The Silent Thief of Sight – What is glaucoma?
Early Prevention and Surgical Advances in Glaucoma: A Conversation with Dr. Yip
This week, we sit down with Dr. Yip, an experienced surgeon and ophthalmologist, to discuss the importance of early glaucoma prevention, recognising warning signs, and the latest surgical approaches to managing this silent yet serious eye condition.
WOI: Glaucoma is often called the ‘silent thief of sight.’ Can you explain why that is?
Dr. Yip: Glaucoma is one of the leading causes of irreversible blindness worldwide. What makes it particularly dangerous is that it progresses without noticeable symptoms in its early stages. People can lose a significant portion of their vision before they realise something is wrong. By the time peripheral vision is affected, the damage to the optic nerve is often advanced and cannot be reversed. This is why early detection and prevention are so critical.
WOI: Who is most at risk for developing glaucoma?
Dr. Yip: There are several key risk factors. Age is a major one—glaucoma becomes more common after the age of 40. Family history is another strong indicator; if a close relative has glaucoma, your risk increases significantly. Other risk factors include high eye pressure (intraocular pressure or IOP), thin corneas, diabetes, and extreme short- or long-sightedness. People of African, Asian, or Hispanic descent also tend to have a higher risk of certain types of glaucoma.
WOI: What steps can people take to prevent glaucoma or catch it early?
Dr. Yip: The most effective prevention strategy is regular eye exams. Comprehensive eye checks can detect early signs of glaucoma before symptoms appear. I recommend that individuals over 40 have an eye exam every two years, or annually if they have risk factors.
In addition to eye exams, maintaining a healthy lifestyle can play a role in overall eye health. Controlling blood pressure, avoiding smoking, staying physically active, and protecting the eyes from injury are all good preventive measures. Some studies suggest that regular exercise may help reduce intraocular pressure, which is a key factor in glaucoma progression.
WOI: When should someone consider surgery for glaucoma?
Dr. Yip: Surgery is typically considered when other treatment methods, such as eye drops or laser therapy, fail to adequately control intraocular pressure. The goal of glaucoma surgery is not to restore lost vision but to slow or stop further damage by reducing eye pressure.
There are several surgical options, depending on the type and severity of glaucoma. Some people benefit from minimally invasive procedures, while others require more advanced surgical interventions.
WOI: Can you tell us more about the different types of glaucoma surgery?
Dr. Yip: Certainly. There are three main categories of surgical intervention for glaucoma:
- Minimally Invasive Glaucoma Surgery (MIGS): This is a relatively new category of procedures designed to lower intraocular pressure with minimal disruption to eye structures. MIGS procedures, such as the iStent or Hydrus Microstent, create tiny drainage pathways to help fluid exit the eye more efficiently. These surgeries are often performed in combination with cataract surgery and are best suited for patients with mild to moderate glaucoma.
- Trabeculectomy: This is a more traditional and widely performed procedure for moderate to advanced glaucoma. It involves creating a small drainage flap in the white of the eye (sclera) to allow excess fluid to drain, thereby lowering eye pressure. While effective, it requires careful post-operative care to prevent complications such as infection or excessive scarring.
- Glaucoma Drainage Implants: For patients with more severe or complex glaucoma, drainage implants such as the Ahmed or Baerveldt devices can be used. These tiny tubes help redirect fluid to an external reservoir, preventing pressure buildup. This approach is often used in cases where previous surgeries have failed.
WOI: What are the risks and recovery expectations for glaucoma surgery?
Dr. Yip: As with any surgical procedure, glaucoma surgery carries risks. These include infection, inflammation, bleeding, or a sudden drop in eye pressure. However, advances in surgical techniques and post-operative care have significantly improved safety and outcomes.
Recovery time varies depending on the procedure. MIGS generally has a quick recovery, with minimal downtime. Trabeculectomy and drainage implants require a longer healing period, often involving weeks of close monitoring and the use of anti-inflammatory medications. Patients may experience blurred vision initially, but this typically stabilises over time.
WOI: Are there any new developments in glaucoma treatment that people should be aware of?
Dr. Yip: Yes, the field of glaucoma treatment is evolving rapidly. One exciting area of research is sustained-release drug delivery systems, which may eventually replace the need for daily eye drops. These include tiny implants that slowly release medication over several months, improving adherence to treatment.
Another promising development is gene therapy. Scientists are exploring how genetic modifications might help regulate intraocular pressure and protect the optic nerve from damage. While still in the experimental stage, these approaches could revolutionise glaucoma management in the future.
WOI: For those already diagnosed with glaucoma, what’s the most important thing they can do to preserve their vision?
Dr. Yip: The most important thing is to follow their treatment plan consistently. Many people with glaucoma need to take medication for life to keep their eye pressure under control. Missing doses or stopping medication without consulting an ophthalmologist can lead to rapid vision loss.
Regular follow-up visits are also crucial. Glaucoma is a progressive disease, and treatment plans may need to be adjusted over time. If surgery becomes necessary, patients should approach it as a proactive step to prevent further deterioration.
Finally, maintaining a healthy lifestyle—good nutrition, exercise, and eye protection—can support overall eye health.
WOI: What’s your final message to people who may be worried about glaucoma?
Dr. Yip: Don’t wait for symptoms to appear. By the time you notice vision loss, it may be too late to reverse it. Regular eye exams are the best defence against glaucoma. With early detection, appropriate treatment, and in some cases surgery, we can significantly slow the progression of the disease and preserve vision for as long as possible.
For more insights from Dr. Yip and updates on ophthalmology advancements, stay informed through trusted medical sources and schedule regular eye health check-ups.
We hope you enjoyed this blog from WOI.
