Pioneering glaucoma procedure expected to save sight of thousands of patients

Posted: 28/03/2018

Glaucoma is a group of eye diseases that occur when the tubes that drain fluid from the eye become slightly blocked and result in a build up of pressure. It is this build up that causes progressive damage to the optic nerve at the point where it leaves the eye to carry visual information to the brain. If the optic nerve is damaged, the patient will suffer irreversible deterioration in their vision. They may first notice worsening peripheral vision but as the condition progresses the central vision will become more and more impaired. In very severe cases, if left untreated, the condition may lead to complete blindness.

It is estimated that 4.5 million people worldwide and 600,000 people in the UK are blind due to glaucoma. It is the second most common cause of blindness worldwide and, because the condition can progress without the patient experiencing any initial visual symptoms, is often described as the “silent blinding disease” or the “sneak thief of sight”.

As any loss of vision caused by glaucoma is irreversible, early detection and treatment is of paramount importance.

The condition is often picked up at routine eye examinations. Once a diagnosis of glaucoma has been made, the treatment of choice to date has been the application of eye drops which work by helping to drain away excess fluid from the eye or reducing the production of it. The drops have to be used every day for the rest of the patient’s life. If the patient forgets to administer the drops, or incorrectly administers them, the glaucoma can progress and could lead to further visual loss, with devastating consequences. The problem with this treatment method therefore, is a heavy reliance on the patient complying with his or her treatment regime.

Now, doctors in Canada have developed a new procedure that can stop glaucoma from progressing and remove the need for eye drops.

The procedure combines inserting miniature stents into the eye to help drain the excess fluid with laser treatment targeted at the ciliary processes to stop so much fluid being produced. This is the first time that stents have been combined with laser surgery to prevent glaucoma progression. It was introduced to the UK by Mr Gok Ratnarajan at Queen Victoria Hospital NHS Foundation Trust and is expected to be suitable for patients with mild to moderate glaucoma. To date, 35 patients in the UK have been treated with this procedure, all of whom now have lower pressures in their eyes.

Arran Macleod, an associate in the clinical negligence team at Penningtons Manches, said: "We previously wrote about the importance of regular eye tests to ensure glaucoma is detected early. This is still vitally important to prevent any irreversible visual deterioration in the first place. Patients over 40, who have a first-degree relative with glaucoma, are entitled to a free NHS eye test to check for early onset of the condition, and should utilise this service.

“We are pleased to see that this innovative procedure involving stents and laser surgery has been brought to the UK and has so far provided patients with excellent outcomes. We will be monitoring the progress of this treatment with interest.

“In our work we see various cases where patients have suffered loss of vision either because their symptoms have been missed when they should not have been, they have been incorrectly diagnosed, or they have been poorly treated. For many this results in a progression of visual loss beyond what would have otherwise been expected. The consequences of visual loss are often devastating for the patient,  their family and loved ones, and it is an area of medicine in which accurate diagnosis and timely treatment is of vital importance. If you, or someone you know, have any concerns about the ophthalmic treatment you have received, we would be happy to speak with you to discuss your options.”

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