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Glaucoma Treatment

Glaucoma is an eye disease associated with elevated eye pressure. This pressure can damage the optic nerve which can ultimately lead to vision loss.

Once the nerve has been damaged, vision loss is permanent. Fortunately, Kremer Eye Center’s glaucoma specialists, Dr. Jesse RichmanDr. Anthony Zacchei and Dr. Aaron Cohn, are very capable of successfully treating glaucoma in most patients, especially when the condition is caught early.

Kremer Eye Center has many glaucoma treatments available, ranging from eye drops to innovative laser treatments. Our glaucoma specialists will recommend a treatment plan after performing a comprehensive eye examination. This treatment plan is often influenced by the type and the severity of the disease.

Glaucoma can generally be divided into two major categories based on the configuration of the drainage angle of the eye. The eye produces a fluid called aqueous humor, which is essential in maintaining the eye’s shape and normal function. Eye pressure can increase as a result of a blockage of the drainage angle (closed-angle glaucoma) or problems within the drainage system itself (open-angle glaucoma.)

Closed-Angle Glaucoma

With closed-angle glaucoma, the iris blocks the drainage area of the eye, causing the pressure within the eye to become quite elevated. This form of glaucoma has a rapid onset and can cause severe eye pain, headaches, blurred vision, halos around lights, and even nausea and vomiting. Certain patients with narrow anterior chamber angles may be predisposed to develop this type of glaucoma and may require laser treatment to prevent it.

Open-Angle Glaucoma

This is the most common type of glaucoma and accounts for about 70% of all glaucoma cases. In this disease, the drainage area in the eye is open but does not function properly. Pressure generally builds up and vision is lost slowly. Open-angle glaucoma has no early symptoms.

Since most cases of glaucoma are not accompanied by pain or any noticeable symptoms, we encourage routine evaluations for all individuals over the age of 40 and for those who have any of the risk factors below. Our glaucoma specialists, Dr. Jesse Richman, Dr. Anthony Zacchei and Dr. Aaron Cohn, are happy to evaluate you and treat you as necessary to manage the disease and maintain good vision. Schedule a consultation today with the experts at Kremer Eye Center.

The only way to catch glaucoma early enough is by scheduling an annual exam with your eye doctor. Check out this video of Dr. Jesse Richman discussing innovative glaucoma technology with CBS News, along with our patient Ronald, recipient of the iStent, who learned he had glaucoma at a recent eye doctor visit.

Glaucoma Facts

  • Three million Americans have glaucoma, but only half know they’re affected.
  • Most types of glaucoma are not curable, however, we are able to successfully manage the majority of cases and halt vision loss.
  • Glaucoma is a chronic disease that must be followed and monitored for life.
  • Everyone is at risk for glaucoma, though traditionally it is seen in older individuals.
  • Glaucoma is the second leading cause of blindness in the United States and the first leading cause of preventable blindness.
  • Glaucoma is 6 to 8 times more common in African Americans, and the leading cause of blindness among this group.
  • African Americans ages 45–65 are 14 to 17 times more likely to go blind from glaucoma than Caucasians with glaucoma in the same age group.
  • It is estimated that there are 65 million cases of glaucoma worldwide.

Risk Factors for Glaucoma

  • Increasing age
  • Race (African-American>Latin American>Caucasian)
  • Family history
  • Steroid treatment
  • History of eye injury
  • Thin corneas
  • Diabetes
  • Hypertension
  • High nearsightedness or farsightedness

Surgical Treatments

Depending on the type and severity of your glaucoma, surgical treatment may be the best option.

During your consultation, our glaucoma surgeon will provide a full evaluation and may recommend one of the following surgical treatments.

Selective Laser Trabeculoplasty (SLT)

SLT is used in patients with open-angle glaucoma. Using a laser, our glaucoma specialist creates small burns adjacent to the drainage angle to open the angle further and reduce eye pressure. This works in about 80% of patients, but may lose its effectiveness over time. Fortunately, SLT may be repeated if needed. The procedure takes about a minute and can be performed in any of our Pennsylvania and New Jersey offices.

Laser Peripheral Iridotomy (LPI)

A LPI is performed on patients who have narrow angles, closed-angle glaucoma, or pigmentary glaucoma. During this procedure, the surgeon makes a small hole in the iris (the colored part of the eye) to reestablish normal drainage angle configuration.

Endoscopic CycloPhotocoagulation (ECP)

In ECP, a camera is placed in the patient’s eye to identify the part of the eye that produces fluid (ciliary body). Our surgeon then uses a laser to shrink this tissue in order to reduce pressure. ECP is usually performed at the time of cataract surgery.


This procedure is performed on patients who have not seen results from eye drops and initial laser surgery. When performing a Trabeculectomy, Dr. Zacchei creates a new drain in the eye to reduce pressure.

Shunt Procedures

During a shunt procedure, such as a Baerveldt or Ahmed Implant, our surgeon places a small, plastic tube into the eye to relieve the pressure more permanently. This is an excellent option for neovascular glaucoma, uveitic glaucoma, or when other treatments have not been effective.

Minimally Invasive Glaucoma Surgery (MIGS)

These are newer surgical innovations designed to have a modest reduction in eye pressure with a good safety profile. The most commonly performed ones are iStent, goniotomy, Cypass, and the Xen Gel.