (5-FU) or mitomycin C (MMC), to limit scarring following glaucoma filtering surgery can improve the surgical outcome of an eye with a poor prognosis.

TRABECULECTOMY RISKS

The risks of glaucoma surgery include bleeding, infection, blindness, and loss of the eye. These risks are not unique to glaucoma surgery. However, eyes with glaucoma are usually “sicker” than eyes without glaucoma. Despite these risks, the benefits of long-term pressure reduction are great. Numerous scientific studies have repeatedly demonstrated that patient’s whose pressures are lowered by at least 30% from their untreated levels have better preservation of visual function over the course of their lifetime.

POST-OPERATIVE COURSE:
Glaucoma surgery attempts to lower the intraocular pressure without the aid of glaucoma medicines. During the early postoperative period, the intraocular pressure can by variable. In some patients, the pressure is quite low. In other patients, the postoperative pressure can be higher than it was before surgery.

When the pressure fluctuates, often a patient’s vision will fluctuate. Patients often experience blurred and frankly poor vision for the first 6 weeks after surgery. Fortunately, by the beginning of the second month following surgery, vision usually returns to its preoperative level and stays there. One of the paramount goals of glaucoma surgery is to minimize an individual’s dependence on glaucoma medication. Although this is not achieved in 100% of cases, it is certainly attainable in a good number. The following pages illustrate and describe a surgical trabeculectomy.

Trabeculectomy Surgery Photo

TRABECULECTOMY SURGERY INFORMATION

1. TRABECULECTOMY lowers the pressure inside the eye! They do not cause the fluid to drain into your tears. The fluid, which is drained out of your eye, is shunted to the back of the eye, and from there it enters the venous system to be removed from the eye as it mixes into the bloodstream.

2. BLURRY VISION IS NORMAL AFTER THIS SURGERY!
Your vision will be very blurry for the first 3 to 6 weeks following this surgery. Many patients become anxious during the first month after surgery because their vision does not return to normal immediately after surgery. I cannot over-emphasize that it is normal to have very blurry vision for 6 full weeks following the surgery. It is important to keep this in mind so as not to become worried that something has gone wrong with your surgery.

3. WATERING OF THE EYE IS NORMAL AFTER SURGERY!
Tearing, watering, and mattering are all common complaints after this type of surgery. The excessive tearing and watering will resolve on their own over the first 3 to 6 weeks. It is not a permanent problem. Be patient, this problem is very common, but always resolves spontaneously over time.

4. A SCRATCHY OR “SANDY” SENSATION IS NORMAL AFTER SURGERY!
Glaucoma surgery requires stitches (sutures). The stitches dissolve spontaneously. It takes about 3 to 6 weeks for the stitches to dissolve. During this period, you may feel the stitch scratching the eye. This is NORMAL! Some people feel this scratchy sensation a few days after surgery; some do not experience it until many weeks after surgery. Do not be alarmed if you experience this. One way to lessen the discomfort is to use an eye ointment, which your doctor can prescribe for you in the office, or call it in to your pharmacy. There are also over the counter ointments available, which your doctor may recommend. The ointments lubricate the stitches and minimize the friction between the stitches and your eyelids. The ointments help the comfort of the eye but can cause blurry vision because they are very thick. They are very helpful if used before going to sleep because they will have minimal effect on your vision, and keep the eye moist when you sleep. They might cause your eye to be stuck shut in the morning, but this can easily be removed with a cool compress.

5. YOU WILL NOTICE A CYST ON THE UPPER PART OF YOUR EYE!
This cyst is called a “bleb.” This is a normal occurrence. In fact, we hope to have a good-sized bleb because this is where your new drain is. The bleb often looks like a blister. Do not be alarmed if you see it. It is supposed to be there!

6. SEVERE PAIN, HEADACHE AND NAUSEA ARE NOT NORMAL!
MUCUS, PUS, OR GREEN-YELLOW DISCHARGE IS NOT NORMAL.
If you experience any of these, please call our office immediately at (602)-955-1000.

GLAUCOMA SURGERY-GLAUCOMA DRAINAGE DEVICES (GDD) OR AQUEOUS SHUNTS
During the past two decades, glaucoma drainage devices (GDD’s) have been increasingly used in the treatment of glaucoma. Approximately 5000 GDD’s are used in the United States annually. Most GDD’s consist of a segment of silicone rubber tubing attached to a rigid plastic or flexible silicone rubber explant.

As previously discussed, glaucoma occurs when the pressure in the eye becomes elevated. The pressure usually becomes elevated due to damage to the natural drain within the eye. GDD’s work by “shunting” excess fluid out of the eye through the silicone rubber tubing. Once removed from the eye, the fluid joins with venous blood, which is returned to the heart

Eye have glaucoma

Over the past 5 years, the use of GDD’s has grown rapidly. This increase is due to both improved devices, as well as improved surgical techniques.

GDD’s are less prone to failure than traditional “trabeculectomy” because they are less effected by post surgical scarring. An important advantage which GDD’s have over trabeculectomy is that they do not leave the eye as susceptible to infections following otherwise successful surgery.

The following illustration displays several types of GDD architecture.

The first GDD was the Malteno glaucoma implant, which initially appeared in 1969. Commercially manufactured GDD’s currently available in the U.S. included both “valved” or “flow-restricted” designs (Ahmed, Krupin) and “nonvalved” (Malteno, Baerveldt) designs. While differing in size, shape, and details of instillation, all of these devices share common features and utilize the same physiologic principles.

GLAUCOMA SURGERY-GLAUCOMA DRAINAGE DEVICES

The human eye produces a clear, water-like, fluid called aqueous humor. In a healthy individual, this fluid is drained out of the eye at the same rate it is produced. In patients with glaucoma, the eye loses its ability to drain the fluid out as fast as it is being produced. As a consequence, the aqueous humor accumulates in the eye and the pressure within the eye increases. The increase in pressure leads to damage of structures within the eye. The structure within the eye which is most susceptible to increased pressure is the optic nerve. Thus, glaucoma is defined as damage to the optic nerve resulting from increased intraocular pressure.

As we have discussed, patients with glaucoma usually have a damaged drainage system. GDD’s lower pressure because they allow the excess fluid to bypass the damaged drainage system. GDD’s work by “shunting” fluid out of the eye. They consist of a one way drain attached to a straw like piece of tubing. The drain is referred to as the “plate.” The tubing is surgically inserted into the eye. It runs from inside the eye to the plate, which is sutured onto the outside of the eye. Thus, aqueous humor is shunted from inside the eye to the plate, where it is absorbed by blood vessels, which return it to the systemic circulation.

INDICATIONS:
The general indications for installing GDD’s include failure of conventional therapies such as medications, laser trabeculoplasty, and standard trabeculectomy with or without antifibrotic agents.

GLAUCOMA SURGERY-GLAUCOMA DRAINAGE DEVICES
POST-OPERATIVE COURSE:
GDD’s have demonstrated, as do some trabeculectomies, a period of elevated pressure before the ultimate lowering occurs. Intraocular pressure often falls initially, and then rises to preoperative levels or even higher for weeks before falling again. Resumption of medications is indicated to minimize the transient pressure rise.

POST-OPERATIVE MEDICATIONS:
Post-operative medications following GDD surgery include topical corticosteroids such as Pred Forte 1% from 4 to 6 times a day. In addition, topical antibiotic (Ciloxan, Oxuflox) drops should be used. Glaucoma medications will usually need to be resumed promptly after placement of a GDD, pending spontaneous or surgical opening of the tube as the absorbable ligature dissolves or is cut with a laser

GLAUCOMA DRAINAGE DEVICES COMPLICATIONS?

Complication rates for GDD’s have fallen drastically over the past decade due to improved knowledge and experience with the devices. In general, the most common complications seen with any ocular surgery are bleeding, or infection, which in the worst-case scenario, can lead to total blindness and loss of the eye. The most common short term complication is low pressure. The major long-term problems seen with GDD’s are double vision, and corneal decompensation. The reasons for double vision are varied and not always predictable. Corneal decompensation occurs when the tube migrates and comes into contact with the inner surface of the cornea. Both of these problems can be surgically remedied. Double vision can be remedied by removing the GDD. Corneal decompensation can be improved by corneal transplantation.

GLAUCOMA DRAINAGE Results

GDD’s offer an excellent alternative to conventional filtration surgery. Surgery should be performed by a surgeon with broad experience with GDD’s. Once functioning, GDD’s can provide good long-term intraocular pressure reduction and glaucoma control. Unfortunately like all glaucoma procedures, the pressure control produced by these devices is not always permanent. However, GDD’s offer the most predictable long-term pressure control for glaucoma patients.

GLAUCOMA SURGERY-GLAUCOMA DRAINAGE DEVICESSURGICAL PROCEDURE

The white part of the eye is called the sclera. The sclera is covered with a thin, film-like layer of clear tissue known as the conjunctiva. Surgery involves opening the conjunctiva thereby exposing the sclera. The drainage device is then placed in a selected quadrant and sutured to the sclera. The tube is then inserted into the eye through a tract created by a small needle. The tube is then temporarily closed off with an absorbable suture and anchored to the sclera. The tube is then covered with a piece of donor sclera or pericardium. The conjunctiva is then closed in a watertight fashion, completely covering the drainage device and the tube.

FIGURE A.
The conjunctiva has been opened. The supero-temporal Quadrant has been exposed. The superior and lateral rectus muscles have been isolated. The plate is placed under the superior rectus muscle.

FIGURE B:
The plate is placed under the lateral rectus muscle. You can see the tube attached to the plate. In this picture, the tube has not yet been placed into the eye.

FIGURE C:
The tube has been placed into the eye. The tube is covered with a square piece of donor sclera or pericardium. As you can see, the tube sits in the anterior chamber (front of the eye). The conjunctiva has not yet been closed.

POST-OPERATIVE PATIENT INFORMATION
GLAUCOMA DRAINAGE DEVICE SURGERY:
ANDREW RABINOWITZ, M.D.
1. GLAUCOMA DRAINAGE DEVICES lower the pressure inside the eye!. They do not cause the fluid to drain into your tears. The fluid, which is drained out of your eye, is shunted to the back of the eye, and from there it enters the venous system to be removed from the eye as it mixes into the bloodstream.

2. DOUBLE VISION IS NORMAL AFTER THIS SURGERY! .
It is not unusual to experience double or triple vision after this type of surgery.
The double vision is usually worst during the first 3 weeks and then slowly improves over the first 3 months. Many patients become alarmed when they experience double vision, but I stress that this is a normal occurrence, and does not mean that something has gone wrong with your surgery. Some people find that patching the eye for a few weeks makes the double vision go away. There is not harm in covering the operated eye even during the daytime to lessen the double vision. I often recommend this to patients who experience double vision.

3. WATERING OF THE EYE IS NORMAL AFTER SURGERY!
Tearing, watering, and mattering are all common complaints after this type of surgery. The excessive tearing and watering will resolve on its own over the first 3 to 6 weeks. It is not a permanent problem. Be patient, this problem is very common, but always resolves spontaneously over time.

4. A SCRATCHY OR “SANDY” SENSATION IS NORMAL AFTER SURGERY

5. BLURRY VISION IS NORMAL AFTER THIS SURGERY!
Your vision will be very blurry for the first 3 to 6 weeks following this surgery. Many patients become anxious during the first month after surgery because their vision does not return to normal rapidly. I cannot over-emphasize that it is normal to have very blurry vision for 6 full weeks following the surgery. It is important to keep this in mind so as not to become worried that something has gone wrong with your surgery.

6. IT TAKES 6 WEEKS BEFORE THE SHUNT LOWERS EYE PRESSURE!
The drainage device is used to control pressure by shunting fluid out of the eye. The device, however, is designed to lower the pressure gradually over 6 weeks following surgery. In fact, the drain does not work at all for the first month after surgery. After that time, it slowly starts to drain out the fluid and lower the pressure. By six weeks after surgery, the drain will be working at full capacity.

Iridectomy and Bleb

7. SEVERE PAIN, HEADACHE AND NAUSEA ARE NOT NORMAL!
If you experience any of these, please call our office immediately at (602)=955-1000.

GLAUCOMA SURGERY-DEEP SCLERECTOMY WITH VISCOCANALOSTOMY (DSVC)
The most commonly performed glaucoma procedure in the United States is the trabeculectomy. Trabeculectomy attempts to make a partial hole in the white part of the eye (sclera). Aqueous humor drains through this hole into a small blister-like cyst known as the “bleb.” Unfortunately, the bleb obtained in successful glaucoma surgery has many unfavorable characteristics. Firstly, the bleb may be elevated, causing the patient to feel as though there is something in their eye. Secondly, large blebs can grow onto the cornea and become cosmetically unacceptable. Finally, blebs make the eye susceptible to severe infections. The risks of developing a profound infection leading to blindness are much greater in eyes with functioning blebs.

Glaucoma surgeons have spent the past decade attempting to invent a glaucoma surgery which does not result in the creation of a bleb. DSVC attempts to bypass the obstructed trabecular meshwork without creating a scleral hole or fistula. DSVC is referred to as non-penetrating filtration because no hole is created in the eye as is done with trabeculectomy.

DSVC involves the creation of a drainage channel without creating a full thickness hole in the sclera. Theoretically, this will greatly decrease the incidence of post-operative wound leaks and infections. In addition, because no hole is made, the surgery is less susceptible to failure because scarring is less critical to the long-term success of the surgery.

DSVC is a surgery in its infancy. The results of our initial experience with DSVC are encouraging enough to stimulate significant worldwide interest in his procedure.

I have performed over 200 of these procedures with promising results. The rate of postoperative complications has been lower than that seen with trabeculectomy. Bleb formation does occur in about 25% of cases. These blebs however, are low lying, and usually disappear by 6 months. The intraocular pressure has remained controlled even in
cases in which the bleb becomes extinct.
DSVC will not completely replace conventional filtration surgery. However, it will likely assume a crucial role as an alternative to trabeculectomy. DSVC may in fact become the treatment of choice in juvenile glaucomas, pigmentary glaucomas, and open angle glaucomas in myopic eyes. Results of DSVC have been less favorable in far-sighted patients, and eyes with inflammatory glaucomas.

Further studies and refinement of the technique will undoubtedly push the envelope of glaucoma surgery. DSVC offers an excellent alternative to trabeculectomy. This is important in patients who have undergone unsuccessful trabeculectomy in one eye and require initial surgery in the fellow eye.

In glaucoma, hope springs eternal. Clinical trials are underway for another novel glaucoma surgery, which involves using a synthetic “wick” to draw aqueous fluid out of the eye through a non-penetrating scleral reservoir. We hope to participate in this international clinical trial in the coming months. This would enable The Barnet Dulaney Eye Center to offer cutting-edge surgical treatment for glaucoma.

SCLERECTOMY SURGERY PROCEDURES

1. DEEP SCLERECTOMY lowers the pressure inside the eye. The fluid, which is drained out of your eye, is shunted to the back of the eye, and from there it enters the venous system to be removed from the eye as it mixes into the bloodstream. The fluid removed from your eye does not join with your tears.

2. BLURRY VISION IS NORMAL AFTER THIS SURGERY!
Your vision will be very blurry for the first 3 to 6 weeks following this surgery. Many patients become anxious during the first month after surgery because their vision does not return to normal rapidly. I cannot over-emphasize that it is normal to have very blurry vision for 6 full weeks following the surgery. It is important to keep this in mind so as not to become worried that something has gone wrong with your surgery.

3. WATERING OF THE EYE IS NORMAL AFTER SURGERY!
Tearing, watering, and mattering are all common complaints after this type of surgery. The excessive tearing and watering will resolve on its own over the first 3 to 6 weeks. It is not a permanent problem. Be patient, this problem is very common, but always resolves spontaneously over time.

4. A SCRATCHY OR “SANDY” SENSATION IS NORMAL AFTER SURGERY!
Glaucoma surgery requires stitches (sutures). The stitches are self-absorbing. It takes about 3 to 6 weeks for the stitches to dissolve. During this period, you may feel the stitch scratching the eye. This is NORMAL! Some people feel this scratchy sensation a few days after surgery; some do not experience it until many weeks after surgery. Do not be alarmed if you experience this. One way to lessen the discomfort is to use an eye ointment, which your doctor can prescribe for you in the office, or call it in to your pharmacy. There are also over the counter ointments available, which your doctor may recommend. The ointments lubricate the stitches and minimize the friction between the stitches and your eyelids. The ointments help the comfort of the eye but can cause blurry vision because they are very thick. They are very helpful if used before going to sleep because they will have minimal effect on your vision, and keep the eye moist when you sleep. They might cause your eye to be stuck shut in the morning, but this can easily be removed with a cool compress.



5. YOU WILL NOTICE A CYST ON THE UPPER PART OF YOUR EYE!
This cyst is called a “bleb.” This is a normal occurrence. The bleb often looks like a blister. Do not be alarmed if you see it. It is supposed to be there!

6. SEVERE PAIN, HEADACHE AND NAUSEA ARE NOT NORMAL!
MUCUS, PUS, OR GREEN-YELLOW DISCHARGE IS NOT NORMAL.
If you experience any of these, please call our office immediately at (602)=955-1000.

GLAUCOMA SURGERY:-TRANS-SCLERAL LASER CYCLOPHOTOCOAGULATION (CPC)

Cpc Surgery

The ciliary body is the structure that produces aqueous humor. Aqueous humor is a clear liquid. This liquid is responsible for keeping the eye formed. Cyclodestruction is a treatment, which destroys cells of the ciliary body. In so doing, the treatment attempts to shut down the production of fluid within the eye. Cyclodestructive procedures are recommended in patients with advanced glaucomas and otherwise poor prognoses. Often these patients have been relative failures of medical therapy and glaucoma filtering surgery. In many respects, CPC can be viewed as a “last-step effort to save the eye.”

The cyclodestructive procedures are also useful in patients in whom conventional surgery is contraindicated by their systemic health or local ocular condition. Generally, these patients have little or no functional vision. Reduction of intraocular induced pain in this clinical setting is an important indication.

WHO IS A CANDIDATE FOR CPC Surgery?
CPC is reserved for patients who undergone multiple eye surgeries including glaucoma surgeries who still have elevated eye pressure. Often, these patients have lost a significant amount if not all of their vision

WHAT ARE THE INDICATIONS FOR  CPC Surgery?

1. Persistently elevated eye pressure despite aggressive surgical treatment.
2. A painful eye with little or no sight remaining.
3. Uncontrolled glaucoma in a patient who is not a good surgical candidate.
4. Reduction of pain in a blind eye.

HOW DOES THE LASER GET TO THE EYE?
The laser energy is delivered to the eye through a probe, which resembles a pen.
The entire procedure usually takes 2 to 5 minutes. The procedure is well tolerated because the patient is treated with a local anesthetic prior to the treatment. The treatment does not require any incisions, sutures, or needles.

WHAT IS THE SUCCESS RATE OF CPC Surgery?

The results of CPC are generally quite good. Most patients can be successfully treated with one to two sessions of laser therapy. In severe glaucomas, the treatment may have to be repeated two to three times over the first year to obtain maximum pressure control. One of the greatest advantages of the procedure is that it can be repeated as often as is needed.

CPC Surgery RISKS

The most significant risk with this procedure is the eye pressure becomes too low and stays that way. This is a very rare occurrence, and often not a problem because control of pain is usually the main indication for this procedure. Like other eye surgeries, bleeding and infection are very low, but possible risks.