EYE/VISION (GLAUCOMA

DRAINAGE DEVICES)
 Introduction

 GLAUCOMA refers to a multifactorial progressive optic disease that destroys

the optic nerve of the eyes leading to loss of vision or blindness.
 This disease is also associated with further changes in structural
characteristics of the eye such as thinning of the layer of retinal nerve as well
as the excavation of a diverse array of optic nerve heads.
 The most common causative risk factor of glaucoma is an elevated IOP.
 Glaucoma drainage shunts are the most preferred medical intervention for
glaucoma.
 Normal Physiology

 A normal eye continually generate fluid referred to as the aqueous humor.

 The fluid keeps the eye healthy and moist.
 It also helps in the maintenance of the eye shape.
 As the eye produces new fluid, it also drains the old one, hence maintaining a
state of balance between what is produce and what is drained.
 The balance between the two keeps the eyeball pressurized properly.
 Abnormal Physiology

 In the case of glaucoma, the eye generates the aqueous humor.

 The drainage angle either closes down or the eye’s trabecular meshwork
becomes clogged.
 The result is the failure of the eye to drain the aqueous humor fast enough to
counter the rate of production.
 The IOP (Pressure inside the eye) increases as a result.
 Too much pressure in the eyes lead to the destruction of the optical nerves
(Leeuwen & Bladh, 2016).
 Damaged nerves cause vision loss and blindness.
 Interventions

 There four main state of the art interventions that have been introduce for
the treatment of glaucoma include:
 Medical therapy
 Filtering surgeries
 Laser treatment
 Glaucoma Drainage Devices
 Interventions : Medical Therapy

 From a medical therapy point of view, glaucoma is normally controlled through the use of
medicated eye drop.
 These eyes dopes are used daily to help lower the eye pressure.
 The eye drops come in two major forms:
 Eye drops that decrease the quantity of aqueous fluid in the eyes
 Eyes that enhances the flow of fluid via the drainage angle
 They have side effects such as itching sensations, blurred vision, red eyes, eyelash growth,
and changes in heartbeat and energy level.
 FDA approved RHOPRESSA eye drops on the basis of three clinical trials.
 The benefits of the drug must far outweigh the associated side effects to gain FDA approval.
 The market size for ophthalmic drug in 2019 was at USD 31 billion and is expected to rise by
5 percent in 2027.
 Intervention: Laser treatment

 Laser treatment is also used as intervention for glaucoma.

 The treatment is done in outpatient surgery centers to drain excess aqueous from an eye.
 The surgery can be categorized into:
a. Iridotomy: This laser operation is for patient with angle-closure glaucoma. It entails the
creation of a small home in an iris to help with the flow of fluid.
b. Trabeculoplasty. This laser operation is for patient with open-angle glaucoma. It entails
the use of laser to make a drainage angle work efficiently to reduce eye pressure.
 Laser treatment can gain FDA approval after Glaucoma Laser Trial indicates that in people
who are newly diagnosed with ALT, OAG, it is as effective as medical intervention.
 The market for glaucoma surgery devices is expected to rise from $353 million in 2016 to
$ 2,143 million by 2023 (Ophthalmic drugs market size, global industry report, 2027," n.d.).
Intervention: Filtration surgery (Trabeculectomy)

 Filtering surgery is used when the laser therapy and medical treatment do not effectively stop the
progression of glaucoma (tefan et al., 2015).
 The procedure is founded on one of the two main ways of decreasing IOP
a. Reducing generation of aqueous humor (AH).
b. Enhancing drainage of AH
 In filtration surgery a portion of tissue in a drainage angle is normally removed, hence creating some
opening.
 Such an opening is covered partially with the flap of tissue extracted from sclera.
 The opening allows the fluid to come out, thereby bypassing the congested drainage conduit of a
trabecular meshwork.
 FDA approval for Filtering intervention must show that the benefit of the process and individual
drugs used in the process outweigh the side effects.
 The market for glaucoma surgery devices is expected to rise from $353 million in 2016 to $ 2,143
million by 2023(Glaucoma surgery devices market size and industry forecast to 2023," n.d.).
 Medical Device Products

 Glaucoma drainage devices treat glaucoma by creating alternative aqueous

conduits from the anterior chamber to either the supra-choroidal space or
sub-conjunctival.
 Valved drainage devices and non-valved are two of the commonly used
medical devices.
 Examples of non-valved drainage devices include Molteno, and Baerveldt.
 Examples of valved drainage devices include Krupin and Ahmed.
 Medical Device Products - Comparison
Valved-Glaucoma Drainage Devices Non-Valved glaucoma drainage devices
They depend on the resistance created by bleb or capsule Drains fluid only at a particular IOP
   

Preferred when there a higher chance of hypotony They are preferred patients do not require immediate IOP
complication or urgent need to bring the IOP under control. control.
   

Entails a simpler surgical technical with localization to only a Entails a complex surgery that extend to the adjacent rectus
single quadrant and does not involve the operation of the muscle.
neighboring rectus muscle.  
 

They offer higher predictability in IOP control during the They do not offer prompt and higher predictability because of
early postoperative periods due to their high flow-restricting their use when patients do not require immediate IOP control.
mechanisms.  
 

Require less postoperative care and follow up, hence suitable They are blocked with ligature suture and stent and hence
for poor compliance patients. require preoperative attention till a fibrous capsule forms.
   
 References

 Glaucoma surgery devices market size and industry forecast to 2023. (n.d.).
Allied Market Research.
https://www.alliedmarketresearch.com/glaucoma-surgery-device-market
 Leeuwen, A. M., & Bladh, M. L. (2016). Textbook of laboratory and diagnostic
testing: Practical application of nursing process at the bedside. F.A. Davis.
 Ophthalmic drugs market size, global industry report, 2027. (n.d.). Market
Research Reports & Consulting | Grand View Research, Inc.
https://www.grandviewresearch.com/industry-analysis/ophthalmic-therapeu
tics-drug-market
 Stefan, C., Batras, M., Iliescu Daniela, A., Timaru Cristina, M., De Simone, A.,
& Hosseini-Ramhormozi, J. (2015). CURRENT OPTIONS FOR SURGICAL
TREATMENT OF GLAUCOMA. Romanian journal of ophthalmology, 59(3), 194–
201.