Glaucoma Treatment & Surgery

The goal of glaucoma treatment is to lower intra-ocular pressure (pressure in the eye), lower the amount of fluid produced in the eye, and/or improve drainage of fluid in the eye. And, even though Glaucoma can’t be cured and damage already caused can’t be reversed, early detection and treatment can slow or prevent any further vision loss.

Everyone should start getting themselves checked for Glaucoma between the ages of 35 and 40, and especially those over age 40. Anyone over age 60, along with anyone considered to be at higher risk, should have their eye pressure checked every 1 or 2 years.

Glaucoma – Eye Drop Treatment

Most often, Glaucoma treatment starts with medication in the form of eye drops. It is very important to use the drops exactly as prescribed to prevent the optic nerve damage from getting worse. This is especially true when multiple eye drop medications are prescribed at the same time.

Some eye drop medications are absorbed into the bloodstream, so patients may experience certain side effects unrelated to the eyes. To help minimize this issue, it is important to keep the eyes closed for a few minutes minutes following application. It is also customary during this time to press lightly at the corner of the eye near the nose to close the tear duct, as well as to wipe any additional medication from the eyelid.

To be effective, most glaucoma medications must be taken once or twice every day, without fail. Some of these medications have some undesirable side effects, so your doctor will work with you to find a medication that controls your pressure with the least amount of side effects.

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Most common eye drops for glaucoma treatment

Prostaglandins

Reason: Prostaglandins are often prescribed to treat open-angle glaucoma, as they increase the outflow of fluid and reduce pressure in the eye.
Possible side effects: mild reddening & stinging, darkening of the iris, eyelid pigmentation changes, blurred vision
Examples: latanoprost (Xalatan), bimatoprost (Lumigan).

Beta-Blockers

Reason: Beta-blockers help to reduce both the production of fluid in the eye and intra-ocular pressure.
Possible side effects: difficulty breathing (not normally recommended for those with heart or lung conditions if any existing breathing issues exist), lower blood pressure, slowed heart rate, fatigue, impotence
Examples: timolol (Betimol, Timoptic), betaxolol (Betoptic).

Alpha-Adrenergic Agonist

Reason: Alpha-adrenergic agonists help to reduce fluid production (aqueous humor) and increase outflow of fluid in the eye.
Possible side effects: high blood pressure, irregular heart beat, fatigue, dry mouth, and red, itchy or swollen eyes
Examples: apraclonidine (Iopidine), brimonidine (Alphagan).

Carbonic Anhydrase Inhibitors

Reason: Rarely used, Carbonic anhydrase inhibitors help to reduce the production of fluid in the eye.
Possible side effects: frequent urination, tingling sensations in fingers and toes
Examples: dorzolamide (Trusopt), brinzolamide (Azopt).

Miotic or Cholinergic Agents

Reason: Miotic or cholinergic agents increase the outflow of fluid in the eye.
Possible side effects: smaller pupils, blurred vision, dim vision, nearsightedness
Examples: pilocarpine (Isopto Carpine), carbachol (Isopto Carbachol).

Sometimes a combination of these medication may be prescribed to intensify their effects. Examples of this might be prescribing a beta-blocker together with an alpha adrenergic agonist, or a beta-blocker together with a carbonic anhydrase inhibitor

Glaucoma – Oral Treatments

Oral medications may be prescribed when eyedrops alone don’t bring eye pressure down to an acceptable level. This treatment normally comes in the form of a carbonic anhydrase inhibitor to help reduce intra-ocular eye pressure.

Possible side effects of Oral Glaucoma Medication may include:

Depression
Kidney Stones
Frequent Urination
Upset Stomach
Tingling in Fingers & Toes

Types of Glaucoma Surgery

Trabeculoplasty (Laser surgery)

This outpatient procedure is used to treat open-angle glaucoma. After receiving numbing eyedrop, a high-energy laser is used to clear clogged drainage canals, which helps fluid drain from the eye more efficiently.

Laser surgery for glaucoma initially lowers pressure in the intra-ocular pressure, but be aware the intraocular pressure may begin to re-emerge after time. Eye pressure also needs to be checked several times in the weeks following surgery, as it may take a few weeks to for the full effects of the surgery to set in.

Trabeculectomy (Filtering Surgery)
This procedure can be performed in a hospital or at an outpatient surgery center, and is used when eyedrops and laser surgery aren’t effectively controlling eye pressure.

Medication is used to help the patients relax, and an injection of anesthetic will normally be administered to numb the eye. Once numb, an opening in the sclera (white of the eye) is created before a small piece of tissue at the base of the cornea is removed. This opening allows fluid to freely flow out of the eye, thus lowering eye pressure.

With this surgery, it is also not uncommon for patients to need additional procedures or treatments. This is often the case when the opening heals over or other optic nerve changes take place. This is also another procedure that requires a number of follow-up visits, as final effects can sometimes take weeks.

Drainage implants
Drainage implant surgery can be done in a hospital or at an outpatient clinic. This procedure helps drain fluid by inserting a small drainage tube directly into the eye. Drainage implants are normally reserved for people with advanced glaucoma, secondary glaucoma or children with glaucoma.

Glaucoma – Possible Complications

Glaucoma surgery is the last option when medication treatments aren’t providing the necessary results by themselves. When Glaucoma gets to this point, it’s also not uncommon for patients to require more than one procedure, as well as it being necessary for them to continue using eye drop and/or oral medications.

Possible complications from Glaucoma Surgery may include: