glaucoma

Glaucoma Treatments

All treatments for glaucoma involve reducing the eye pressure to slow down or halt progression of the disease. Strategies to reduce the eye pressure include gentle laser, daily pressure-lowering eye drops or glaucoma surgery.

1. Selective Laser Trabeculoplasty (SLT)

Selective Laser Trabeculoplasty (SLT)

SLT is a safe, gentle and effective laser treatment that reduces the eye pressure. It is performed by your Ophthalmologist at Glaucoma Care.

How does SLT work?

SLT uses brief pulses of low-energy light targeting the eye’s normal drainage area, located in the angle between the iris (coloured part of your eye) and cornea (clear window at the front of your eye). This gently stimulates the cells in the drainage area, causing them to improve normal drainage pathways and reduce the eye pressure.

Should I have SLT treatment?

SLT is a great treatment option for raised eye pressure (ocular hypertension) or glaucoma, especially if drops are bothersome, uncomfortable, difficult to administer or remember. It is a good option for people who prefer a long-lasting laser treatment to regular daily drops.

For how long does the pressure-lowering effect last?

The effect of SLT can last up to years, but may begin to wear off after 9-18 months.

Can the treatment be repeated?

Yes, it can.

Will SLT reduce my need for eye drops?

SLT lowers eye pressure on average by 25% for most patients. For those already on pressure-lowering eye drops, they probably will be able to reduce the number of these. If SLT is the first treatment it may delay the need for eye drops, sometimes indefinitely.

2. Laser peripheral iridotomy

Laser peripheral iridotomy is a safe, gentle and effective treatment for relieving a narrow drainage angle in the eye. It is performed by your Ophthalmologist at Glaucoma Care.

What is a narrow angle?

The drainage angle is located where the iris (coloured part of the eye) meets the cornea (clear window at the front of the eye). Some people have narrow angles, preventing fluid draining freely from the eye.

Laser Peripheral Iridotomy drainage angle

Why do narrow angles matter?

A narrow drainage angle can lead to raised pressure in the eye, causing glaucoma.
Rarely, narrow drainage angles can completely block off, causing an attack of sudden angle closure. This is a rapid, large rise in eye pressure causing eye pain, headache and blurred vision. It can lead to permanent visual loss if not treated immediately.

How do I know if I have narrow angles?

Narrow angles can only be detected by examination of your eye using a special contact lens. Your Ophthalmologist uses this to visualise your angles.

What should I do if I have narrow angles?

If you have narrow angles you will probably benefit from a treatment that widens the angle called a laser peripheral iridotomy. Opening the drainage angles can reduce pressure in your eyes, and prevent future development of glaucoma. It also prevents attacks of sudden angle closure.

How does the laser procedure work?

An iridotomy is a small hole created by a laser beam in the periphery of the iris. It allows fluid to pass freely from behind to in front of the iris, widening the angle.

Laser Peripheral Iridotomy Laser Procedure

3. Topical glaucoma medications

Topical medications (eye drops) are commonly used to lower eye pressure. These are applied on a daily or twice daily basis. Sometimes, more than one drop is required to lower the eye pressure.
It is important to use your eye drops as directed by your clinician – missing or omitting doses can lead to incomplete and inadequate treatment.

What types of pressure-lowering eye drops are available?

Prostaglandin analogues (latanoprost, travoprost, bimatoprost, tafluprost)
Prostaglandin analogues lower eye pressure by encouraging drainage through an alternative pathway (the uveoscleral route) from the eye. These are administered once daily. They are generally well tolerated, but may cause red, itchy eyes or exacerbate symptoms of dry eye.

Beta-blockers (timolol, betaxolol)

Beta-blockers lower eye pressure by reducing the production of fluid in the eye.  They are administered twice daily.  They are generally well tolerated but may cause red, soreeyes and may also be absorbed into the blood stream and affect other parts of the body, notably the lungs, heart and blood vessels. They can cause a range of symptoms, including breathlessness, reduced exercise tolerance, nightmares and impotence. They should be avoided in patients with asthma, low blood pressure and abnormalities of the heart beat.

Carbonic anhydrase inhibitors (dorzolamide, brinzolamide)

Carbonic anhydrase inhibitors lower eye pressure by reducing the production of fluid in the eye.  They are administered twice or three times daily.  They can cause stinging of the eyes and red, sore eyelids. Rarely they can lead to a severe allergy affecting the skin and whole body.

Alpha-2 agonists (brimonidine, apraclonidine)

Alpha-2 agonists reduce eye pressure by reducing fluid production and increasing drainage from the eye.  They can cause red, irritated eyes and have a slightly greater risk of allergy and tachyphylaxis (effect of the drop reduces over time) than the other types of drops. Brimonidine should be avoided in children

Miotics (Pilocarpine)

Miotics are used to treat some forms of glaucoma (eg narrow angle glaucoma). They work by constricting the pupil and widening the drainage angle of the eye. They can result in dimmed vision and eye or brow ache.

Combination drops

Sometimes more than one glaucoma medication is required; for this reason combination bottles (2 eye drop types mixed within one bottle) are available.

Preservative-free glaucoma medications

Eye drops come in two forms of packaging:
a.    Bottles that have enough drops to last 1 month;
b.    Tiny dispensers (“minims”) that are used 1-2 times then discarded.

The month-long bottles can be easier and more convenient to use, but contain preservatives that may be irritating to your eyes. Rarely people can develop an allergy to preservatives in medications If this is the case, preservative-free glaucoma medications can be used to reduce the eye pressure.

How do I instill my drops?

Preservative free glaucoma drops

1.    Wash your hands.
2.    Tilt your head back as far as you can, or lie down.
3.    Gently pull down the lower lid and look up.
4.    Lightly squeeze the bottle until a drop lands inside your lower eyelid.
(You may find it easier to rest the bottle on the bridge of your nose. Avoid touching your eye with the tip of the bottle.)
5.    Use a clean tissue to gently dab away the excess drops.
6.    After the drop, close your eye and place a finger on the inner corner of the eye for 1 minute to prevent the drop flowing down the tear sac.

Topical Glaucoma Medications – common concerns

4. Glaucoma drainage surgery

Glaucoma surgery can be performed to reduce the pressure in the eye. If untreated, pressure-related damage to the optic nerve can lead to permanent loss of vision.

When is a glaucoma surgery performed?

Glaucoma surgery is performed if drops and/or laser are ineffective or unable to lower the pressure to a satisfactory level.  It may also be performed when drops are poorly tolerated or difficult to administer. Two types of glaucoma surgery are commonly performed: trabeculectomy and drainage tube insertion

Trabeculectomy

Trabeculectomy

Trabeculectomy is the most common operation performed to lower eye pressure.

A small channel is made to drain fluid from the eye and create a reservoir of fluid located underneath the eye’s natural lining, the conjunctiva. This reservoir, known as a bleb, may appear like a blister-like bump on the white of the eye, usually covered by the upper eyelid. Anti-scarring drugs (5-fluorouracil or Mitomycin C) may be used to improve the success of the operation.

A trabeculectomy is most often carried out under a local anaesthetic.

The aim of the operation is to reduce the risk of further damage to the optic nerve by lowering the eye pressure. It will not improve your sight, but will hopefully help protect your vision in the long term.

Drainage tube insertion

trabeculectomy drainage tube

A drainage tube is inserted into the eye to lower eye pressure.

The device has the appearance of a small hollow tube connected to a drainage plate. The tube is inserted into the front of the eye to drain fluid. This fluid travels along the tube to enter into the plate. This plate is hidden from view outside and behind the eye.

The tube is tied off with a dissolvable suture that takes 6-7 weeks to dissolve. This is why the pressure is characteristically high for 6 weeks after this procedure. The lumen of the tube is stented by a thick piece of black nylon to prevent over-drainage. This can be later removed if the pressure remains high.

The surgery is most often carried out under a general anaesthetic.

The aim of the operation is to reduce the risk of further damage to the optic nerve by lowering the eye pressure. It will not improve your sight, but will hopefully help protect your vision in the long term.