Volusia practice gets a new optic neuropathy doc. Let’s learn about him, the ailment and treatments.
Joah F. Aliancy, MD
Joah F. Aliancy, MD, is a Floridian through and through. He grew up in South Florida before earning his bachelor’s degree in chemistry from the University of South Florida and his medical degree from Florida State University.
Dr. Aliancy fell in love with ophthalmology while at FSU. His excitement is evident as he shares how ophthalmology is a “hidden gem.”
“I was fortunate to have an amazing mentor during medical school that was an ophthalmologist. I had the opportunity to shadow him in clinic and in the operating room,” he remembers. “Observing how he interacted with his patients and walked them through the treatment process was central to my pursuit of a career in the field.”
Dr. Aliancy completed his ophthalmology residency training at Columbia University in New York City. While at Columbia, Dr. Aliancy cared for individuals with glaucoma from underserved areas of New York, particularly patients of Dominican and West African descent. The richness of culture and community pride were unfortunately matched by limited health care resources and utilization.
“We served patients from Harlem, and the disease severity within that population broke my heart,” he describes. “Many patients presented with very advanced glaucoma and needed surgery immediately. Seeing this need and the disparity in access for minorities propelled me to pursue additional training in glaucoma.”
As a result, Dr. Aliancy furthered his training by completing a glaucoma fellowship at the University of Michigan in Ann Arbor.
Recently, Premier Eye Clinic in Volusia County welcomed Dr. Aliancy and his expertise in glaucoma management as the newest member of its clinical team. Premier Eye Clinic was founded by Q. Jocelyn Ge, MD, PhD, a board-certified ophthalmologist and ophthalmic surgeon. Premier Eye Clinic has offices in Port Orange and Ormond Beach.
Glaucomatous Optic Neuropathy
“It is a common misconception that glaucoma is defined as high eye pressures,” Dr. Aliancy contends. “Whereas elevated eye pressure is a condition of glaucoma, it does not define the disease. Glaucoma is an optic neuropathy that is characterized by structural changes of the optic nerve with corresponding visual decline.”
Glaucoma is an umbrella term. There are multiple subtypes with different etiologies that may require different forms of treatment. There are subtypes of glaucoma that are associated with ocular inflammation, the doctor informs.
“Sometimes, an individual’s cataract can grow to the extent that it begins interfering with the eye’s natural drainage system,” he describes. “This compromises fluid drainage and subsequently increases intraocular pressure. Another subtype of glaucoma is normal tension glaucoma, where individuals experience worsening of their glaucomatous optic neuropathy despite having ocular pressures within what is deemed average for the general population. It is important to determine the subtype because knowing that helps shape treatment.”
“Glaucoma is an optic neuropathy that is characterized by structural changes of the optic nerve with corresponding visual decline.” – Dr. Aliancy
Unfortunately, glaucoma is the “silent thief of sight” because it often has no symptoms in its early stages. Typically, the first noticeable sign of glaucoma is peripheral vision loss. If undetected or poorly treated, the disease can progress and affect central vision.
“Treatment for glaucoma should be personalized and based on the patient’s disease severity,” Dr. Aliancy explains. “Patients with mild glaucoma may be treated with eyedrops that lower eye pressure. Another treatment is selective laser trabeculoplasty (SLT), which uses laser energy aimed at the eye’s drainage system to augment fluid outflow.
“Sometimes, eyedrops and SLT are not sufficient options to lower ocular pressure, especially in patients who have moderate to advanced disease. For these patients, I provide an array of surgical options that can be performed to lower eye pressures.”
Surgical Options
During his fellowship, Dr. Aliancy developed expertise in both minimally invasive glaucoma surgeries (MIGS) and incisional subconjunctival surgeries. MIGS procedures are typically performed in conjunction with cataract surgery, often involving state-of-the-art stents or microshunts to facilitate fluid drainage and pressure reduction.
These devices include the iStent®, Hydrus® microshunt and XEN® gel implant. Stents bypass the trabecular meshwork, a spongy tissue responsible for draining fluid from the eye.
“The XEN gel implant is a contemporary form of the traditional trabeculectomy during which the surgeon creates a new drainage pathway in the eye,” Dr. Aliancy discloses. “The OMNI is a MIGS that combines canaloplasty and goniotomy. Canaloplasty involves using a microcatheter or tube to enlarge the natural drainage canal in the eye. During goniotomy, the doctor creates an opening in the trabecular meshwork.”
Another option for patients with advanced disease is the placement of a glaucoma drainage tube, Dr. Aliancy notes.
“There are a variety of tubes on the market, both valve and non-valve types. Whereas most MIGS aim to augment the natural drainage system to facilitate improved outflow of fluid from the eye, surgeries such as trabeculectomy and tube placement create a whole new drainage system.”
At Premier Eye Clinic, Dr. Aliancy also evaluates and manages anterior segment disorders.
“The anterior segment is the front part of the eye,” he explains. “Common conditions affecting this area include cataracts and ocular inflammation.”
With compassionate service, Dr. Aliancy employs leading-edge techniques, such as minimally invasive glaucoma surgeries and cataract surgery with premium and astigmatism-correcting lenses, to best serve his patients.
