Glaucoma Treatments

A Biodegradable Implant for Glaucoma

Featured Article Image | Durysta |

Novel Durysta improves compliance for treatment of glaucoma.

Sustained release technology solves an old treatment issue—patients who don’t take their medicine or don’t take it properly.

Durysta™ was approved by the FDA in March of this year to deliver medication to control open-angle glaucoma. It is the first implantable sustained-release delivery system for reducing intraocular pressure.

Biodegradable Implant for the Eye

Durysta is a tiny implant smaller than a grain of rice. It comes preloaded in its own injection delivery system. The implant is placed underneath the cornea, on the edge of the iris where it will deliver intraocular pressure reducing medication to the exact area it is needed. Once the medication is all dispensed the implant biodegrades. 

Implants are made biodegradable by using compounds present in nature to create polymers. These polymer plastics degrade, and the body naturally eliminates the wastes.  The system is very similar to Ozurdex, a sustained release platform used to treat complications of diabetic retinopathy and retinal vascular occlusions.

The implantation is not painful and can be done in a doctor’s office.

Implant Release Bimatoprost

The implant releases Bimatoprost, a drug that lowers intraocular pressure by increasing the outflow of aqueous humour. While the drug has been used as pressure-reducing eye drops since being approved by the FDA in 2001, the sustained release formulation is novel.

Advantages of Implanted Sustained-Release Medication 

Non-adherence to glaucoma treatment has been a problem for many years. Reports vary, and non-adherence has been reported to be from 30% to 80% of patients treated. Having an implant that delivers the medication will eliminate the issue of non-adherence in the patients receiving the implants.

How does Glaucoma Damage Eyesight?

A buildup of fluid (aqueous humor) causes eye pressure to increase. The increased eye pressure damages the optic nerve causing it to gradually deteriorate. 

The first symptoms of this optic nerve deterioration is a subtle loss of peripheral (side) vision.

Damage to the optic nerve is irreversible. The cable of nerve fibers that carry visual signals to the brain do not have the ability to regenerate or heal. That’s why it is important to begin treating glaucoma before any vision loss occurs.

How is Glaucoma Diagnosed?

The presence of glaucoma can be discovered during a routine eye exam. 

In the early stages, before it causes any vision loss, glaucoma has no symptoms. Having regular eye exams can detect glaucoma in the very early stages and treatment to lower eye pressure can be started.

Randall V. Wong, M.D.
Retina Specialist
Virginia and Washington D.C.


When You need a Glaucoma Specialist

When you need to see a glaucoma specialist | Randall Wong MDWhen do you need to see a glaucoma specialist?  Not everyone needs to see a glaucoma specialist, but when is the right time to be referred?

The World Health Organization designates each January as Glaucoma Awareness month.  As glaucoma is the second leading cause of blindness in the world, by raising awareness of the disease through education, perhaps blindness from glaucoma can be decreased or avoided altogether.

What is Glaucoma Specialist

A glaucoma specialist is an ophthalmologist who has complete specific specialty training in the medical and surgical treatment of glaucoma.  This specific training is called a fellowship and follows a residency in general ophthalmology, that is, additional training is sought after a doctor has completed necessary training to practice as a general ophthalmologist.

Glaucoma specialists may practice alongside other eye doctors in the same practice or establish their own ophthalmology practice.  Some glaucoma specialists limit the scope of their practice to “glaucoma only” while others may combine their practice with some elements of general ophthalmology such as cataract surgery.

Residency in ophthalmology follows a year long internship and lasts for 3-4 years.  Fellowship in glaucoma usually is 1-2 years more.

Who Treats Glaucoma

General ophthalmologists, most optometrists and glaucoma specialists all can diagnose and treat glaucoma.  The diagnosis and treatment of glaucoma is an important part of basic training for both ophthalmologists and optometrists.

Screening for glaucoma is part of every comprehensive eye exam and includes measurement of the eye pressure and examination of the optic nerve.  Glaucoma principally damages the optic nerve.  The optic nerve connects the eye (the retina) to the brain.  A damaged optic nerve leads to poor vision.

Most ophthalmologists and optometrists are equipped and skilled in making an initial assessment.  Many will institute treatment if needed.  Treatment almost always begins with medications aimed at reducing the eye pressure.

When to Consult a Glaucoma Specialist

The decision to refer a patient to a glaucoma specialist varies from region to region.  Referral usually depends upon the availability of specialists in the locale and the severity or complexity of the glaucoma.

Each doctor has his or her own preferences for referring to a glaucoma specialist.

Many practices, especially in larger cities, have a glaucoma specialist in the same practice.  In cases where a colleague is not “in house,” there is usually a glaucoma specialist nearby who has established his/her own practice.

A glaucoma specialist may use the same medications to treat glaucoma, but also has experience with both laser surgery and glaucoma surgical procedures to aid in the treatment of the blinding disease.


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“Other” Eye Conditions Glaucoma

Glaucoma Awareness Month

January is Glaucoma Awareness MonthThis month is Glaucoma Awareness Month as designated by the World Health Organization.  While glaucoma is the second leading cause of blindness in the world, vision loss can be prevented if diagnosed and treated during the early stages.  Only diabetes causes more blindness than glaucoma, yet both can be prevented.

In this article, I will address the following questions about glaucoma:

  1. What is Glaucoma?
  2. How to diagnose Glaucoma?
  3. Risks of developing Glaucoma
  4. Treatment of Glaucoma

What is Glaucoma?

Glaucoma is a disease of the optic nerve.  The optic nerve connects the eye, more specifically the retina, to the brain.  If this connection is not healthy, we do not see.

There are many types of glaucoma and all differ by the mechanism by which they cause damage to the optic nerve.  Most are associated with a higher than normal intraocular eye pressure.  The common denominator among most types of glaucoma is a high intraocular pressure.

Open-angle glaucoma is the most common form of the disease in North America.  Eye pressure is usually elevated and symptoms of vision loss are insidious.  Most patients with vision loss from glaucoma are unaware of the deficit until testing is performed.  Open-angle glaucoma causes very gradual vision loss and patients only become aware until the very late stages of the disease.  The hallmark of open-angle glaucoma is high eye pressure, characteristic appearance of the optic nerve and gradual loss of vision.

Angle-closure glaucoma can happen suddenly and cause profound pain, redness and tearing.  In this situation, the normal pathway for fluid to leave the eye becomes suddenly closed.  The internal pressure of the eye soars and the acute symptoms of pain, nausea and decreased vision ensue.  This type of glaucoma is most common in Asia.

Vision loss from open-angle and angle-closure can usually be prevented with proper and timely examination.

Trauma can also cause glaucoma.

Diagnosis of Glaucoma

Your eye doctor will take a thorough family and medical history.  The risk of developing glaucoma increases with age, ethnicity and family history.  Certain medications can exacerbate glaucoma.

A comprehensive eye examination includes dilation of the pupils.  Thorough examination of the structures of the eye can yield risk factors for certain types of glaucoma.  Dilation of your pupils will allow thorough examination of your optic nerve.  There is a characteristic appearance of optic nerves damaged by glaucoma.

Computerized examination of your optic nerve and the nerve fiber layer of the retina are the newest advances in glaucoma detection.  Visual field testing (assessing the health of your peripheral vision) remains a mainstay of glaucoma testing.

Glaucoma Risk Factors

There are a number of risk factors which increase your risk of developing glaucoma, including:

  • age >60
  • family history of glaucoma
  • ethnicity – patients of African, Hispanic or Asian backgrounds
  • long term steroid use
  • diabetes, hypertension, migraines
  • previous eye trauma

None of these risk factors guarantee you have glaucoma, but do increase the risk of developing glaucoma.

Treatment of Glaucoma

The mainstay of glaucoma is to reduce eye pressure.  Again, higher than normal eye pressure does not mean you have glaucoma, but eye pressure should be viewed as a big risk factor.

Therefore, treatments of glaucoma are aimed at reducing eye pressure with the use of eye drops, laser or ocular surgery (e.g. drainage tubes, filtering surgery or minimally invasive glaucoma surgery).

In most cases, medical therapy (non-surgical) is very successful in lowering IOP and reducing/slowing down vision loss.

What Can You Do?

In recognition of Glaucoma Awareness Month, talk to your friends and family about blindness from glaucoma.  Stress awareness, early diagnosis and intervention.  Remember, most loss of vision can be prevented with early detection and treatment.  No one is immune from glaucoma.

If you are concerned about your own chances of developing glaucoma, call your eye doctor and get an examination.  Remember, glaucoma causes painless loss of vision which may be prevented.


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January is Glaucoma Awareness Month

Glaucoma Awareness Month | Risk Factors of Glaucoma | Randall Wong, M.D.Happy New Year!  January is national Glaucoma Awareness Month.

Do you or a family member have glaucoma?

Glaucoma is a leading cause of blindness and affects over 3 million Americans and 60 million others globally.

There are many forms of glaucoma, but the most common type of glaucoma in the United States is called “open angle glaucoma.”

Risk Factors for Glaucoma

Everyone is at risk for developing glaucoma.  The disease becomes more prevalent (common) as we get older.  Family history is a huge risk factor, too.

Other risk factors for glaucoma;

  • Family History
  • Diabetes
  • African American patients have a higher chance > age 40
  • Everyone above the age of 60 – especially Latino/Hispanic patients
  • Farsighted/Asian patients

Symptoms of Glaucoma

In general, there are no immediate symptoms of glaucoma.  In other words, most patients with glaucoma do not even know they have the disease.  This is especially true of patients with open angle glaucoma.  They are completely unaware until they lose central vision.

Pain, redness, tearing and nausea/vomiting can be signs of “angle closure” glaucoma and result from sudden and large increases in the eye pressure (Intraocular Pressure – IOP).

This usually does not happen in open angle glaucoma.

How to Diagnose Glaucoma?

Talk to your family if you have glaucoma.  Early detection and treatment is vital to saving your vision.

Diagnosis of glaucoma can be made with a complete dilated eye exam.

One of the early findings of glaucoma is loss of peripheral or “side” vision.  This is true of every type of glaucoma.  Subtle loss of your visual field may be the only sign of the disease.

Here are some of the diagnostic tools your eye doctor may consider;

  • Visual field testing – looking for loss of peripheral vision
  • Optical coherence tomography (OCT) is useful for actually measuring destroyed optic nerve tissue
  • Eye pressure (Intraocular Pressure, IOP)
  • Dilated Eye Examination allows direct examination of your retina and optic nerve

If you have risk factors of glaucoma or if you are concerned, make a New Year’s resolution to get examined!  Early detection and treatment is the key to saving your sight.

All the best


Randall V. Wong, M.D. is a board certified ophthalmologist practicing in northern Virginia.  Though a retina specialist, this website contains information on various eye diseases.


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