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Vision and Eye Health 2019

The microscopic implant for glaucoma

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Professor Philip Bloom

Consultant Ophthalmic Surgeon at the Western Eye Hospital and Hillingdon Hospital, and Chairman of the International Glaucoma Association

Once, treatment options for glaucoma patients were limited. Now, however, a range of treatments are available, including stents which are implanted into the eye to act as drainage devices.

There’s a good reason why glaucoma — a serious and progressive eye disease which causes permanent damage to the optic nerve — is known as ‘the silent thief of sight’. It doesn’t usually affect a person’s central vision until its advanced stages, so can remain unnoticed and undiagnosed for years. By then, however, any damage may be irreversible. It can even lead to blindness.

Professor Philip Bloom is Consultant Ophthalmic Surgeon at the Western Eye Hospital, London and Hillingdon Hospital, and Chairman of the International Glaucoma Association, a charity which supports patients with the condition. His message is: make sure you visit your optometrist for regular eye checks. “Generally, sight lost to glaucoma can’t be regained,” he says. “So prompt treatment is important, because there’s no doubt that it can delay or prevent loss of vision.”

The risk of glaucoma increases with age and ethnicity (people of Afro-Caribbean origin are at increased risk of certain forms of the disease); but, as a rule, the over 60s should have regular eye tests, as should anyone over 40 who has a close relative with the condition. What optometrists will be looking for is damage to the optic nerve, which is most commonly caused by raised pressure of fluid in the eye that hasn’t been able to drain away properly. If they have any concern, patients will be referred to the eye department of their local hospital for further tests.

A simpler way of treating glaucoma

If you’re diagnosed with glaucoma, several treatment options are available to reduce intraocular pressure from the build-up of fluid: eye drops, laser treatment, surgery or implants.

Some people tolerate drops well, while others can be non-compliant to their prescription, and these drops can cause ocular surface disease in some cases. Laser treatments reduce pressure by opening drainage tubes in the eye or decreasing the amount of fluid that forms there.

Normally, the most effective form of treatment for advanced glaucoma is an invasive surgical operation called a trabeculectomy, where a drainage hole is made into the eye wall which is then covered up by a flap of tissue.

Like all operations, however, it carries a risk of complications and often requires multiple follow up appointments with an ophthalmologist. “In some cases, it can lead to infection, and it also produces a little blister of fluid under the eyelid which may feel uncomfortable,” says Professor Bloom.

So, in the last five to ten years, there has been a drive to discover an easier way of treating glaucoma, resulting in a plethora of new implant devices designed to treat early glaucoma through to glaucoma in the advanced stages.

The benefits of stent implants

One such device is a stent, which is put into the eye to act as a drainage device. “The newer stents are effective in early-to-moderate glaucoma because they are tiny, work long-term and have a safety profile similar to cataract surgery alone,” says Professor Bloom. “We usually implant more than one stent at a time because it enhances the result for the patient.”

Up to one in five cataract patients may also have early-moderate glaucoma. For some forms of glaucoma, cataract surgery — or lens replacement surgery — is an effective way of helping reduce intra-ocular pressure and can be carried out at the same time as a stent implant procedure. The procedure is painless and, afterwards, the patient won’t know the stents are in place. 

The future of glaucoma treatment

“Because these implants have an excellent safety profile, there is reduced need for follow-up appointments, which is not only beneficial for the patient, but also the NHS. I think in future we’ll be relying less on eye drops and more on laser surgery and trabecular micro-bypass devices, such as the stent, especially if their implantation is combined with cataract surgery.”


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