Ease the Pressure of Glaucoma

Combo stent-cataract procedure brings clear vision without glasses, eyedrops.

Bill Farrell sitting in front of his lrge fish tank,

Bill’s peripheral vision is “100 percent better than it was before” surgery

Bill Farrell is a natural manager. He was still a youngster when he first displayed management skills.

“As a kid, I worked as an assistant manager for Bradlees Department Store in Boston,” details Bill, 76. “I moved around to different areas until they decided to close Bradlees, then I moved to New York.”

In New York, Bill worked in management positions for several retail operations, including Kmart.

“I was an assistant store manager for Kmart,” Bill recounts. “I oversaw the general operations and helped the manager run the day-to-day activities of the retail store. I managed the Kmart during the day and worked in the hotel business part time at night.”

That evening job signaled a shift in Bill’s career focus from retail management to hotel management. He eventually relocated to Florida, where he managed three hotels: two independent brands and one national chain. Bill ultimately retired as a general manager for Best Western Hotels & Resorts in Miami.

“At Best Western, I was in charge of the entire hotel,” Bill relates. “My duties included controlling the budget, hiring and dismissing employees and making sure housekeeping was up to par. I retired about five years ago.”

Bill spent part of his career managing a hotel in Hollywood. While there, he was diagnosed with glaucoma, a serious disease associated with high pressure in the eyes, or high intraocular pressure (IOP). Consistently high IOP can damage the optic nerve and lead to vision loss.

“For years, I saw an eye doctor in Hollywood for my glaucoma,” Bill details. “I was having problems with my peripheral vision and was using several different eyedrops.”

Over time, Bill also developed cataracts in both eyes. Cataracts involve the clouding of the natural lens.

“The cataracts caused blurry vision, and my eyes were very sensitive to light, so I always wore heavily tinted glasses,” Bill describes. “I’m nearsighted and have worn prescription glasses to correct it since I was in my 30s.”

Bill also had trouble reading small print and suffered with eye strain and headaches due to the cataracts and glaucoma. When he moved to Tampa following his retirement, a friend introduced him to Brandon Eye Associates, where he met George Fisher, MD, a board-certified, comprehensive ophthalmologist specializing in cataract surgery.

“Mr. Farrell first came to our practice on February 2, 2018, for management of glaucoma,” Dr. Fisher reports. “He was initially diagnosed in 2005 and had been seeing another physician for treatment for 13 years.

“At the time we first saw Mr. Farrell, he was using three glaucoma medications and was complaining about the expense of the drops. We made some adjustments to his medication regimen to assist with that situation and eliminated one of the medications. But as we continued to follow him, we realized that cataracts were causing blurry vision.”

Following a detailed discussion with Dr. Fisher, Bill agreed to surgery to remove his cataracts. At the same time, Dr. Fisher would perform a second procedure that might eliminate the need for one or both of Bill’s remaining glaucoma medications.

“I thought we could eliminate Mr. Farrell’s dependence on glasses for distance vision with the cataract surgery,” Dr. Fisher observes. “At the same time, we could address the high IOP causing his glaucoma with a minimally invasive glaucoma surgery, or MIGS.”

Textbook Surgeries

MIGS is an add-on procedure performed at the time of cataract surgery. Research shows that adding MIGS does not increase risk for complications compared to standard cataract surgery alone.

The MIGS procedure Dr. Fisher performed for Bill involved the implantation of the iStent inject®.

“The iStent inject is a tiny medical device, the smallest known to be implanted into the human body,” Dr. Fisher describes. “Unlike its predecessor, the iStent, which consisted of one stent, iStent inject utilizes two stents to create bypass pathways through the drainage system of the eye.”

The iStent inject is made of implant-grade titanium and is one-third the size of the first generation iStent, which was 1 mm in length and 0.3 mm in height. Each iStent inject contains a central inlet and multiple outlets designed to provide multidirectional flow through the canal that drains aqueous humor from the eye.

Aqueous humor is the clear fluid that flows in the front part of the eye to nourish the eye. Aqueous is constantly produced by the ciliary body, a structure that supports the lens. To maintain a proper amount of aqueous, excess fluid is drained through specialized tissue called the trabecular meshwork. Resistance to aqueous outflow through this drainage system causes fluid to build up and the IOP to increase, leading to glaucoma.

Dr. Fisher performed surgery on Bill’s left eye on June 20, 2019, followed by his right eye on July 18, 2019. According to Dr. Fisher, both procedures went smoothly and achieved the desired objectives.

“The outcome of the MIGS surgery depends on how the patient responds to the stent,” the ophthalmologist explains. “The majority of my patients who receive the iStent inject go down to one glaucoma drop or eliminate drops altogether.

“Mr. Farrell’s IOP is well-controlled with no eyedrops at all now, and he’s no longer dependent on glasses because he sees 20/20 without them. Mr. Farrell experienced a beautiful result from his surgeries. They were textbook surgeries.”

Excellent Vision Clarity

“I don’t have to use eyedrops for my glaucoma anymore,” Bill confirms. “I use drops for dryness once in a while, but that’s it. And the clarity of my vision now is great. I don’t have to wear prescription glasses, and I can read from quite a distance away.

“The only time I have to wear glasses now is when I’m reading a book or newspaper up close. I actually see a lot of the words without the reading glasses on, but that causes a little too much strain on my eyes.

“I don’t have to use eyedrops for my glaucoma anymore.” – Bill

Bill also noticed a tremendous difference in the clarity of his peripheral vision.

“It’s 100 percent better than it was before,” he reports. “I don’t get headaches anymore, and my eyes don’t get tired. I don’t experience any pain or pressure. Nothing.”

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. js
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    • Brandon Eye Associates, PA

      The doctors at Brandon Eye Associates use their hearts to help care for your eyes. In addition to being lauded, board-certified physicians at the height of their careers, your Brandon, Sun City Center and Plant City Ophthalmologists are car... Read More

    • George Fisher, MD

      George Fisher, MD, a comprehensive ophthalmologist specializing in cataract surgery, is board-certified by the American Board of Ophthalmology. He earned a dual degree in preprofessional studies and anthropology from University of Notre Dame in... Read More