3101 W. 57th St., Sioux Falls, SD 57108
(605) 361-EYES (3937) or (877) 522-EYES (3937)

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1925 N 22nd Ave, Suite 201, Bozeman, MT 59718
(406) 219-0700 or (866) 620-EYES (3937)

3101 W. 57th St., Sioux Falls, SD 57108

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GlaucomaLed by Dr. John Berdahl, the experts at Vance Thompson Vision provide specialized glaucoma care, working to halt the progression of glaucoma through cutting edge research, treatment and surgical options. Because everyone deserves to live a life full of sight at every age.

Glaucoma is the second leading cause of blindness in the United States, and it's usually preventable

At Vance Thompson Vision, glaucoma treatment, surgery and research represent one pillar of our specialized care. By reviewing this literature with a family member or loved one, you are taking the first steps toward understanding glaucoma.

What is Glaucoma?

Glaucoma is known as the “silent-thief” of sight because it steals your vision often without warning signs or symptoms. In fact, nearly two and a half million people have glaucoma, and more than half don’t even realize it.

Glaucoma is a disease that damages the optic nerve. Like a cable wire, the optic nerve is responsible for carrying the images from our eyes to our brain. Damage to the optic nerve can occur when the pressure within the eye increases, usually due to a build-up of aqueous fluid inside the eye.

This leads to the development of blind spots in our field of vision. Without routine eye exams to check the health of your eyes, these blind spots can go undetected until the optic nerve is significantly damaged and a great loss of peripheral or central vision has already occurred.

Damage to the optic nerve may also occur without elevation of intraocular pressure. This is known as normal tension glaucoma. Conversely, the pressure may be elevated at times without damaging the optic nerve. This is a condition known as Ocular Hypertension.

Who is at Risk for Glaucoma?

Since glaucoma can affect anyone, it’s important to receive regular, comprehensive eye examinations. Although everyone may be at risk for glaucoma, there are certain factors that can increase your risk:

  • 45 years or older
  • Increased eye pressure
  • Family history of glaucoma
  • Severe nearsightedness
  • African-American, Hispanic or Asian descent
  • History of eye injury causing bleeding in the eye

Regular exams by your eye doctor are the only way to detect glaucoma. Depending on your age the frequency of routine exams that can detect glaucoma should be at least:

  • 40 and under: once every three years
  • 40-65: once every two years
  • 65 and older: every year

Types of Glaucoma

Not every type of glaucoma is the same or will have the same impact on your life. If you have been diagnosed with glaucoma, please familiarize yourself with the different types of glaucoma below. The specialists at Vance Thompson Vision are happy to provide additional information regarding your specific type of glaucoma and what it will mean to your life.

Open-angle glaucoma

This is the most common type of glaucoma. The drainage angle (where the fluids in the eye drain) is open but working less efficiently. This inability to drain causes pressure within the eye to rise, which results in a gradual loss of side-vision. This can be likened to an air filter, which gathers dust over time and eventually becomes too laden with dust to work properly.

Angle-closure glaucoma

Angle-closure glaucoma occurs when the drainage angle is completely blocked, often by the iris. This prevents any fluid to drain from the eye, causing pressure within the eye to suddenly rise. This extreme rise in pressure results in blurred vision, headaches, severe eye pain and the appearance of halos around lights.

Chronic angle-closure glaucoma

With this type of glaucoma, the condition is painless and involves a more gradual closing of the drainage angle. Chronic angle-closure glaucoma occurs most frequently in people of Asian descent.

Secondary glaucoma

Secondary glaucoma progresses very much like chronic open-angle glaucoma, occurring when scar tissue or pigment blocks the drainage angle. The first symptom is a loss of side-vision. Pseudoexfoliation glaucoma and pigment dispersion glaucoma are examples of secondary glaucoma.

Congenital glaucoma

Congenital glaucoma is a rare birth defect affecting the drainage angle. To prevent blindness, this condition must be treated shortly after birth. Symptoms include enlarged eyes, a cloudy cornea, light sensitivity and excessive tearing.

Glaucoma Treatment Options


Glaucoma can be treated with daily eye drops that decrease eye pressure either by slowing the amount of fluid produced within the eye or by improving the flow through the drainage angle. Glaucoma medications may have side effects, so be sure to talk to your doctor if you experience any unusual symptoms.

Selective Laser Trabeculoplasty (SLT)

SLT is a good in-office treatment option for glaucoma that is completely painless. By engaging in this laser technology, ophthalmologists can lower pressure and possibly help a patient avoid a more invasive surgery. The surgery may even reduce dependence on medications or drops.


In a standard operating room procedure, your doctor can also use fine, microsurgical instruments to create a new drainage channel for outflow of aqueous fluid. Though serious complications of modern glaucoma surgery are uncommon, they can occur. Surgery is recommended if your ophthalmologist feels that it is necessary to prevent further damage to the optic nerve. Before considering surgery, it is important you visit a qualified surgeon who can educate you about all of your surgical options. Vance Thompson Vision’s glaucoma surgeons, led by Dr. John Berdahl, specialize in glaucoma Treatment reduces the need for eye drops.surgery and glaucoma research. This ensures that you will know all of your options prior to surgery and will be a participant in deciding the best option for your vision and lifestyle.

Minimally Invasive Glaucoma Surgery (Glaukos)

Minimally Invasive Glaucoma Surgery (MIGS) is a tremendous recent advance in glaucoma care. Prior to MIGS, treatment options were limited to medications, laser, and major glaucoma surgeries. MIGS, using devices like the Glaukos iStent, provides a less invasive and very safe surgical approach to glaucoma surgery. MIGS is usually, but not always, performed at the same time as cataract surgery in patients with mild to moderate glaucoma. The iStent is the smallest medical device ever implanted into humans, and is used to decrease eye pressure by internally bypassing the high resistance portion of the eye’s drainage system. The iStent was approved by the FDA in the summer of 2012, and is the most thoroughly studied glaucoma device on the market today. Other MIGS include:

  • KDB: The Kahook Dual Blade (KDB) is an elegant, single use, ophthalmic blade designed to excise a clean strip of trabecular meshwork. It can be a stand-alone procedure or performed in combination with cataract surgery in patients with mild to moderate glaucoma.
  • ABiC: Ab Interno Canaloplasty (ABiC) is a procedure designed to improve the natural drainage in the eye. In the ABiC procedure, the surgeon inserts a microcatheter into the eye through a tiny incision and then rotates the tool to open up the entry point. The surgeon then inserts gel into the canal, which enlarges the drainage area. Through this surgery, the doctor increases and restores the eye’s natural outflow passage. By improving the drainage pathway, fluid can drain more normally, allowing eye pressure to lower.
  • ECP: Endoscopic cyclophotocoagulation (ECP) is a procedure used to treat glaucoma that applies laser energy to the ciliary body epithelium in an effort to lower eye pressure. ECP’s initial studies have shown it more promising than its predecessors. Its advantages consist of precise tissue treatment, short surgical times, rapid postoperative recovery, and reduced complications. 
  • CyPass: The CyPass Micro-Stent is a small device used to improve the natural fluid drainage of the eye and, in turn, lower eye pressure. It is designed to aid in the treatment of patients with open-angle glaucoma. Less invasive than traditional surgery for glaucoma, the device is intended to stabilize intraocular pressure (IOP), and it can be inserted during cataract surgery. The device may decrease a patient’s need for glaucoma medications
  • XEN Gel Stent: The XEN Gel Stent is a soft, gelatin device inserted into the eye to decrease the eye’s intraocular pressure (IOP). The stent is designed to treat glaucoma with a less invasive procedure with fewer complications than traditional glaucoma treatments. The stent is about as wide as a human hair, and it is 6mm long. The device is inserted through a small, corneal incision intended to seal itself.
  • iStent: The iStent Trabecular Micro-Bypass Stent is the smallest FDA approved implantable device, measuring only 1mm by .3mm. The iStent is a tiny device placed in the eye to improve fluid drainage. The iStent creates a pathway through the eye, which helps fluid drain naturally from the eye, in turn lowering intraocular pressure. The iStent is generally implanted during cataract surgery.

Trabeculectomy and Tube Shunts

Trabeculectomy and tube shunt procedures are performed by an ophthalmologist and can lower the pressure in your eye to help prevent further damage to the optic nerve. However, any damage that has already been done is irreversible.
During a trabeculectomy, or tube shunt, your surgeon creates a passageway that drains fluid from the inside of your eye to behind it. These surgeries are more commonly used after medications have not worked as planned, laser surgery has not been effective or other methods of treatment, such as the Glaukos iStent, are simply not stopping the increase in intraocular pressure.

Glaucoma needs to be taken seriously now more than ever. Although glaucoma is the second leading cause of blindness in the U.S. and can be extremely problematic to your vision, most people with glaucoma lead a normal life. If you have been diagnosed at an early point, you’ll need to make some simple changes in order to manage your disease. After diagnosis, your eye doctor will make a suggested treatment protocol based on taking medication, laser treatment or surgery. If medication is prescribed, developing a daily routine can ensure medication is taken properly. Patients often try to take medicine or drops when they wake up, go to sleep or during meals and snacks.

Although patients can be nervous about a new diagnosis of glaucoma, it is important to keep a positive attitude. Glaucoma does not have to limit your lifestyle, and for the most part, you should be able to continue with your regular habits and activities. Take comfort in knowing that many individuals, including our doctors, are stepping up to help glaucoma research initiatives. The eye care community, including the Glaucoma Research Foundation, surges forward in an effort to find better methods to treat glaucoma. Someday there may even be a cure for this disease.

Please feel free to consult with our staff or the surgeons at Vance Thompson Vision for your glaucoma treatment and care. Our team, led by Dr. John Berdahl, is nationally recognized for glaucoma research and surgery, authoring numerous book chapters and scientific articles in addition to lecturing nationally and internationally. We are committed to using the world’s most advanced technology and techniques to halt glaucoma progression so you can live a life full of sight.