Glaucoma Treatment options
Treatment for glaucoma depends on the specific type of glaucoma, its severity and how the eye responds to treatment. The main goal is to lower the eye pressure to a level that stabilizes the disease to prevent further damage/vision loss. The level of "safe" eye pressure is different for each individual. Unfortunately, glaucoma treatment does not reverse damage to the optic nerve.
Lowering eye pressure is accomplished in one of two ways: by decreasing aqueous fluid production (inflow), or increasing aqueous fluid drainage (outflow). Methods of eye pressure reduction include: medications, glaucoma laser surgery and glaucoma surgery.
Medications in the form of eye drops or pills, or a combination of the two can increase outflow, decrease inflow or a combination of the two. The prescription drugs can be eye drops or pills. Some patients cannot tolerate these medications, and some side effects may outweigh the benefits of the treatments.
Glaucoma Laser Surgery procedures vary in the way that they work.
Laser trabeculoplasty stimulates the trabecular meshwork (drainage angle) to function more efficiently. This is an in-office procedure. It is relatively safe with few side effects. We offer two different types of laser trabeculoplasty: Argon Laser Trabeculoplasty (ALT) and Selective Laser Trabeculoplasty (SLT).
SLT and ALT lower the intra ocular pressure (IOP) by ~20%. They are about 80% effective in the first year. However the efficacy may wear off over time: @ 5 years – 50% effective and @ 10 years – 33% effective.
These lasers may not need to be repeated at the frequency that many ophthalmologists are performing them. In a study by Dr. Frenkel, treating 1/3 of the eye is just as effective as treating 1/2 of the eye. While SLT can be repeated over the same area of the eye, ALT cannot.
In laser iridotomy, a small hole is created in the iris to improve outflow of aqueous humor into the drainage angle. This procedure is done for narrow or closed angles.
A laser iridioplasty removes a portion of the iris near the root to alter the shape of the pupil therefore drainage angle, improving outflow of aqueous humor.
Glaucoma surgery is called for when eye medications and laser surgery are insufficient to control glaucoma progression. In Trabeculectomy, a new drainage channel is created in the eye. In Aqueous shunt or Seton procedures, a small plastic tube drains fluid from the front of eye to lower eye pressure and is usually reserved for eyes at high risk for failure with trabeculectomy.
The goal of glaucoma surgery is to reduce damage to the optic nerve by lowering the pressure inside the eye. Micro-Invasive Glaucoma Surgery, or MIGS, achieves this using microscopic instruments to make very small incisions in the eye. We use VISCO 360. iStent & MicroPulse at EFEI.