Glaucoma Treatment Options
Denver Glaucoma Treatments
If you are diagnosed with glaucoma, treatment is available to save your vision. The primary goal of glaucoma treatment is to lower the intraocular pressure (IOP) and stop the optic nerve damage. Several kinds of treatment are available to lower IOP. These include eye drops, laser therapy, and surgery.
Eye Drops (First Line of Activity)
Eye drop medications lower IOP by either reducing the amount of fluid entering the eye or increasing the amount of fluid exiting the eye. There are several different kinds of glaucoma medications, and each differs in terms of both its ability to lower IOP and its potential side effects. Laser therapy often is used when medications fail to lower IOP; it is also used for patients who cannot tolerate medications due to side effects. If eye drop medications or laser therapy fail to bring the intraocular pressure down to a safe range, surgery is available to lower this level.
SLT, Selective Laser Trabeculoplasty and ALT, Argon Laser Trabeculoplasty
Laser trabeculoplasty is a gentle and non-invasive treatment for glaucoma. Selective Laser Trabeculoplasty is an advanced type of laser treatment to manage patients with open-angle glaucoma.
Instead of burning tissue as in ALT, SLT selectively stimulates only precise pigmented cells to activate increased fluid drainage. Both SLT and ALT produce comparable drops in IOP; however, SLT does not have the associated damage to other tissues and adverse scarring effects. For this reason, where ALT is limited to one or two treatments, SLT has the potential to be repeated more often. This procedure is a treatment option for most glaucoma patients but is in particular suited to patients who cannot tolerate or are unable to adequately self-administer important glaucoma medications.
SLT is most often performed in the office and only takes about 10-20 minutes. Prior to the procedure, eye drops will be given to prepare the eye for treatment. The laser applications are made through a microscope, similar to the one used for eye examinations. About two hours of office time should be planned so the IOP can be checked after the eye is treated.
Commonly no special post-operative medications are needed and there are no restrictions on activities after treatment. Most patients will have to return for follow up visits to re-check the treated eye. It often takes several weeks for the pressure to be lowered and for the full response of the procedure to be known. Over-the-counter pain medications are fine to use for any discomfort. Unlike some glaucoma medications, there are no incidences of allergy or systemic side effects with SLT. Complications are minor but may include inflammation, temporary increase in IOP, conjunctivitis, or eye pain. For more information about SLT and how it may benefit you, please ask the doctor.
Trabeculectomy is the most common surgical method used to reduce the pressure associated with glaucoma. During the procedure, the surgeon removes a tiny section of the wall of the eye, creating a drain which allows for the outflow of aqueous fluid. Using instruments under an operating microscope, your surgeon creates an opening in the white of your eye (sclera) and removes a small piece of the trabecular meshwork. The aqueous humor can now freely leave the eye through this hole. As a result, your eye pressure will be lowered. The hole is covered by the conjunctiva, so trabeculectomy leaves no open hole in your eye. You will need several follow-up visits and to use antibiotic and anti-inflammatory eye drops to fight infection and scarring of the newly created drainage opening (bleb).
iStent® Trabecular Micro-Bypass
Today, adding another step to your cataract surgery that may allow you to treat your mild to moderate open-angle glaucoma in an entirely new way. The iStent Trabecular Micro-Bypass Stent is designed to reduce your eye pressure and you have it done at the same time you have cataract surgery. During cataract surgery, iStent is implanted and creates a lasting opening in the drainage system in the eye. This restores the aqueous outflow mechanism lowers and controls pressure within the eye
Another type of surgical procedure, called drainage implant surgery, may be an option for people with secondary glaucoma or for children with glaucoma. Also known as “aqueous shunts” or “glaucoma drainage devices, ”we’ll refer to them simply as “implants.”
The idea behind implants is to enhance standard glaucoma surgery by positioning a device that will help keep the surgically-created drainage opening from healing and closing down. Many current implants include a tube through which the aqueous fluid passes. Others are solid and promote the flow of fluid along the surface of the implant. Regardless of type, implants have a common goal - to lower IOP by increasing outflow. Some implants commonly used are “valved” (Ahmed ) and “non-valved” (Molteno, Baerveldt) designs.
A hole or bleb is created similarly to conventionally trabeculectomy surgery. With implant surgery, most of the device is positioned on the outside of the eye under the conjunctiva. A small tube or filament is carefully inserted into the anterior chamber of the eye, just in front of the iris (colored part of the eye). The fluid drains through the tube, or along the filament, into the area around the back of the implant where fluid collects. The tube provides a passageway for the movement of this fluid out of the eye and into a place where the capillaries and lymphatic system reabsorb it back into the body.
There is often an inflammatory reaction immediately after surgery. This is commonly associated with variable IOP (often IOP elevation), and usually stabilizes within four to six weeks There is the possibility of IOP being too low. This is known as “hypotony.” Additionally, the implant may interfere with other ocular tissues such as extraocular muscles (muscles that move the eye from side to side) and the cornea. Like most surgeries, those with a smooth uncomplicated surgical course do the best over time.