Glaucoma specialist Melbourne

Everything you need to know about glaucoma and glaucoma treatment

Glaucoma occurs when high eye pressure causes progressive damage to your optic nerve, resulting in irreversible vision loss. The key is to detect glaucoma early and start treatment before any significant sight loss has occurred. Most patients with glaucoma are treated with eye drops or laser, or a combination of both. In some cases, however, glaucoma surgery may be recommended.

Internationally trained

In United Kingdom, Switzerland, New Zealand and India

cataract surgeries
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glaucoma surgeries
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Glaucoma symptoms

What is glaucoma?

Before we answer that question, let’s use the analogy of

  • the eyeball being a camera,
  • the brain being a computer,
  • and the optic nerve being the cable that connects the eyeball (camera) to the brain (computer).

To be able to see, all 3 components need to function well.

Glaucoma is a disease whereby pressure within the eyeball (camera) causes progressive and irreversible damage to the optic nerve (the connecting cable). This optic nerve damage will cause you to gradually lose your peripheral vision, giving you a progressively worsening tunnel vision effect.

Brian Ang | Eye Surgeon Melbourne
Dr Brian Ang

Glaucoma specialist Melbourne

"The reason there is pressure in the eye is because of a fluid called aqueous. Aqueous is constantly produced to provide nutrients to the cells of the eye, and also constantly drained to take away waste material from the same cells. Eye pressure is increased when there is build up of aqueous in the eye due to inadequate drainage."

Once glaucoma has already damaged your vision, there is no treatment that will be able to restore the damage or recover your vision fully. It is therefore crucial to detect glaucoma early and to start treatment before any significant vision loss has already occurred. Most people with glaucoma, when detected early and managed appropriately, retain useful vision for the rest of their lives. 

"My job as a glaucoma specialist is to work with you to minimise vision loss from glaucoma so that you can maintain your best possible vision for the rest of your life."

Glaucoma is fairly common, affecting up to 2% of the population. In Australia, it is estimated that over 300,000 people suffer from glaucoma. Glaucoma is the leading cause of irreversible blindness in Australia and worldwide. 

Can I prevent glaucoma?

Unfortunately, there is no guaranteed way to prevent glaucoma. The most important thing is to be aware of your risk of glaucoma and to be monitored regularly by an eye care professional (optometrist or ophthalmologist).

Risk factors include:

  • A family history of glaucoma
  • Previous ocular trauma
  • Prolonged use of steroid medication
  • Known high eye pressure

It is a good idea to have your eyes checked at least once a year once you hit the age of 50, or earlier if you have risk factors.

If you are a glaucoma suspect, it means you are at higher risk. We should proactively manage this risk to reduce the likelihood of progression to glaucoma.

Symptoms of glaucoma

Symptoms depend on how advanced the glaucoma is and how high the eye pressure is. 

Early glaucoma is asymptomatic. It is when you get to the advanced stage that you notice your peripheral vision has decreased. You may find yourself bumping into things, unable to see steps clearly, or having difficulty noticing incoming cars when you are crossing the road. By the time you reach this stage, your peripheral vision will almost certainly no longer be safe for driving.

Glaucoma vision | Brian Ang
Normal vision after treatment | Brian Ang
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Sometimes, acute glaucoma can occur when the eye pressure becomes very high (more than 40 mmHg). When this happens, your eye will become very red and painful. Your vision will be blurry and you will see haloes. You will most likely also experience a headache and nausea. 

Types of glaucoma

There are quite a few types or classifications of glaucoma, but the underlying principle of optic nerve damage due to eye pressure remains the same, regardless of the type of glaucoma. 

Glaucoma specialist Melbourne Dr Brian Ang

Glaucoma Melbourne

First-line treatment for glaucoma

The main goal of glaucoma treatment is to reduce the eye pressure.
The first-line treatment options for glaucoma are:

  • Eye drops.
  • Laser treatment (either selective laser trabeculoplasty or laser iridotomy).

Selective laser trabeculoplasty (SLT)

Selective laser trabeculoplasty (SLT) is performed to reduce eye pressure in open angle glaucoma. The laser stimulates cells in the trabecular meshwork to work harder to drain aqueous from the eyeball. 

Laser iridotomy

Laser iridotomy is performed to widen the drainage angle in angle closure glaucoma. The laser creates a hole in the iris, thus providing better access for aqueous to drain out via the trabecular meshwork. 

About laser treatment for glaucoma

Both SLT and laser iridotomy are performed in the rooms. The laser procedures take less than 5 minutes each to perform. Before laser treatment, eye drops are instilled to constrict your pupil. These drops can take up to 30 minutes to work and may blur your vision and cause a headache for a couple of hours. 

Laser treatment is delivered through a special contact lens placed at the front of your eye. You will feel some discomfort during the procedure.

After laser treatment, you may have to wait 30 to 60 minutes to have your eye pressure rechecked before you go home.

Research :

Dr Brian Ang has published scientific papers on both selective laser trabeculoplasty and laser iridotomy.

Glaucoma surgery

Types of glaucoma surgery procedures

Most patients with glaucoma are treated with eye drops or laser, or a combination of both. 

"In some patients however, these glaucoma treatments are not able to reduce the eye pressure enough. The pressure remains stubbornly high and the glaucoma continues to cause damage to the optic nerve. This is when glaucoma surgery becomes necessary."

The 2 main reasons that I recommend surgery are:

  • Uncontrolled eye pressure despite using maximum possible medical therapy and having undergone laser treatment
  • Rapidly progressing glaucoma, where there is a significant risk of blindness if surgery is not performed

Trabeculectomy

Trabeculectomy is currently the gold standard surgery to reduce eye pressure. The surgery involves creating a drainage channel to allow aqueous to drain out from the eye into a ‘bleb’, which is a pocket of aqueous underneath the conjunctiva (skin of the eye). 

The surgery is performed as a day case and will take 45 to 60 minutes to complete. Your postoperative reviews will be fairly regular in the first month. As the eye settles, additional procedures may be required, such as removal of sutures, laser to cut sutures, and injection of anti-scarring medication around the bleb. It can take a few months (and quite a bit of fluctuation in eye pressure) before the eye eventually settles.

Glaucoma damage is irreversible, so any vision loss from glaucoma cannot be recovered. The aim of surgery is to try to slow down glaucoma progression, and if possible, stop further damage from occurring altogether.

Glaucoma tube shunt implants

If trabeculectomy surgery has failed, glaucoma tube shunts are your next option. They are tubes that are implanted into the front part of the eye, through which aqueous drains out of the eye. 

Brian Ang | Eye Surgeon Melbourne
Dr Brian Ang

Glaucoma surgeon Melbourne

“In some cases, glaucoma tube shunts are implanted as first-line surgical treatment. For example, if you are at high risk of conjunctival scarring or if you are unable to undergo the intensive postoperative management that a trabeculectomy demands.”

In general, the recovery period after glaucoma tube shunt implantation is around 2 to 4 months. 

The main benefit of the glaucoma tube shunt over trabeculectomy is that the postoperative management is not as intensive and is less susceptible to failure from scarring. This operation may therefore be suited to you if you live a long distance from care, or if you scar easily (meaning that trabeculectomy is very likely to fail if performed in your eye).

MIGS

In the last few years, a new class of treatment called minimally invasive glaucoma surgery (MIGS) is becoming increasingly popular. 

MIGS can be performed as an independent procedure but is normally performed in conjunction with cataract surgery. It is ideal if you want to reduce the number of eye drops you use, or if you need your eye pressure reduced but are wary of the risks of traditional glaucoma filtering surgery.

The two commonest MIGS devices are the iStent and the Hydrus microstent. These tiny stents are implanted to help reduce eye pressure by assisting with aqueous drainage via the trabecular meshwork.

When combined with cataract surgery, there is no change to the way cataract surgery is performed. The stent is implanted after the artificial lens implant has been inserted. This adds an extra 5 to 10 minutes to the overall cataract surgery time without any significant added risk. These stents are MRI-safe.

Main advantages of MIGS compared to traditional glaucoma filtering surgery (trabeculectomy and glaucoma tube shunt):

  • MIGS is less invasive
  • MIGS is quicker to perform
  • MIGS has a faster recovery period (of 4 to 6 weeks)
  • MIGS has less risk of complications

Research : Dr Brian Ang has published scientific papers on trabeculectomy, glaucoma tube shunt surgery, and MIGS.

Glaucoma surgery costs

How much does glaucoma surgery cost?

The cost of glaucoma surgery depends on your health fund. There will be an out-of-pocket fee for the initial consultation, as well as for any other tests that may be required during the consultation (such as a visual field test and OCT scan). 

Benefits of private glaucoma surgery

The main benefit of doing your glaucoma surgery privately is that you know who will be performing your surgery and managing your postoperative visits. Vice versa, the glaucoma specialist knows you and your individual case. 

With public hospitals, surgery is free but you cannot choose your surgeon or the doctors you see during your follow-up visits. Furthermore, not all public hospitals offer glaucoma surgery and those that do often have a long waiting list.

Private glaucoma surgery can usually be scheduled within 3 to 4 weeks, or even on the same day, if urgent.

What patients appreciate about Dr Brian Ang

Patients like the fact that my explanations are clear, concise, and easy to understand. I make sure that I provide enough relevant information so that patients can make the best informed decisions based on their own circumstances. What I will not do is to pressure patients into making decisions that they are not comfortable with. Instead I will respect and support your decisions as we work together to achieve the best clinical outcomes for your eyes.

Multilingual consultations

I am multilingual and fluent in English, conversational Mandarin, Cantonese and Bahasa Malaysia.

Consulting and operating at multiple locations in Melbourne

I work as an associate consultant for these private practices in and around Melbourne.

I operate at multiple locations in and around Melbourne.

  • Royal Victorian Eye & Ear Hospital, East Melbourne
  • St Vincent’s Hospital, Fitzroy
  • Sunshine Private Day Surgery, St Albans
  • Epworth Hospital, Geelong
  • Footscray Day Surgery

To make an appointment, please contact Dr Brian Ang here.

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