Laser for Narrow Angle Glaucoma - Part 1 from The Eye Clinic of Florida

[theonlysuz]

How do I know if they are occludable? by finding out the degree of the angle now?

[AMahootchi]

A patient wouldn't be able to tell on their own. You could only tell by gonioscopy. That's what the ophthalmologist should be 1) skilled at performing, 2) skilled at determining your near future risk of acute closure and 3) should be communicating to you. Did they do gonioscopy?

[theonlysuz]

ok I looked up "occludable" and it says "An "occludable" angle was one in which the trabecular meshwork was seen in less than 90° of the angle circumference by gonioscopy." Why don't docs tell me these things when I am there.  Is it a secret? - wouldn't it be good to know that I have narrow angles so I know what to look for as I get older? (I am older now - 65) Pressure is good, under 20 (I asked) and I have no problem with peripheral vision. So I think I'm ok for now. Thanks again.

[AMahootchi]

You're welcome. You definitely need to know the signs and symptoms of acute angle closure so that you avoid delay in treatment and where to go for treatment if it happens after hours or on a weekend. If your angles are not occludable ( again, this is asymtomatic) you have less to worry about.

[theonlysuz]

thank you! I have learned a lot and seen a glaucoma doc since I wrote. Now I understand the difference between narrow angles in general and NAG which is an acute situation. I did not have other symptoms, my pressure is normal and distance vision is 20/20 in both eyes. I will have to do this laser but not immediately. Thanks again for taking the time to reply.

[AMahootchi]

Great. At this point the decision for you and your doctor is whether the narrow angles are likely occludable or not.

Being 20/20 or having normal pressure don't really figure into the decision making of whether to do a prophylactic PI to avoid acute angle closure and all the bad things that go along with it. If the angles are narrow but not occludable, then observation is the reasonable choice.

[theonlysuz]

I was just diagnosed 4/3/2010 after sudden blurring of vision while driving on the expressway. I am looking for info about what can go wrong. Do I need to find a special place to have it done or is this doc in VT who works in a eye laser surgery center ok? how can I find out? Is there a site that classifies ranges of success, excellence etc around the country? p.s. I have Ehlers Danlos. thank you for you video.

[AMahootchi]

I don't know of a place on line that would have outcome measures posted for this specific procedure for the various doctors in your locality. In the US, the complication rate is very very small. It's one of the first procedures taught in Ophthalmology Residency because it is so easy to perform and can really save someone's vision. It should be in the skill set of any ophthalmologist.

[AMahootchi]

There are two types of Laser ( Argon and Yag) that are commonly used to perform the procedure and some doctors have them in their office and some share one in a surgery center. It probably doesn't make a difference where it is done. I like the Yag better because the procedure is performed faster and the inflammation seems to be less afterwards.

[AMahootchi]

It is best to make the PI under the lid ( from the 10 to 2 o'clock) position so that the lid normally will cover the opening and stray light won't get into the eye. Steroid eye drops are usually used afterwards to control inflammation. Post op pressure spikes are not common but can occur--I would say less than 1% of the time. Acute worsening of a previously dry eye from the procedure so using artificial tears before and after can help avoid that problem

[AMahootchi]

You will have to read my comments in reverse order from your question for them to make sense--to many words to answer for this system to handle--

-again it is a less than 1% occurrence in most hands.

Good luck with your treatment.

Ahad Mahootchi, MD

[quallupiluit]

Great video, very well illustrated. Thanks!

[skylineanimation]

YEAH! ANIMATION!! XD

[sf2fs]

Are tonometry tests done when you go in for regular eye exams with an optometrist (in Canada)? Or, do you have to ask to have one done? And how long does it take for you to lose all of your vision after the onset of glaucoma?

[sabmu498]

i am a medical student, previously having difficulty conceptualizing glaucoma. this helped a lot, thank you.

[utsuginteen]

Nice explanation, but poor in presentation. tnx.