In order to preserve eyesight, it is critical to decrease and control the elevated intraocular pressure (IOP) associated with glaucoma. Depending on your individual situation, there are several treatment options available:
Medication (eye drops) is the most common form of treatment for glaucoma; however, there are side effects, and medication is not effective for all patients – and you have to remember to take your medication every day. There are a number of different types of eye drops, but all are used to either decrease the amount of fluid (aqueous humor) in the eye or to improve the outflow of this fluid in order to stabilize or reduce IOP. Your doctor will decide which medication is best suited to you based on a number of considerations, including: medical history and current medication regimen. Your doctor may also elect to prescribe a combination of eye drops.
SLT or Selective Laser Trabeculoplasty, is a gentle, low-energy laser therapy, which triggers a natural healing response in the eye in order to reduce the IOP associated with glaucoma. SLT effectively lowers eye pressure in the majority of patients, but the length of time that pressure remains low depends on many factors, including: age of the patient, the type of glaucoma, and other medical conditions that may be present. In many cases medication may still be necessary, but in reduced amounts.
Note: Previously, Argon Laser Trabeculoplasty (ALT) was used to treat glaucoma. ALT uses a high-energy laser to “open” the clogged areas of the trabecular meshwork (the eye’s drainage system), allowing fluid to bypass this drainage system and flow out of the eye. However, unlike SLT, ALT causes permanent coagulative damage to the eye and cannot be repeated.
SLT treatment takes just a few minutes to perform. Prior to treatment, your doctor will administer eye drops in order to prepare the eye and provide mild anesthesia. Then, gentle pulses of SLT laser light are delivered through a specially designed microscope, known as a slit lamp. The entire process takes just a few minutes. Once complete, your doctor may treat your eye with anti-inflammatory eye drops. One to three days after the procedure, your IOP should drop significantly. And of course, your doctor will want to re-check the treated eye during periodic follow-up visits.
Surgery may be attempted to create a new drainage channel, by-passing the natural outflow pathways, if very low IOP is required to prevent glaucoma progression. Such surgery is generally used to treat more aggressive or advanced stage open-angle glaucoma:
Trabeculectomy is normally performed with local anesthetic and on an outpatient basis, but may require an overnight stay in a hospital. During the surgery the ophthalmologist will cut a flap in the white part of the eye (sclera) and remove a piece of trabecular meshwork, creating a new opening through which the eye’s fluid will flow.
Potential side effects include blurred vision, bleeding in the eye, infection and discomfort.
Tube/shunt surgery involves placing a tube through which the aqueous will exit the eye and a valve placed on the eye’s surface to regulate the flow.
Laser surgery may be attempted through the sclera, targeting the ciliary processes, in order to reduce the production of aqueous (trans-scleral cyclocoagulation).