Glaucoma Treatment Options
If you have glaucoma, it is critical to decrease and control your intraocular pressure (IOP) in order to preserve your eyesight. Depending on your individual situation, there are several treatment options available:
Canaloplasty is an advanced surgical treatment for glaucoma, which uses breakthrough microcatheter technology to restore your eye’s natural drainage system. Unlike other glaucoma treatments, which only address one or two aspects of ocular outflow, Canaloplasty comprehensively opens up all components of the eye’s natural outflow system in order to deliver a sustained reduction in IOP. It is also less invasive than traditional glaucoma surgery and can be used across the entire glaucoma treatment spectrum.
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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 IOP. SLT effectively lowers IOP in the majority of patients, but the length of time that pressure remains low depends on many factors, including the age of the patient, the type of glaucoma, and other medical conditions that may be present. In some cases medication may still be necessary, but in reduced amounts. SLT is suitable for use across the entire glaucoma treatment spectrum, but it is most effective when used as a first-line therapy in newly diagnosed glaucoma patients.
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. However, ALT has been shown to cause permanent coagulative damage to the eye and its use is now limited.
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Medication (eye drops) are the most common form of treatment for glaucoma; however, there are side effects, and medications aren’t effective for all patients – and you have to remember to take your medication every day. There are a number of different categories 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 intraocular pressure. Your doctor will decide which medications are best suited to you based on a number of considerations, including your medical history and current medication regimen. Your doctor may also elect to prescribe a combination of eye drops.
Traditionally surgery has been performed to create a new drainage channel by effectively by-passing the natural outflow pathways. Such surgery is generally used to treat the more aggressive or advanced stages of glaucoma.
Trabeculectomy is an outpatient procedure but may require an overnight stay in a hospital. During the surgery your surgeon will cut a flap in the white part of the eye (sclera) and remove a piece of trabecular meshwork. This creates a new opening through which the eye’s fluid will flow, reducing IOP. Trabeculectomy is a highly invasive procedure, which carries an elevated risk of complications and side effects, including 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.
Minimally Invasive Glaucoma Surgeries (MIGS) refer to a number of devices/techniques that are used to address one or two of the areas of outflow resistance associated with IOP in glaucoma patients. Typically performed during cataract surgery, these procedures are said to be quicker and safer than traditional glaucoma surgery. The long-term efficacy of these new procedures has yet to be determined, however.