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 the type and severity of the condition, there are numerous treatments available to effectively treat glaucoma.
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.
Selective Laser Trabeculoplasty (SLT)
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.
Traditionally surgery has been performed to create a new drainage channel by effectively bypassing the natural outflow pathways. Such surgery is generally used to treat the more aggressive or advanced stages of glaucoma.
Trabeculectomy is a surgical procedure usually reserved for glaucoma patients for whom medication and laser therapy have not proved effective. During the procedure, the eye is numbed with a local anesthetic and a small incision is made in the white of the eye. A tiny portion of the spongy meshwork is removed to improve fluid drainage, resulting in reduced eye pressure. If this procedure does not reduce eye pressure to the optimal level, medication may be necessary.
Drainage Implant Surgery
Drainage implants are small silicone tubes that are surgically placed into the eye behind the cornea. They make it easier for fluid to flow out of the eye and into adjacent capillaries and tissues, where it is reabsorbed by the body. While drainage implants do not improve vision, they can be highly effective at reducing pressure in the eye, which helps to prevent damage to the optic nerve. Drainage implant surgery is typically reserved for more complex glaucoma cases. At our North Carolina eye care centers, we perform drainage implant surgery as an outpatient procedure.
iStent Inject (Your Once-In-A-Lifetime Opportunity to Treat Glaucoma & Cataracts at the Same Time)
If you’ve been managing your glaucoma symptoms with medication, and now are preparing for cataract surgery, iStent inject® may be an ideal option for you. Around the world, iStent inject® has helped people with glaucoma successfully manage their intraocular pressure. Implanted during cataract surgery, iStent inject® can effectively lower IOP, one of the most important risk factors for glaucoma, and may reduce your reliance on glaucoma medication at the discretion of an eye care professional.
The XEN® Gel Stent is a surgical implant designed to lower high eye pressure in open-angle glaucoma patients where previous surgical treatment has failed and/or medications alone were insufficient (also known as refractory glaucoma). The XEN® Gel Stent is a small tube that, when inserted into the eye, becomes soft and flexible and designed to help lower eye pressure.
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.
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.
*Indications for MIGS are different compared to invasive glaucoma surgeries and do not include patients with advanced disease or patients who require very low unmedicated postoperative IOP.