Sat | Nov 18, 2017

Changing the face of glaucoma management in Jamaica

Published:Wednesday | March 15, 2017 | 12:00 AMDr Maynard McIntosh

Glaucoma is sometimes referred to as the silent thief of sight, because of how insidious its onset and course can be. The condition can be rather asymptomatic at first, unless it assumes the more aggressive form of an acute angle closure or painful secondary glaucoma.

Standard approach to the treatment is eye drops that either reduce the rate at which aqueous humor is produced, or up-regulates its drainage. Surgery is indicated when intra-ocular pressure (IOP) is too high or fails to be controlled by eye drops. The surgery may involve simple drainage procedure called Trabeculectomy, or implantation of drainage device (Shunt). The foregoing refers to Primary Open Angle Glaucoma (POAG). Other forms are managed with either LASER therapy or other specific surgical interventions.

Minimally Invasive Glaucoma Surgery (MIGS) is a refinement of the surgical approach minimizing incision size and degree of invasiveness. These include micro-shunts (eg. EX-PRESS by Alcon) or small tunnelling into the anterior chamber, (front of the eye) with as little tissue disruption as possible. Such efforts often fall short of target IOP.

SLT (selective laser rabeculoplasty) is the simplest of the procedures often used as first line or adjunctive therapy in managing elevated pressures in open angle glaucoma, when additional drop of 5mmHg or so is desired.

Cyclo G6 by Iridex is a new kid on the block, just over 18 months post-FDA approval in the USA, and already proves to surpass even the best surgical efforts. This trans-scleral Laser results in phenomenal lowering of eye pressures by reducing the production of fluid by the Ciliary Body without destroying the structure itself.

This is made possible with micro-pulse technology delivered through an MP3 probe. For severe, painful intractable glaucoma-permanent destruction of the fluid-producing mechanism may be necessary to manage a painful blind eye, in which case the G-Probe is employed. All Cyclo G6 treatments are administeredat Ophthalmic Suites under local anaesthesia to avoid pain. The results have been very promising, and it is my view that the NHF should look into approving the procedure for subsidy, as it will save millions in eye drops and other glaucoma medications.

- Dr Maynard McIntosh, MB BS; Adv DO, is a graduate University of the West Indies with MB BS (Hons); consultant ophthalmologist Eyelite Optical & Ophthalmic Suites; anterior segment and phaco-refractive surgeon; certified Femto-LASIK surgeon; national blind sports classifier.