Glaucoma can be separated into two broad categories, Open Angle and Angle Closure (narrow angle) Glaucoma. Open Angle Glaucoma, the more common condition, occurs when the glaucoma drain of the eye (trabecular meshwork) does not function properly and the fluid pressure builds up within the eye. Open Angle Glaucoma tends to develop slowly and may have no symptoms until some vision has been permanently lost.

In Angle Closure or Narrow Angle Glaucoma, the iris physically obstructs the drain of the eye. The glaucoma drainage inlet becomes so narrow due to the position of the iris that the trabecular meshwork is not visible upon examination. This type of glaucoma can develop suddenly with an abrupt closure of the drainage inlet. Emergency treatment may be required for this acute and often painful condition.

Open Angle Glaucoma is usually first treated with eye drops. If eye drops are insufficient to achieve satisfactory control, laser therapy (trabeculoplasty) may be added. For patients requiring additional intervention, glaucoma surgery may be performed.

Treatment of Angle Closure (narrow angle) Glaucoma
Course of Treatment: Laser Therapy � Medical Therapy � Surgical Therapy

Angle Closure (narrow angle glaucoma) therapy initially involves making a small opening (iridectomy) in the iris to relieve the blockage of fluid that causes angle closure. The procedure is performed painlessly with use of a laser on an outpatient basis. Depending on the extent of irreversible angle closure, medicines and surgery are sometimes added to treatment to satisfactorily control intraocular pressure.

For further details, see glaucoma laser surgery. Please click here to request additional information.

Pachymetry is a measurement of the thickness of the cornea. Thin corneas may predispose a patient to glaucoma, whereas thick corneas may occasionally be protective.

Gonioscopy allows Dr. Shingleton to directly visualize the glaucoma drainage inlet in the eye with the use of a special lens. It is quick, painless, and performed after the use of a topical anesthetic drop. The test helps differentiate between open angle and angle closure glaucoma.

Visual field tests assess your peripheral vision. Early damage from glaucoma can often be detected by this important test. Dr. Shingleton uses the latest computerized technology to assess peripheral vision. Both eyes are easily tested in 10 to 20 minutes and the visual field examination is repeated at varying intervals to monitor progression of glaucoma damage.

Optic nerve photography documents the configuration of the optic nerve. Changes that develop in the shape or pattern of the optic nerve help us to monitor glaucoma. Color photography of the optic nerve serves as a permanent record for future comparisons and evaluations.

Nerve fiber analysis is another computerized assessment of the optic nerve that measures the thickness of the nerve fiber layer, which is damaged from glaucoma.

Dr. Stephen Taylor, Dr. Teresa Stone, Dr. Claudine Kawabata, Dr. Anmarie Russo, Dr Bao-Kim Nguyen, Dr. Nancy Flatten, Dr. Sma-hee Desai and a team of certified ophthalmic technicians support Dr. Shingleton. Various members of this team help perform tests required to monitor your glaucoma. Every member of our team has extensive experience to assist you in the diagnosis, evaluation and treatment of your glaucoma. To learn more about Dr. Shingleton's glaucoma team, click here.

• Please complete and bring the patient registration and medical history forms that are mailed to you prior to your appointment.
• Bring your glasses, contacts, and all glaucoma medications used currently.
• Bring any old records of previous glaucoma care and names of any medications used in the past.
• Your eyes will be dilated during the examination; therefore, you should bring sunglasses or someone to drive you home after the examination.

• Vision test
• Slit lamp biomicroscopic examination
• Applanation tonometry
• Pachymetry
• Gonioscopy
• Optic nerve assessment—ophthalmoscopy, color photography, nerve fiber layer analysis
• Visual fields

• Continue your current glaucoma medication treatment program up until the time of your laser appointment
• Plan to spend 90 minutes at the Surgery and Laser Center
• Call Dr. Shingleton's Boston surgical coordinator at 617-314-2612 or 1-800-635-0489, extension 2612 if you have any questions
• or call Dr. Shingleton's Cape Cod surgical coordinator, at 508-534-6082

• Eye drops are administered prior to your laser treatment
• The laser treatment is performed by Dr. Shingleton in the laser room of the Surgery and Laser Center
• You will sit at the laser in a manner similar to the way you were examined in our office by Dr. Shingleton
• The laser procedure is painless and takes anywhere from 2 to 10 minutes
• Post-laser eye drops are given and pressure measurements recorded

• Eye drops are prescribed for several days
• There are no limitations on activity and you can be fully active
• Little or no discomfort can be expected
• A post-operative examination is scheduled one to four weeks after your laser treatment

• Eye drops are prescribed for use for three days prior to surgery
• Our staff will give you the approximate time of surgery about a week prior to your surgery
• Consent forms and medical evaluation forms must be completed prior to arrival at the surgery center
• To provide you with thorough preparation and care, please plan to spend approximately 4 hours at the surgery center

• Your eye is prepared for surgery by surgical nurses and board certified anesthesiologists
• In the operating room, you will rest on a comfortable, reclining stretcher bed
• After the eye is anesthetized, it is cleaned and prepared for surgery in a sterile manner
• Dr. Shingleton performs surgery utilizing a microscope. Your accompanying family and/or friends may watch the surgery live on a TV monitor in the waiting area
• After surgery, you will rest in the recovery area for approximately 30 minutes and be joined by your family members
• After surgery, a friend or relative must escort you to your home or hotel where you should relax quietly for the remainder of the day. Most patients feel well and may go out to dinner; however, please devote the entire day to the appropriate care of your eye

• Depending on your anesthesia, you will wear an eye patch for several hours or overnight
• If the patch is removed prior to bedtime, a metal shield will be placed over the eye to wear while sleeping
• A list of postoperative instructions will be given to you and reviewed with you prior to departure from the surgery center
• Most patients experience little or no pain after the procedure, although some experience low to moderate discomfort
• You will be seen for a postoperative checkup the day after surgery. Expect your vision to be blurry because the shape of the eye is temporarily changed from the glaucoma operation. Best vision and intraocular pressure control take up to 2 months following surgery.
• A follow-up visit is scheduled and postoperative instructions reviewed. Eyedrops are typically used on a tapering schedule for 4 to 8 weeks postoperatively.
• Your post-operative activity level is determined by eye pressure and shape after surgery. Activity levels are reviewed with you at your first postoperative visit.

For most patients, Dr. Shingleton performs your initial consultation and glaucoma surgery, and, along with his team, provides post-operative care. For some patients, follow-up care is shared between Dr. Shingleton and your primary eye care doctor to maximize convenience for you . For some patients of doctors who work regularly with Dr. Shingleton, or who come from a long distance, all preoperative and postoperative care is provided by your local doctor and Dr. Shingleton performs your glaucoma surgery.

Laser Trabeculoplasty for Open Angle Glaucoma -
  Controls Pressure in approximately 75% of Patients