MDNews - Greater Kansas

the sink analogy, the uveoscleral outflow is the equivalent of making a crack in the sink next to the drain and letting the fluid fall into the cupboards below. I n t h e p r o s t a g l a n d i n c a t e g o r y, Vy z u lta helps i ncrea se dra i na ge v ia the uveosclera l outf low, but because its formu lation includes nitric oxide, it additiona lly rela xes vascular smooth muscle to open up the meshwork. This dua l-action mechanism ma kes Vyzulta a go od i n it i a l g l auc om a t reat ment , Dr. Ca mpbell says. R hopressa fa lls in the rho-associated pr ot ei n k i n a s e i n h ibit or c a t e gor y. The rho k i na se en z y me is activated downstream from nitric oxide's cellular messa g ing. By in hibiting production of the rho kina se enz y me, R hopressa helps rela x the muscles in the mesh- w o r k t o a l l o w f o r m o r e d r a i n a g e . Dr. Ca mpbell prescribed the medica- tion for about 60 eyes by Ja n. 1, a nd it has reliably lowered pressure in those eyes, she says. One patient 's pressure reading went from 18 to 7, she says, saving the patient from surgery. Rhopressa is an effective adjuvant glaucoma therapy, Dr. Campbell says. Like any medication, the new eyedrops can have some side effects. Vyzulta's side effects can include eyelash growth, which is common with the prostaglandins, and a color change in the patient's iris. The latter has been a risk that some patients aren't willing to take, Dr. Campbell says. Rhopressa's side effects can include eye redness or conjuctival hemorrhage, which lessen over time. NEW SURGICAL OPTIONS For patients who need surgical interven- tion, the options for MIGS are growing. " The older surger ies t hat we ca l l traditional surgeries were invasive and involved making larger incisions that took months to heal," Dr. Campbell says. "With the minimally invasive surgeries, the incisions are extremely small and heal within a week." Because of advancing technologies, several MIGS procedures have become available in recent years. The two lat- est options, joining four other MIGS on Dr. Campbell's surgical list, are the Kahook Dual Blade and the OMNI. Both help salvage the drainage functions of the trabecular meshwork, unlike the other options that either decrease fluid production or provide alternate drain- age channels. The Kahook procedure removes a section of the meshwork tissue, so the fluids flow directly to the Schlemm's canal. The OMNI also removes part of the meshwork to allow direct drainage, but it also injects visco- elastic fluid farther downstream to clear out the pipes and improve eye pressure. For more information about glaucoma treatment options or to make a referral, con- tact Grene Vision Group, 316-684-5158 or visit grenevisiongroup.com . n 'Seeing Fine' FOR MORE THAN 20 years, Wichitan Joe Van Metre has dealt with high intraocular pressure (IOP) readings in his eyes. This past fall, he benefited from a new mini- mally invasive glaucoma surgery (MIGS) — performed by Anita Campbell, MD, of Grene Vision Group, in conjunction with cataract surgery — that helped decrease the pressure by 40 percent in his right eye. He also was able to reduce the medication he needs to keep his open angle glaucoma in check in that eye because of the Kahook Dual Blade surgery. A recently FDA-approved procedure, the Kahook helps increase outflow past the trabecular meshwork farther upstream. Normal eye pressure runs from 10 to 21. Chronically elevated IOP can cause damage and blindness. For a patient with glaucoma, a personalized eye pres- sure is chosen to protect each eye. Van Metre's pre-surgery right eye pressure was 30. He has glaucoma in both eyes and was using two prescription eyedrops in both eyes daily. Needing cataract surgery because of blurring vision in the right eye, Van Metre took Dr. Campbell's recommendation to undergo a simultaneous MIGS procedure. Before MIGS were introduced, traditional glaucoma surgery at the same time as cataract surgery would limit the vision for several weeks and take months to heal. "Within a week I was seeing fine," Van Metre says. "It was such an easy, low-stress experience." Being active in not only watching sports but also participating in activities with his children, Van Metre says saving his eyesight was important. "It's nice to be able to continue to see." For more than 20 years, Wichitan Joe Van Metre has dealt with high intraocular pressure (IOP) readings in his eyes. This past fall, he benefited from a new minimally invasive glaucoma surgery — performed by Anita Campbell, MD, of Grene Vision Group, in conjunction with cataract surgery — that helped decrease the pressure by 40 percent in his right eye. M D N E W S . C O M /// M D N E W S G R E AT E R K A N S A S ■ 2 019 1 5

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