The Glaucoma Research Foundation (GRF) Patient Summit highlights the latest in glaucoma treatment advances, giving patients practical information to help them live their best lives with the condition. In this fifth recording from the fourth annual GRF Patient Summit, glaucoma specialists Anjali Hawkins, M.D., Ph.D., Inder Paul Singh, M.D., and Mary Qiu, M.D. answer audience questions on a variety of disease topics.*

Are steroids a risk factor for glaucoma? (0:13)

Steroids, even those applied to the skin and not near the face, can raise eye pressure, says Hawkins. People with glaucoma, or are suspected of having glaucoma, are typically not prescribed steroids. Patients’ primary care physicians should be informed of eye conditions that are sensitive to steroidal medications. Hawkins also urges people taking steroids to get regular eye exams to monitor their eye pressure. 

Besides steroids, what are other potential causes of secondary glaucoma? (1:25)

Secondary glaucoma occurs when an underlying medical condition is raising internal eye pressure. Some possible culprits include:

• Diabetic retinopathy,
• Stroke in the eye,
• Trauma, and
• Inflammation.

Are there ways of monitoring eye pressure at home? (1:42)

There are several companies working on home-monitoring devices. For example, Qiu has one glaucoma patient who uses an iCare home device. It’s “actually been very useful” for observing real-time pressure fluctuations not seen during office visits, she says. The patient emails her the higher readings so adjustments can be made to medications. 

How does glaucoma with normal eye pressure happen? (3:16)

Normal tension glaucoma is when optic nerve damage and visual field loss occur despite eye pressure consistently staying within normal range, Hawkins says, but the treatment approach is the same. Risk factors can include:

• Migraine headaches
• Sleep apnea
• Rheumatic diseases

Low blood pressure and reduced blood flow to the optic nerve, especially at night, may also be a contributing factor. 

What is microinvasive glaucoma surgery and when is it done? (6:49)

Microinvasive glaucoma surgery (MIGS) is an umbrella term for minimally-invasive procedures that are generally performed during cataract surgery, and for patients with less severe glaucoma that can be controlled with medication. 

MIGS involves either an opening being made in the eye tissue, or the implantation of a stent, to improve the eye’s fluid drainage. MIGS, says Qiu, is typically quicker and involves fewer risks than either trabeculectomy or tube shunt surgery.

What is the Ahmed valve? (11:55)

The Ahmed® Glaucoma Valve is one of two types of shunt devices that improve drainage:

• Valved shunts have a plastic straw that’s inserted into the eye. Unlike non-valved shunts, the Ahmed has a valve at the end of the straw to moderate fluid outflow from the eye so internal pressure doesn’t drop too low. Scar tissue forms over time that may require pressure-lowering eye drops; if scarring clogs the shunt, corrective surgery or a second tube implant may be needed.

Pressure reduction may be greater over the long term in non-valved versus valved shunts, though non-valved devices can take longer to work. 

When should a person be concerned about a family history of glaucoma? (16:37)

According to Hawkins, people diagnosed with glaucoma at an older age should inform their children so they can pursue regular eye exams beginning at age 40 or 50. If, however, the parent’s glaucoma began at a younger age and the disease is severe, children may want to begin screening earlier.

How often can SLT surgery be repeated? (17:25)

Selective laser trabeculoplasty (SLT) can wear off after a year or so. Qiu says that she’ll perform it a second or third time, but usually not more than that. At that point, she says, cataract surgery may be needed, and a MIGS procedure can be done at the same time.

She also says research has shown SLT can be done first instead of eye drops. She offers it as a first-line treatment option for people with a new diagnosis of open-angle glaucoma. 

Why do you get dry eyes from glaucoma drops? (19:24)

Eye drop preservatives can irritate the eye surface, where glands make protective oils, says Singh. Even the drugs themselves can affect glands in the eyelids that make oils that protect against dry eye. Getting off eye drops through SLT, or using preservative-free drops, can be beneficial for patients with dry eyes.

What can be done for plateau iris? (19:51)

Plateau iris syndrome is a less common form of angle-closure glaucoma in which the structure that makes eye fluid is abnormally large or positioned farther forward, and pushes against the iris.

It’s “a tough condition,” says Hawkins, where higher pressure remains even after laser peripheral iridotomy. In those cases, cataract surgery may help, and traditional eye drops are needed.

*Glaucoma Research Foundation. (2022, August 16). Questions and Answers with Glaucoma Experts – session 1 [Video file]. Retrieved from https://www.youtube.com/watch?v=8gBlrZp0Hsg

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