You may not need any treatment if your eye pressure is only slightly elevated and there’s no damage to your optic nerve. Instead, your doctor may choose to monitor your condition with regular eye exams. But if you have signs of optic nerve damage, treatment can help slow its progression. Unfortunately, it’s not currently possible to reverse damage that has already occurred. Most people have good results with glaucoma medication, but some may need surgery instead.
Medications for glaucoma
Most glaucoma medications are applied directly to your eyes in the form of drops, although a few may be taken orally. Because a portion of the drops may be absorbed into your bloodstream, you sometimes may have side effects unrelated to your eyes. In addition, some medications may lose their effectiveness over time. In that case, you may need to change or add medications or have surgery to control your glaucoma. It’s not always easy to use glaucoma medication as directed. Drops usually need to be applied several times each day, and if you’re using more than one medication, you need to wait at least 5 to 10 minutes between applications. This rigorous schedule can sometimes seem time-consuming and confusing.
Furthermore, because glaucoma rarely causes symptoms in its early stages, you may not notice any change in your vision when you start using medication. Still, it’s extremely important to follow your treatment plan exactly as your doctor prescribes. Skipping even a few doses of medication can cause your glaucoma to become worse. If you have trouble with your treatment plan, tell your doctor.
Surgery for glaucoma
When medications aren’t effective or well tolerated, surgery may be an option. Keep in mind that surgery doesn’t cure glaucoma. As a result, you may need to keep using antiglaucoma medications even after surgery. In some cases, you may need a second operation.
Laser surgery (trabeculoplasty)
In this procedure, your doctor uses a beam of high energy light to shrink part of the meshwork of your eye’s drainage angle. This causes other areas of the meshwork to stretch, which helps aqueous fluid drain more easily. Laser surgery, which usually takes between 10 and 20 minutes, will likely be performed in your doctor’s office under local anesthesia. Following surgery you should have almost no discomfort, but you’ll need to continue taking eyedrops, at least for a time, and you may need more surgery within 5 years. In some cases intraocular pressure actually may increase following laser surgery. In most cases this is temporary, but sometimes the rise in pressure may be permanent, leading to further vision loss.
In this procedure a surgeon creates a new drainage pathway for fluid in the white part of your eye (sclera) using traditional surgical techniques. Many people who have had this type of surgery no longer need eyedrops. But there are also risks. In some cases, scars may form that close the drainage channels. This is a particular problem in young people, blacks and people who have had cataract surgery.
This may be an option for adults when other treatments have failed as well as for infants and children. In this procedure a small silicon tube is inserted in your eye to help drain aqueous fluid. Possible complications include the clouding of the lens of your eye (cataracts) and implant failure.
Medications and surgery for acute glaucoma
Doctors may administer several different medications during an attack of acute glaucoma in an effort to reduce eye pressure as quickly as possible. Once your eye pressure is brought under control, you may have an emergency operation known as an iridotomy to create a drainage hole in your iris. This surgery is now almost exclusively performed with lasers, which allow specialists to form an opening without making an incision in your eye. Laser iridotomy is an outpatient procedure that avoids many of the risks of traditional surgery. After treatment you can usually resume your normal activities right away.