Dr. Matthew Nutaitis of MUSC's Storm Eye Institute discusses treatment options for glaucoma.
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Again, with the primary open-angle glaucoma, in the US, as well as throughout the world, there are really three groups. There are medicines that you can use, there are laser treatments that you can use and there's surgery you can use. If we get in to the secondary glaucoma, it doesn't quite follow that because, for example, if you think somebody has an angle closure glaucoma, they just go get a laser. I mean, you can use the medicine to temporize things, but really you want to go ahead and get the laser and it helps divert the flow properly and breaks the attack. Okay. So there are exceptions to somewhat I'm going to say when you are outside open-angle glaucoma diagnosis. Another good example is congenital glaucoma, because little babies can get glaucoma. They can be born with it. Really the worst case for children is to be born with high pressures, cloudy corneas and enlarged eyes. Babies, up to two year, their eye will stretch because of the pressure, once you are over two year, it doesn't stretch, the pressure just keeps going up. So that child needs surgery and there are several specific surgeries to help cure that. You can use medicines to temporize things, but when I see a one-month-old that has congenital glaucoma, we were picking a form, and we're going to plan to do that surgery which is actually very successful in children. So the challenge there is, they get the pediatricians and the nursery personnel to sort of be suspicious that this is going on and ask for us to take a look because we've got a cure for them. You get these kids before they get a lot of damage, you can cure them with one or two surgeries. It's a grand slam homegrown type of deal. So we want to find those people. But back to the open-angle glaucoma patient, the medicines, there is 8 or 10 of them, some of them are more popular than others. They either increase the way the outflow of the eye works or they decrease the amount of fluid produced or they do a bit of both. Then the side effect profile and contraindications for the medicines, in general, they're all pretty good for patients. There are some exceptions to that rule, but in general, we were able to find some combination of medicines that help the patient. If the medicines don't work or they have trouble taking all of these medicines, if it's a chronic disease, we put them on three medicines they're going to take these, rest of their lives. People are busy, can't remember, they become non-compliant or they struggle with it. Then you can entertain a laser treatment that has a pretty high success rate as long as you do it and somebody who is on the older side, hasn't had any surgery, still hasn't had cataract surgery, that group does well with it.
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