How do we treat glaucoma?

What is glaucoma?
Symptoms

Although there is no cure for glaucoma it can usually be controlled so that further loss of vision is prevented or at least slowed down. Treatment can save your remaining vision but does not improve eyesight.

At Eye Surgery Associates we provide a wide range of treatment options that have all been proven effective using clinical studies. There are medical, laser and surgical options available. The treatment that we decide upon will be individually tailored for each patient.

Medication for glaucoma

Eye drops:

There are several different eye drops that can be used to treat glaucoma. They work by lowering pressure in the eye to prevent worsening glaucoma. The drops need to be used regularly and often have to be used for life.

One or more of the following eye drops may be used:
  • Prostaglandin analogues (e.g. Hysite, Lumigan, Travatan)
  • Beta blockers (e.g. Timolol, Betoptic)
  • Alpha agonists (e.g. Alphagan)
  • Carbonic anhydrase inhibitors (e.g. Azopt, Trusopt)
  • Miotics (e.g. Pilocarpine)
  • Combination eye drops (e.g. Combigan, Cosopt, Duotrav)

Sometimes these eye drops cause side effects that can be troublesome and occasionally serious. You will be informed of possible side effects before any eye drop is started.

Tablets:

There is a medication called Diamox that can be used for glaucoma. Unfortunately it has several side effects that stop it from being used except in emergencies or special situations.

Laser treatment

Selective laser trabeculoplasty (SLT)

This is a laser procedure used for patients with open-angle glaucoma. The laser is applied to the drainage part of the eye to improve the flow of fluid out of the eye and hence lower eye pressure. It is often used when eye drops are not effective or cause troublesome side effects. It can also be used as an initial treatment for glaucoma in suitable patients.

SLT has an estimated success rate of 75% and typically lowers eye pressure by about 30%. The effect can last anywhere from 1 to 5 years and sometimes longer. SLT may need to be repeated if the effect wears off over time. Eye drops may still be needed for some people.

The procedure is performed in clinic and usually only takes a few minutes. The laser is painless and you can get back to your normal routine afterwards. The advantage of SLT is that it is very safe with no risk of vision loss or damage to the eye. Side effects are uncommon but are mild redness and temporary increase in eye pressure (5%).

Video provided by Ellex Medical (www.ellex.com)

Laser peripheral iridotomy (LPI)

This is a laser procedure for patients with angle closure glaucoma or narrow drainage angles. The laser creates a tiny hole in the coloured part of the eye (the iris) which causes the iris to move backwards thereby unblocking the drainage part of the eye.

Laser peripheral iridotomy (LPI) diagram

Glaucoma Surgery

If medical or laser treatment does not relieve eye pressure then glaucoma surgery may be needed. At Eye Surgery Associates we provide the following surgical options:

iStent

The iStent is one of many newly developed procedures called ‘Minimally Invasive Glaucoma Surgeries’ or MIGS. The iStent is the worlds smallest medical device (length 1 mm). The iStent is recommended for patients with mild to moderate glaucoma and is usually performed with cataract surgery. It is therefore very useful for patients with both glaucoma and cataract. The tiny stent is placed into the drainage part of the eye to create a permanent opening for fluid to drain out of the eye and into the bloodstream.

Video provided by Glaukos (www.glaukos.com)

Cataract Surgery

Cataract surgery can help to treat closed angle glaucoma. By removing the cataract there is more space in the front part of the eye which leads to opening of the drainage angle. In some patients with open angle glaucoma removing the cataract can also lower eye pressure. At Eye Surgery Associates we have particular expertise in cataract surgery for glaucoma patients.

Cataract Surgery

Cataract Surgery diagram

Trabeculectomy

This is the most common surgical procedure for glaucoma and allows the eye fluid to bypass the blocked drainage part of the eye. In this operation a small hole is made in the wall of the eye (the sclera). The hole is covered by a ‘trapdoor’ created from the outer part of the eye wall. Fluid from inside the eye drains through the small hole and out the sides of the trapdoor. The fluid drains into a small blister-like space under the outer lining of the eye (conjunctiva) before being absorbed by the surrounding eye tissues. The ‘blister’ is called a bleb and is located under the upper eyelid so it cannot be seen.

Video provided by Ophthalmoltext (www.ophthalmoltext.net)

ExPRESS miniature glaucoma device

This is best considered a modified trabeculectomy operation. Instead of making a small hole a miniature stainless steel shunt (about the size of a grain of rice) is implanted under the ‘trapdoor’ created in the outer wall of the eye. Like trabeculectomy this allows the eye fluid to bypass the damaged drainage part of the eye to exit the eye more freely thus lowering eye pressure.

Video provided by Optonol - Alcon (www.alcon.com)

Glaucoma tube surgery

This operation is typically performed in patients are not suitable for one of the above procedures. A flexible plastic tube is inserted throught the eye wall into the front part of the eye to help drain fluid from the eye. At the other end of the tube is a small pouch that the fluid drains in to before being absorbed into surrounding tissues.

Cyclophotocoagulation

This procedure is used for severe glaucoma when all other options have been unable to lower the eye pressure. A very strong laser in applied to the part of the eye where fluid is produced (the ciliary body). This helps to reduce the amount of fluid being made hence lowering the eye pressure. Sometimes the eye pressure can become too low after this procedure which is why it is not commonly used.

Cyclophotocoagulation diagram