Glaucoma Treatments

All modern methods for treating glaucoma are designed to lower the eye pressure. This can be accomplished with medications, lasers, and surgery. To treat glaucoma and lower the pressure in the eye, you can either decrease the amount of fluid going into the eye or open the drain to help fluid leave the eye more easily.

Medications

Glaucoma medications are medicated eye drops or gels that are dropped onto the surface of the eye one or more times each day. We share some tips, side effects, and advice for anyone with financial concerns on our Glaucoma Medication article.

Target Pressure

At one of your initial visits after glaucoma treatments have been initiated your doctor will choose a target pressure as a goal pressure for your eyes. This target eye pressure is your doctor’s best guess as to a “safe” pressure so no further glaucoma nerve damage develops. The number will depend on how high the eye pressure was before treatment, how much damage has developed, and your age and medical conditions. It is beneficial for you to understand the concept of a target pressure and know the target pressure your doctor has chosen for your eyes. If you don’t know your target pressure, ask your doctor at your next visit.

Laser

Laser treatments in glaucoma are high technology treatments that are safe and effective at lowering the eye pressure. The most common laser treatment for pressure lowering is the SLT (Selective Laser Trabeculoplasty). During this 5 minute treatment, an intense green light is directed at the eye drain (trabecular meshwork). This bright light causes microscopic damage to the drain. The eye then heals the small damage, during which time the drain gets cleaner and starts to work better, which lowers the eye pressure. The laser is effective in most cases (85% or so) and is generally safe. Some patients have minor light sensitivity and pain for a few days after. Some patients experience an increase in eye pressure. In many cases, eye drops can be avoided or discontinued if the laser is successful.

There are a few other laser procedures done in the treatment of various types of glaucoma. A laser peripheral iridotomy (LPI) makes a small hole in the iris. This laser is done to treat a condition known as a narrow-angle which is a risk factor for developing a type of glaucoma known as angle closure. Cyclophotocoagulation (CPC or ECP) is a laser treatment to the ciliary body, the area of the eye that makes the aqueous fluid. If the pressure is high, the CPC laser damages the fluid-producing cells and decreases the amount of fluid entering the eye.

Surgery

Glaucoma surgeries help create a new way for fluid to drain away from the eye. This helps to lower the eye pressure. Glaucoma surgeries are outpatient surgeries done in an ambulatory surgery center. This means you do not have to stay in a hospital after surgery. Glaucoma surgeries are generally safe, but rare severe side effects such as infection or bleeding can develop. Glaucoma surgeries are usually done when medications or lasers are not effective or not tolerated because of side effects. There are two main types of surgery, a trabeculectomy, and a glaucoma tube implant.

Trabeculectomy

Trabeculectomy makes a small trap door in the wall of the eye that acts like a pressure release valve to help fluid leave the eye. As fluid leaves the eye, the eye pressure decreases. The final eye pressure depends on how much scar tissue develops after the surgery. If a lot of scar tissue develops the eye pressure can increase and the surgery can fail.

Glaucoma tube implant

With this surgery, a small soft silicone tube is implanted in the eye as a new drain to help lower the eye pressure. It is also a relatively safe procedure. The fluid passes out of the eye through the new drainage tube. There are a few different versions of this surgery; the main tubes are either a Baerveldt or an Ahmed.

Other surgical procedures

There are numerous other surgeries in development or in use to treat glaucoma. They are generally designed to help fluid leave the eye and are related to the surgeries mentioned above. Other surgeries include canaloplasty, deep sclerectomy, express implant, and the trabectome. Unfortunately, no surgery stands out as the best option, and the eye pressure can remain high even after a glaucoma surgery.