Less invasive glaucoma surgery allows faster return to normal activity

Surgeons at the Washington University Eye Center and Barnes-Jewish Hospital in St. Louis are among the first to use a new surgical device to treat glaucoma.

Surgery with the device, called a Trabectome, is an outpatient procedure that takes less time to perform and offers a shorter recovery than traditional glaucoma surgery.


The device reduces pressure in the eye without the need for the filtration or shunts used in traditional glaucoma surgery by allowing surgeons to remove tissue so fluid more easily drains out of the eye.

“Glaucoma surgery typically redirects fluid so that it no longer builds up inside the eye,” says Carla J. Siegfried, M.D., associate professor of ophthalmology and visual sciences. “The surgeon creates a new space where fluid can flow, and then it is slowly reabsorbed by the eye. Less fluid building up in the eye means lower pressure in the eye.”

But traditional glaucoma surgery has meant several weeks before a patient fully recovers. During this time, the patient can’t do any heavy lifting or bending, and there are long-term risks of infection. With the new procedure patients usually resume normal activity after about a week.


“The benefit of the new procedure is that we’re draining fluid from the eye in a more physiological way,” Siegfried explains. “Rather than creating a new drainage pathway, we’re utilizing what nature gave us, and in that way it has less risk, takes less time and offers quicker recovery.”

In glaucoma patients, the optic nerve is damaged — that’s the nerve that brings information from the eye to the brain. In most cases, pressure from fluid inside the eye is the main culprit in that damage. Lowering eye pressure is the focus of treatment.

That can be done in a number of ways: topical medications such as eye drops, laser treatment or surgery. Candidates for surgery are those patients who either don’t respond to other therapies or can’t tolerate them.

“Anyone who does not reach treatment targets with medications or laser therapy can be a candidate for surgery,” says Edward M. Barnett, M.D., Ph.D., also an associate professor of ophthalmology and visual sciences. “A patient doesn’t need to have severe damage before traditional glaucoma surgery is considered, but often, those who undergo surgery have more advanced damage.”

Glaucoma affects more than 4 million Americans, but according to the Glaucoma Research Foundation, only half are aware of it. It typically has no symptoms, and left undiagnosed can lead to severe vision loss and blindness. A comprehensive eye exam is the best way to screen for glaucoma.

Siegfried and Barnett began using the Trabectome in 2007. Now they train other glaucoma specialists how to use the device, which is manufactured by NeoMedix.

Not all glaucoma patients are good candidates for the device. Those with more advanced disease and patients with certain sub-types of glaucoma will benefit from more traditional types of surgery, according to Siegfried. She says patients in the early to moderate stages of the disease are the best candidates. The new procedure also is an option for glaucoma patients having cataract surgery who want to reduce the number of glaucoma medications they use.

“It’s the level of the disease that allows us to use this procedure in certain patients,” Siegfried says. “Those who get this procedure are often very happy because the recovery is so rapid, but it’s not for everyone, and it doesn’t cure glaucoma. At this time, there is no cure. Our goal is to control it, to preserve vision and to prevent further damage.”

For more information about the procedure, please contact Siegfried or Barnett at the Washington University Eye Center at 314-362-3937.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s Hospitals. The School of Medicine is one of the leading medical research, teaching, and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s Hospitals, the School of Medicine is linked to BJC HealthCare.