What Are the Treatment Options for Glaucoma?
The optic nerve carries visual information from the eye to the brain, and glaucoma is a group of eye conditions that damage this nerve. In many cases, this damage is linked to elevated intraocular pressure (IOP). The eye continuously produces a clear fluid called aqueous humor; this fluid normally drains through a mesh-like tissue called the trabecular meshwork, located where the iris meets the cornea. When the drainage system becomes blocked or works less efficiently, fluid can accumulate and raise pressure inside the eye. Treatments aim to lower eye pressure with eye drops, oral medications, laser procedures, or surgery. Here’s information on some common treatment options for glaucoma:
Laser Treatment Options
Open-angle glaucoma develops gradually as the drainage tissue becomes less effective over time, while angle-closure glaucoma occurs when the iris blocks the drainage angle. Laser peripheral iridotomy (LPI) is commonly used for angle-closure glaucoma or for eyes with narrow drainage angles. During the procedure, an ophthalmologist uses a laser to create a small opening in the outer edge of the iris, giving aqueous humor an alternate path. LPI is an outpatient procedure, and it usually takes only a few minutes per eye. Your ophthalmologist will schedule follow-up visits to check eye pressure and confirm the opening remains clear.
Selective Laser Trabeculoplasty
Selective laser trabeculoplasty (SLT) is often used for open-angle glaucoma. Some patients receive SLT as an initial treatment, while others receive it alongside eye drops. This laser treatment targets pigmented cells within the trabecular meshwork using low-energy pulses to stimulate a biological response that may improve fluid drainage. SLT leaves surrounding tissue largely intact, allowing it to be repeated in some cases. SLT focuses on drainage, but cyclophotocoagulation focuses on fluid production.
Cyclophotocoagulation
Cyclophotocoagulation takes a different approach, but also uses lasers. Rather than addressing drainage, it targets the ciliary body, the structure that produces aqueous humor. The laser treats part of this tissue to reduce fluid production. Ophthalmologists may recommend cyclophotocoagulation when other treatments have not adequately lowered eye pressure. It may be delivered from outside the eye or through an endoscopic approach during surgery.
Goniotomy
Goniotomy is a minimally invasive surgery that opens or removes a portion of the trabecular meshwork tissue, originally developed to treat congenital glaucoma in children. Today, surgeons also use updated techniques and instruments for certain adults with open-angle glaucoma. During goniotomy, the surgeon views the drainage angle through a special lens called a gonioscope. A small blade or device then cuts through the meshwork; this incision gives fluid more direct access to Schlemm’s canal, the eye’s natural drainage channel. Goniotomy is sometimes combined with cataract surgery.
Trabeculectomy
Trabeculectomy is a traditional glaucoma surgery, but ophthalmologists may still use it when medications or laser procedures haven’t controlled eye pressure effectively. For a trabeculectomy, the surgeon creates a small flap in the sclera, the eye’s white outer layer. Fluid can then drain through this opening into a pocket called a bleb. The bleb forms under the conjunctiva, the thin membrane covering the white of the eye.
The bleb usually sits beneath the upper eyelid, so others cannot see it. Surgeons sometimes apply medications during the procedure to reduce scarring at the surgical site. Trabeculectomy requires careful postoperative monitoring. This means patients attend several follow-up appointments in the weeks after surgery to support recovery.
Manage Your Glaucoma Effectively
The appropriate treatment for your glaucoma depends on its type and stage, as well as your overall eye health. Eye surgery isn’t always necessary, as many patients manage eye pressure with prescription eye drops or oral medications. Regular eye exams allow an ophthalmologist to track changes in eye pressure and the optic nerve over time. A specialist can review your medical history, measure your eye pressure, and explain which options may suit your needs. To learn more about your treatment options, contact an ophthalmologist today.
