Glaucoma Treatment Options
Your ophthalmologist will control and stabilize your glaucoma using one or more of the treatments below. Every case is different and depending on the severity of glaucoma your doctor will determine the best treatment for your specific needs.
Drug Therapy (Eye Drops)
Drug therapy is the most common form of glaucoma treatment; however, there are many side effects associated with long-term drug use, and medications aren’t effective for all patients – and you have to remember to take your medication every day. Common side effects include allergic reactions, iris discoloration, drowsiness and burning sensations.
Traditional drug therapy has been based on topical eye drops, including beta-blockers and carbonic anhydrase inhibitors (CAI), which decrease aqueous fluid production. Newer drugs increase aqueous fluid outflow.
SLT, Selective Laser Trabeculoplasty
Laser trabeculoplasty is a gentle and non-invasive treatment for glaucoma. This quick procedure is an effective option for most glaucoma patients but is especially suited to patients who cannot tolerate or are unable to self-administer important glaucoma medications.
Highly effective, laser trabeculoplasty is used as primary treatment for early stages of open angle glaucoma and can be used in combination with drug therapy or as an alternative therapy when drugs fail. It is also a flexible treatment option because it can be repeated, if necessary, depending on the individual patient’s response.
Laser trabeculoplasty is an office procedure lasting 10 to 20 minutes and patients can usually resume normal activities without discomfort within a day.
The doctor will need to check eye pressure in the following weeks. It may take a few weeks before the full effect of the surgery becomes apparent. It is important to realize that the laser treatment is not a cure for glaucoma. In most cases, laser surgery for glaucoma initially lowers intraocular pressure. After time, however, intraocular pressure may begin to increase in some patients.
If non-surgical methods fail to lower intraocular pressure to a safe level, your ophthalmologist may decide to perform surgery. The three major types of glaucoma surgery are:
Trabeculectomy is the most common surgical method used to reduce the pressure associated with glaucoma. During the procedure, the surgeon removes a tiny section of the wall of the eye, creating a drain which allows for the outflow of aqueous fluid. This procedure is done in a hospital or an outpatient surgery center. You’ll receive eyedrops, a medication to help you relax and usually an injection of anesthetic to numb your eye. Using delicate instruments under an operating microscope, your surgeon creates an opening in the sclera — the white of your eye — and removes a small piece of the trabecular meshwork. The aqueous humor can now freely leave the eye through this hole. As a result, your eye pressure will be lowered. The hole is covered by the conjunctiva, so trabeculectomy leaves no open hole in your eye. This procedure works best if you haven’t had any previous eye surgery. Your doctor will check your eye during several follow-up visits and you’ll need to use antibiotic and anti-inflammatory eyedrops to fight infection and scarring of the newly created drainage opening.
Another type of operation, called drainage implant surgery, may be an option for people with secondary glaucoma or for children with glaucoma. Like the trabeculectomy, drainage implant surgery is performed at a hospital or an outpatient clinic. The patient will be given medication to help the patient relax and eyedrops and an anesthetic to numb the eye. Then the doctor inserts a small silicone tube in the eye to help drain aqueous humor. After the surgery the patient will wear an eye patch for 24 hours and use eyedrops for several weeks to fight infection and scarring. The doctor will check the eyes several times in the weeks that follow.
Canaloplasty: A New Alternative Non-Penetrating Filtration Surgery
There is new hope in the fight against glaucoma. Canaloplasty is a breakthrough procedure available to help patients who may be frustrated with their medications and aren’t ready for traditional surgery. Canaloplasty is proven to safely lower intraocular pressure (IOP) and dependence on medications. And unlike traditional procedures, Canaloplasty uses a less invasive, non-penetrating approach and has fewer complications and less follow-up.
Canaloplasty is a newer surgical method, similar to a trabeculectomy, except for the important distinction that the final thin layer of the wall of the eye is left intact. A microcatheter is used to dilate Schlem’s Canal and a small suture is used to stent the canal open to allow the natural filtration channels in the eye to re-open. Some have come to refer to this procedure as “angioplasty for the eye”. This procedure lowers the chances for infection, and is ideal for patients not wanting to under go traditional filtering surgery or can no longer tolerate eye drops.