Seeing Things Through

Medical advancements provide options for glaucoma patients.

Wafaiey Boutros had dealt with glaucoma for years when his eye disease progressed, despite therapies like eye drop medication. Called the silent thief of sight, because it typically has no signs or symptoms such as pain or a sudden loss of vision, glaucoma is the second leading cause of blindness.
Glaucoma comes in many forms. The most common type of the disease harms the optic nerve through increased pressure within the eye.
“My eyesight was deteriorating over the past year, according to my ophthalmologist,” Wafaiey confirms. “I had a really hard time driving, especially at night. It got to a point where I felt like I couldn’t drive safely. I struggled to see.
“I was also seeing black spots all the time,” he describes. “No matter what direction I was looking in, black spots were everywhere.”
At the recommendation of his ophthalmologist, the first step Wafaiey took to resolve the situation was to undergo laser surgery. Unfortunately, that procedure failed to stop the progression of the disease.
“I waited about four to five months after the laser surgery, and even at that point, my vision was not better,” he recalls. “I went back to my doctor, and they decided there was little more they could do at their level.”
That’s when Wafaiey was referred to Sandra Johnson, MD, a glaucoma specialist at The Eye Institute of West Florida.

Tried-and-True Solution

“Glaucoma really has no symptoms,” Dr. Johnson educates. “The main risk factor for glaucoma is definitely age, so the older a person gets, the greater the risk that person could get glaucoma. It’s the leading cause of blindness in African-Americans. They get it about a decade earlier than Caucasian- or European-Americans. More often than not, it is pretty far advanced before it’s discovered.”
Most people in the US have open-angle glaucoma, which is asymptomatic until it’s very far advanced. Sufferers lose their mid-peripheral vision but still see really well out to the side – far-peripheral vision. That’s the last thing they lose.
“Wafaiey has refractory glaucoma, which is glaucoma that hasn’t responded to previous treatments,” Dr. Johnson shares. “His was uncontrolled with his drops, and laser treatment did not work, so the disease was progressing. He was a surgical consult when he first came in. Initially, I performed extensive testing to see where the pressure was in his eyes.
“Once I determined that pressure was continuing to rise, I advised that an advanced surgery was his best option. I then discussed with him the procedures that would have the highest likelihood of being successful.”Dr. Johnson discusses and personalizes each procedure based on the individual patient’s lifestyle, age, medical history and stage of glaucoma.
“With Wafaiey’s first eye, I performed a conventional trabeculectomy, where we create a drainage system for the eye out of the patient’s own tissues.”
A trabeculectomy lowers the intraocular pressure inside the eye (IOP) in patients with glaucoma. This is achieved by making a small hole in the eye wall (sclera), covered by a thin trap door in the sclera to release excess fluid.
“It’s known as the tried-and-true standard of care for people who need a surgical glaucoma procedure. It worked like a charm.”

XEN® Technology

When it was time to perform surgery on Wafaiey’s other eye this year, Dr. Johnson utilized the newest FDA-approved technology available called the XEN Gel Stent.
“XEN is an established option for lowering high eye pressure in refractory glaucoma patients where medications and other options have failed,” Dr. Johnson explains. “The stent is about the size of an eyelash and is made of a flexible material. Its main function is to create a small channel in the eye to drain fluid and lower the pressure.
“It is placed just under the conjunctiva, which is the clear membrane that covers the white of the eye. It is permanently placed, and most patients no longer need to use the eye drops after the surgery.”
Dr. Johnson says the surgery was quick, painless and an overwhelming success.
“Wafaiey’s recovery was seamless, and best of all, he no longer has to use the glaucoma drops anymore. The pressure in both eyes has been stabilized, and his numbers have gone up. He’s doing great!”
Dr. Johnson confirms that while there really is no cure for glaucoma, the latest advances can slow its progression.
“We do our best to slow it down and stay ahead of it so that people don’t have such noticeable problems with their vision that they can’t function,” she explains.
Wafaiey says he had his second eye surgery done just prior to the time he was renewing his driver’s license.
“I was worried that I would not pass the test if I had waited to have the surgery done afterward,” he shares. “I passed the test, and my eyesight is wonderful! I am extremely thankful for Dr. Johnson’s knowledge and expertise. She is a great surgeon and a great glaucoma specialist.
“My vision is so much better and clearer than before!”

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    • The Eye Institute of West Florida

      The Eye Institute of West Florida was founded by Stephen Weinstock, MD, in 1974. For more than forty years, the practice has provided excellence in eye care in a warm, personal environment combined with a tradition of service and devotion to th... Read More

    • Stephen M. Weinstock, MD, FACS

      Stephen M. Weinstock, MD, FACS, is a cataract specialist. He founded The Eye Institute of West Florida in 1974, pioneering sub-specialty eye care in Pinellas County. Today, as President and Medical Director, Dr. Weinstock is recognized as a worl... Read More

    • Robert J. Weinstock, MD

      Robert J. Weinstock, MD, is a board-certified ophthalmologist and is fellowship trained in cataract and refractive surgery. Dr. Weinstock joined the practice in 2001 after completing his residency at the St. Louis University School of Me... Read More

    • Sandra Johnson, MD

      Sandra Johnson, MD, is a board-certified ophthalmologist specializing in glaucoma. Dr. Johnson earned her undergraduate degree from Dartmouth College in Hanover, NH. She earned her medical degree from Boston University. Dr. Johnson served her ... Read More