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Treatment Options

Treatment options for glaucoma vary widely, depending on the form and severity of glaucoma. Typically, for the most common form of glaucoma (open angle glaucoma), treatment options will include medications, laser treatments, or eye surgery. Frequently, a combination of these options may be used. The goal of glaucoma treatment is to decrease intraocular pressure and prevent damage to the optic nerve. At the beginning of treatment, the doctor will generally recommend medication or a combination of eye drops and oral medications for the specific condition.

Glaucoma is a chronic condition that is not “cured” by the treatment; it requires continued monitoring. When deciding on which treatment options, it is necessary for the physician and patient to thoroughly discuss the risks and benefits.

Medications

Several different classes of glaucoma medications are available, including beta blockers, prostaglandin analogues, alpha adrenergic agonists, miotic, epinephrine compounds and oral and topical carbonic anhydrase inhibitors. These medications work by either reducing the rate at which fluid in the eye is produced or increasing the outflow of fluid from the eye.

Laser treatment can open the drainage angle and reduce intraocular pressure. Although surgery can be done to create a new passage for fluid drainage, it is usually reserved for cases that cannot be controlled by medication or if laser treatment was not successful.

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Eye Drops

All eye drops may cause a burning or stinging sensation at first. This is often due to the antibacterial agent present in the drop solution, not the drug itself. While uncomfortable, it only lasts for a few seconds. It is important that you take your medication exactly as prescribed.

Since eye drops are absorbed into the bloodstream, it is important that you tell your doctor about all other medications you are taking. Some drugs can be dangerous when mixed with others. Ask your doctor or pharmacist if the medications you are taking together are safe. To minimize absorption into the bloodstream and maximize the amount of drug absorbed into the eye, close your eyes for one to two minutes after administering your drops and press lightly against the nasal corner of your eyelids to close the tear duct that drains into the nose.

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Oral Medications

Sometimes, drops are not enough to control intraocular pressure. When this is the case, pills may also be prescribed. These pills also serve to lessen the production of fluid in the eye. The medication is usually taken two to four times daily. It is important to share this information with your other doctors so that they can best prescribe medications for you that will not cause potentially dangerous interactions.

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Surgical Procedures

Laser surgery has become increasingly popular as an intermediate step between drugs and traditional surgery. The most common type performed for open-angle glaucoma is called trabeculoplasty. This procedure takes 10 to 20 minutes, is painless and can be performed in either a doctor's office or outpatient facility. The laser beam is focused upon the eye's drainage area. Contrary to what most people think, the laser does not burn a hole through the eye. Instead, its intense heat causes some areas to shrink, resulting in adjacent areas stretching open and permitting the fluid to drain more easily.

You may go home and resume normal activities following surgery. Your doctor should check your intraocular pressure one to two hours later. After this procedure, nearly 80 percent of all patients respond well enough to be able to delay or even avoid traditional surgery. It may take a few weeks to see the full pressure-lowering effect of this procedure, during which time you may have to continue taking your medication. Many patients are eventually able to discontinue some of their medications, however this is not true in all cases. Your doctor is the best judge of determining whether or not medication is still necessary for you. Cataracts do not occur after laser surgery and complications are minimal, which are other reasons why this has become increasingly popular.

The most common form of traditional surgery is called a trabeculectomy. In this procedure, the surgeon removes a small section of the trabecular meshwork to allow the aqueous humor to drain more easily, reducing pressure in the eye. This procedure is usually done under local anesthesia, either as an outpatient or with a brief hospital stay since your doctor will want to see you the day after surgery. It is important to note that your eyes may not have their normal visual acuity for several weeks following this procedure. Although trabeculectomy is a relatively safe surgical procedure, about one-third of patients develop cataracts within five years of surgery. After trabeculectomy, most patients are able to discontinue all anti-glaucoma medications. Ten to 15 percent of patients require additional surgery.

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