GLAUCOMA TREATMENT

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Treatment options for glaucoma includes:

• Medications

• SLT laser

• Minimally invasive glaucoma surgery

• Trabeculectomy

• Tube shunt operation

• Cyclodiode laser

 

Medicines.

Medicines, in the form of eye drops, are the most common early treatment for glaucoma. Taken regularly, these eyedrops lowers eye pressure. Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye. Rarely are tablet medications used regularly for eye pressure. 

Before you begin glaucoma treatment, tell your eye care professional about other medicines and supplements that you are taking. Sometimes the drops can interfere with your health conditions and the way other medicines work.  Tell your eye specialist if you have:

• Asthma

• Heart rate problems

• Pregnant or plan pregnancy

• Allergies to sulfur or sulfur related medications

Glaucoma medicines need to be taken regularly as directed by your eye care professional. It is important to get into a habit of taking the medications.  Make it a routine.  There are also special memory aids or apps on your phone that can help you remember.  Ask your eye specialist for further information on this.

 

Most people have no problems. However, some medicines can cause headaches or other side effects.  Some of these side effects are caused by the preservative in the medication bottle rather than the medication itself.  For example, preservatives may cause stinging, burning, and redness in the eyes.  Your eye specialist may change you to a preservative free formation that is the case.

 

Many medicines are available to treat glaucoma. If you have problems with one medicine, tell your eye care professional. Treatment with a different dose or a new medicine may be possible.

Because glaucoma often has no symptoms, people may be tempted to stop taking, or may forget to take, their medicine. You need to use the drops or pills as long as they help control your eye pressure. Regular use is very important.  There are alarms and apps on your smartphone that is able to help remind you how to use eye drops regularly.  Talk to your eye specialists to see if some of these could help you.

 

Selective Laser trabeculoplasty- Selective Laser Trabeculoplasty (SLT) helps fluid drain out of the eye. Your doctor may suggest this treatment to reduce your eye pressure without addition of further eye drops.

Selective laser trabeculoplasty is performed in your doctor’s office or eye clinic. Before the surgery, numbing drops are applied to your eye. As you sit facing the laser machine, your doctor holds a special lens to your eye. A beam of laser light is aimed through the lens and reflected onto the drainage channels inside your eye.  This improves the fluid to drainage out of the drainage system. 

Like any surgery, laser surgery can cause side effects, such as inflammation. Your doctor may give you some drops to take home for any soreness or inflammation inside the eye.

Studies show laser surgery can be very good at reducing the pressure in some patients. However, its effects can wear off over time. The laser treatment can be repeated.  Your doctor may suggest further treatment after six months.

 

Minimally invasive glaucoma surgery (MIGS)

MIGS are relatively new procedures that use very small incisions and microscopic device to allow fluid in the eye to exit the eye and therefore lower eye pressure.  The devices allow the fluid to bypass the obstruction in the trabecular meshwork in a controlled manner, draining fluid often into the natural drainage pathways.  Therefore the devices are able to achieve lowering of eye pressure with less possible complications as conventional surgery.

The various devices each have their unique mechanism of action and are suitable in different conditions.  These will be discussed in more detail in other pages.

 

Conventional surgery. Conventional surgery makes a new opening for the fluid to leave the eye. Conventional surgery often is performed after medicines, laser surgery and/or MIGS procedures have failed to control eye pressure.

There are two types of conventional surgeries – Trabeculectomy and Glaucoma Tube Shunt operation.  These surgeries are performed in an operating room.  The surgeries involve incision on the mucosal surface called the conjunctiva, creating a drainage channel out of the eye and sutures to close the conjunctiva.

For trabeculectomy the fluid will drain between the eye tissue layers and create a blister-like “filtration bleb.”  For Tube shunt operation, a silicon stent (tube) keeps the drainage channel open and directs fluid into a reservoir that sits between the muscles that control eye movement. 

For several weeks after the surgery, you will be asked to put drops in the eye to prevent infection and inflammation.  Your usual eye drops for glaucoma will typically stopped after the surgery.  Eye drops for inflammation (steroid eye drops) are often used for up to 3 months for Trabeculectomy and 1 month for Tube shunt operation.

Success of the operation is dependent on how the eye heals after the operation.  Excessive scarring can occlude the drainage channel or limit the extent of drainage from the eye.  Overall success of conventional operation range from 70-90% over first 5 years, therefore small number of patient may require future surgery in the future to treat glaucoma.

Following conventional surgery, your vision may not be as good as it was before the surgery for a period of few weeks.  Other potential complications from conventional surgery including development of cataract, problems with the cornea, inflammation, infection inside the eye, or low eye pressure problems.   Your eye specialist will monitor your eyes to prevent chance of complications.

Risk of bleb infection (blebitis)  -  Trabeculectomy drains fluid out of the eye which forms a blister-like bubble (bleb).  This blister can become infected by bacteria, often several months or even years after the surgery.  It is therefore very important that if you had trabeculectomy in the past you must look out for symptoms of eye pain, eye redness or discomfort.  If you have these symptoms, do not simply go to see your GP for routine antibiotic eye drops, instead you should see your eye specialist urgently.  If these symptoms happen after hours or during public holiday then please call Royal Victorian Eye and Ear Hospital on (03) 9929 8666.

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Cyclodiode laser

Cyclodiode laser is a special laser that is able to treat parts of the eye that produces fluid inside the eye called ciliary body.  It can achieve this treatment without making any incision into the eye, therefore there is no risk of infection from this treatment.  Because cyclodiode laser often produces significant inflammation following the procedure it has been reported to sometimes cause reduction in vision after treatment.  Therefore cyclodiode laser is traditionally more commonly used on patients with poor vision, such as patients with endstage glaucoma, refractory glaucoma or neovascular glaucoma.  However, more recent development of micropulse technology has made cyclodiode laser safer and there is increasing use of cyclodiode laser in even situations where the patient has reasonable vision.

Cyclodiode laser treatment with micropulse technology can be performed in our eye clinic under local anaesthetic.   

 

Treatment of other forms of glaucoma?

Open-angle glaucoma is the most common form. Some people have other types of the disease.

In low-tension or normal-tension glaucoma, optic nerve damage and narrowed side vision occur in people with normal eye pressure. Lowering eye pressure at least 30 percent through medicines slows down glaucoma in most of these patients, although glaucoma may worsen in others despite low pressures.  Normal-tension glaucoma is more common in Japanese, Korean and Chinese populations.  It is also more common in patients with migraine, low blood pressure, obstructive sleep apnea or Raynaud’s condition (cold fingers and feet).

In congenital glaucoma, children are born with a defect in the angle of the eye that slows the normal drainage of fluid. These children usually have obvious symptoms, such as cloudy eyes, sensitivity to light, and excessive tearing. Conventional surgery typically is the suggested treatment, because medicines are not effective and can cause more serious side effects in infants and be difficult to administer. Surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision.

Secondary glaucomas can develop as complications of other medical conditions. For example, a severe form of glaucoma is called neovascular glaucoma, and can be a result from poorly controlled diabetes or from retinal vessel occlusion. Other types of glaucoma sometimes occur with cataract, certain eye tumors, or when the eye is inflamed or irritated by a condition called uveitis. Sometimes glaucoma develops after other eye surgeries or serious eye injuries.

Steroid drugs used to treat eye inflammations and other diseases can trigger high IOP in some people (known as steroid response).  

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Depending on the cause of these secondary glaucomas, treatment includes medicines, laser surgery, MIGS or conventional surgery or cyclodiode laser.