Glaucoma Treatment Options
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.
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.
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Glaucoma medications are medicated eye drops or gels that are dropped onto the surface of the eye one or more times each day. The medicine is then absorbed into the eye where it interacts with the structures inside the eye. Eye medications either decrease the production of eye fluid (aqueous) or help clean out the drainage system so it works better. Once started, medications are usually used for many years, and sometimes for the remainder of your life. To be effective, medications must be used every day. A common reason patients go blind from glaucoma is a failure to use the medications on a daily basis. Most glaucoma medications only work for 6-12 hours, so regular dosing is important for them to be effective. If doses are missed, the eye pressure will begin to increase within just a few hours. If you take medications, it is important that you pay attention to how much is in the bottle so that you can get refills at the pharmacy regularly. Try to get to the pharmacy BEFORE the medicine runs out so that you don’t miss any days of treatment. Never stop using a medication without first calling your doctor and discussing with them the problems you are having (side effects, cost, etc.).
To avoid confusion, it is very helpful if you know the exact names of your medications and take the bottles with you when you come in for an eye pressure check at the eye doctor’s office.
Tips on using glaucoma medications
Because some of these drops are expensive, it is good to not waste drops. Helpful ways to get your drops in easily include having a friend or family member put the drops in for you or lying down on the couch or sofa when putting in the drops. To help the medication absorb into the eye, close your eyes for a few minutes after putting the eye drop in. Some doctors recommend gently squeezing the small eyelid drains by the nose for a few minutes after putting the drops in the eye. This is probably no more helpful than closing your eyelids, so we don’t recommend this.
Although glaucoma medications are generally very safe and well-tolerated, there are some possible side effects. All topical eye drops can cause an allergic reaction with redness and itching or eye irritation with burning and a scratchy sensation. Timolol and other Beta-blockers can worsen breathing problems if you have asthma, bronchitis, or COPD. They can also lower the heart rate and cause other heart issues. If you experience any side effects with any medication, you should contact your eye doctor immediately.
Using Medications Correctly
If you have a headache or back pain, a dose of Tylenol usually takes the pain away and makes you feel better. It is easy to take medications that make you feel better. Did you know that patients with chronic medical conditions such as high blood pressure or high cholesterol miss doses or take their medication incorrectly up to 50% of the time? The reason that patients don’t do a good job at taking their medications correctly is that these medical conditions have no symptoms, and the medications give no immediate improvement in how the patient feels. Glaucoma is very similar – it has no symptoms and the eye drops don’t improve the vision or make the eye feel better. In fact, the drops sometimes cause a little eye redness and irritation. Medical studies show that many patients with glaucoma don’t use their eye drops, forgetting doses regularly and in some cases not using the drops at all! The only way you can beat glaucoma is by being a good patient and consistently using your drops correctly. If you miss a dose the eye pressure will increase and you have an increased risk of developing nerve damage. To try to improve your consistency with eye drop medication use, time the doses with some of your daily routine activities. For example, use a morning eye drop when you brush your teeth, or take an evening eye drop with dinner. Keep your eye drop bottle out on the counter in your bathroom, or kitchen where you can see it as a reminder to use it regularly. If you continue to have difficulty using the drops regularly, please be open and honest with your doctor so he can make other recommendations for your treatment. It is important for him to know if you are using the medications correctly.
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.
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 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.
Life can be challenging! People can lose their jobs, lose their insurance, run low on money and then have trouble buying expensive medications or paying for doctor visits. Dr. DeBry wants you to know that he will never let financial concerns interfere with his ability to care for your eyes. It would be a shame to suffer permanent vision loss or even blindness because of financial difficulties. Dr. DeBry can help arrange free care and free medications for patients who qualify for financial hardship. If you have financial difficulties which are interfering with your ability to take care of your glaucoma, please communicate this to Dr. DeBry or his staff. We will work to help overcome these issues and keep your eyes healthy and strong. Remember, glaucoma damage is permanent, so staying on top of your treatment even during difficult times is important.