Treatment of Glaucoma
Glaucoma is treated in one 3 ways. The first method is to use eye drops that reduce the intraocular pressure. If eye drops are not working or if the patient is having unacceptable side effects from drops or has difficulty complying with daily use, then selective laser trabeculoplasty (SLT) may be recommended. For patients where drops and/or SLT have not reduced the IOP enough, other laser treatments like micro-pulse diode cyclophotocoagulation may be considered. In some cases, incisional surgery may be required to reduce the intraocular pressure.
These treatments (drops, laser, and surgery) do NOT repair the damage already caused by glaucoma. Glaucoma is not reversible. Once a ganglion cell has died, there is no bringing it back. The goal of treatment for glaucoma is to stop the disease and keep it from continuing to damage the retinal ganglion cells that make up the optic nerve.
Eye drops for glaucoma. These either reduce the formation of fluid in the front of the eye or increase its outflow. Side effects of glaucoma drops may include allergy, redness of the eyes, brief stinging, blurred vision, and irritated eyes. Some glaucoma drugs may have systemic side effects. Be sure to tell your doctor about any glaucoma medication you are currently taking or are allergic to.
Laser surgery for glaucoma. Laser surgery for glaucoma can increases the outflow of the fluid from the eye in open-angle glaucoma or eliminates fluid blockage in angle-closure glaucoma. Types of laser surgery for glaucoma include 1.) trabeculoplasty (SLT), in which a laser is used to create openings in the trabecular meshwork drainage area; 2.) iridotomy, in which a tiny hole is made in the iris, allowing the iris to move away from the drainage angle and allow for the fluid to flow more freely; and 3.) cyclophotocoagulation, in which a laser beam treats areas of the ciliary body, reducing its production of fluid.
Incisional Surgery for Glaucoma. In an operation called a trabeculectomy, a new channel is created to drain or filter the fluid, thereby reducing intraocular pressure that causes glaucoma. Sometimes this form of glaucoma surgery fails and must be repeated. For some patients, a glaucoma tube implant (Ahmed or Baerveldt Valve) is the best option. Potential complications of incisioinal surgery for glaucoma include pain, infection, bleeding, temporary or permanent loss of vision, failure, and need for further surgery.
Minimally-Invasive Glaucoma Surgery (MIGS). Finally, newer procedures like canaloplasty or the iStent are less invasive and carry less risk than traditional surgeries like trabeculectomy. In canaloplasty, Schlem’s canal is entered and dilated with a viscoelastic gel for 360 degrees (similar to a ballon angioplasty performed on the heart). The iStent is a tiny stenting device inserted through the trabecular meshwork into Sclemm’s canal. This bypasses areas of resistance to allow fluid to drain directly into Schlem’s canal. The risks of MIGS is similar to incisional glaucoma surgery, but to a lesser degree.