Glaucoma

Narrow Angles

As a glaucoma specialist in Las Vegas, Dr. Peter DeBry often sees patients who are seeking a second opinion after receiving a diagnosis of a narrow angle.  A narrow angle is a common condition related to the size and shape of the eye, and is a risk factor for developing an increased eye pressure.  To review eye anatomy – there is a fluid called the aqueous that circulated within the eye.  This aqueous is produced by the ciliary body, circulates within the eye, then drains away through the trabecular meshwork.  The trabecular meshwork is located near the outer edge of the iris.  This small space called the “Angle” has an upper boundary of the cornea (clear window of the eye) and a lower boundary of the iris (colored part of the eye), with these structures coming together like the sides of a triangle.  There is usually plenty of space for the fluid to pass next to the iris and out through the trabecular meshwork.

In some people the eye is shaped differently and the drainage area is very narrow.  Under certain circumstances, such as dim illumination or stressful situations, the drain can completely close off.  When this occurs the fluid continues to be produced and the pressure inside the eye increases over minutes to hours.  This is considered an attack of angle closure glaucoma.

Fluid called the aqueous circulates within the eye

Fluid called the aqueous circulates within the eye

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What is my risk of angle closure glaucoma?

This is a very difficult question to answer and depends somewhat on how narrow your angles are.  The majority of people with a narrow angle will not develop angle closure.  However, it is impossible to predict who will and who will not get glaucoma.  Therefore treatment is recommended for all individuals who are determined to have narrow angles.

What is the treatment for narrow angles?

Patients with mildly narrow angles need no treatment and should have a detailed eye exam yearly. In patients with moderate to severe narrowing, to lower the risk of acute angle closure glaucoma a small hole is placed in the iris with a laser (laser iridotomy). This laser procedure is done in the office or laser center, takes only 2-3 minutes to complete, and has some pain involved.  By placing a hole in the iris an alternate pathway is made for the fluid to reach the drainage area of the eye.   This prevents complete closure of the angle and the resulting high eye pressure.

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Are there any alternatives to having the laser done?

Laser surgery is the best treatment for narrow angles.  If for some reason you do not want the laser there are two options. The first option is no treatment. Without treatment you will still have the small risk of angle closure glaucoma.  This risk will slowly increase from year to year as the angle becomes narrower as you age.  The second option is to use an eye-drop (pilocarpine) to lower the risk.  The eye drop needs to be used 3-4 times daily, and may make the vision dim or blurry.  It will reduce the risk of angle closure, but can’t completely prevent it.

Are there side effects of the laser?

Yes, but generally they are minimal.  In most people there is a small elevation in the eye pressure and some inflammation inside the eye.  These problems are easily treated with medications.  You will be given some drops before the laser and some after to prevent the pressure increase.  You will also be given eye drops (Prednisolone) to use for 7 days after the laser to help with the healing process.  One out of every 100 people will have a significant increase in eye pressure.  Usually this is treated with additional medications, but in extremely rare instances emergency surgery may be needed.

Will the laser affect my vision?

In most cases you will not be aware of any differences in your vision.  Approximately 1-in-100 people will report a faint line or crescent of light in their vision.  This is caused by stray light coming in through the new opening in the iris.  Most people report that the symptoms get less noticeable over time, but if they persist there are several techniques that may improve the visual changes.  If your eye has had other problems in the past such as chronic inflammation, cataracts, or corneal swelling, the laser may cause short-term increases in inflammation or corneal swelling.  This may make the vision worse for days-to-weeks after the laser.  In most cases the vision improves with the use of medications.  It is extremely rare for a laser iridotomy to cause visual loss.

What am I to expect on the day of the laser treatment?

After arrival your eye pressure will be checked.  Dr. DeBry will review the procedure with you and answer any question that you may have.  You will need to sign a consent form before the procedure.   You will be given several drops to prepare the eye for the laser.  The laser surgery takes 2-3 minutes.  You will feel a slight burning and/or snapping sensation.  Most people describe this as uncomfortable rather than painful.  When the laser is complete you will be given additional drops to prevent the pressure from increasing.  You will then need to wait for 30 minutes for a pressure check.  If the pressure is fine you will be able to leave.   The vision may be dark and blurry for 2-3 hours after the surgery because of the bright lights and lenses used.  Because of this we recommend that you have someone with you to drive you home.  This is especially true if you have poor vision in your eye that did not have the laser.  Please check with Dr. DeBry if you are unable to arrange for a driver.  A follow-up appointment will be arranged for 4 weeks after the laser.

Are there symptoms to watch out for after the laser?

After any eye surgery there are certain signs and symptoms to look for.  If you experience significant redness, light sensitivity, blurred vision, headache, halos around lights, or nausea you should contact the office immediately.  This could be from increased inflammation or high pressure in the eye.

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