Glaucoma Surgery and Treatment

What about Glaucoma

Glaucoma is a common condition where increased pressure within the eye causes damage to the optic nerve. It can affect anyone, but it is more common in people aged 60+. The condition is the result of an increase in aqueous fluid in the front of the eye and, if not treated, can lead to loss of vision.

In the early stages of glaucoma, most people are asymptomatic, which means that the only way to diagnose the condition is through regular eye checks. Although this can happen to anyone, the condition is known to be hereditary. This means that if a direct member of your family has glaucoma, this puts you at higher risk of developing the condition.

Before the treatment of glaucoma

You may experience severe eye pain, see halos around the lights, have nausea or vomiting, headache or loss of vision.

Glaucoma, Glaucoma Surgery, High Intraocular Pressure, Loss of vision Glaucoma, Glaucoma Surgery, High Intraocular Pressure, Loss of vision
After the treatment of glaucoma

If treated immediately your symptoms will subside and there should be no damage to your vision.

Glaucoma Surgery and Treatment - eye clinic

The most common form of glaucoma, known as open-angle glaucoma, usually affects both eyes. The early stages do not cause obvious symptoms. The condition is caused by an obstruction that affects the circulation of aqueous humor flowing in and out of then eye. This causes the pressure within the eye to rise.

Because of the slow progression, many people are not aware that their vision is becoming impaired. For this reason, it is usually picked up during a regular eye examination or when your doctor determines that you may be at risk and refers you to a glaucoma specialist.

Although it is not clear why some people develop the condition.

The following are known to be risk factors:

  • Your ethnicity: Glaucoma is more common in people of Asian, African, Caribbean, and Hispanic descent.
  • Your age: The condition becomes more common as you get older. It is less common in people under the age of 40 (rarely, children can also be affected).
  • Your family history: It is known to be hereditary, so risk factor is increased if a member of your immediate family has been diagnosed.
  • You suffer from the following medical conditions: Hypertension (high blood pressure), diabetes, heart disease or sickle cell anemia.
  • You have been diagnosed with the following eye diseases: Thin corneas, high intraocular pressure, severe myopia or hypermetropia, or you have a significant history of poor vision.
  • You regularly take high doses of certain steroid drugs: Such as prednisolone.

Other, less common, forms of glaucoma include:

  • Angle-closure glaucoma: This occurs when the drainage of eye fluid is suddenly blocked, causing a rapid increase in eye pressure. It is caused by the change of position of the iris. It tends to occur in one eye and, when it occurs very quickly, it is a medical emergency. When one eye is affected, the other eye is also in danger.
  • Secondary glaucoma: This is due to a separate underlying condition, such as uveitis (an inflammatory condition of the eye), cataracts or diabetes.
  • Childhood glaucoma: Also called congenital glaucoma, it is a rare condition that develops at a young age.

There are a variety of surgical treatments, all of which aim to reduce the eye pressure. If glaucoma eye surgery is deemed appropriate, then a specialist glaucoma surgeon has a number of options available.The choice will be determined by the type of glaucoma, its severity and any other health problems you have.

The possibilities of laser treatment and glaucoma eye surgery include:

  • Selective laser trabeculoplasty (SLT): A form of laser glaucoma surgery used to treat open-angle glaucoma, whereby the surgeon increases the fluid drainage from the eye.
  • Laser peripheral iridotomy (LPI): Another type of laser glaucoma surgery, the pressure within the eye is reduced by making a small opening in the iris itself. This is commonly used in cases of closed angle glaucoma.
  • Trabeculotomy (Filtering Surgery): This is a glaucoma surgical procedure that involves removal of a tiny areaof the eye wall (sclera) to allow drainage of aqueous humor.
  • Antiglaucoma Valve Surgery: Again, an option for all types of glaucoma involves placing a tiny tube within the eye through which the aqueous fluid can drain.

Selective laser trabeculoplasty (SLT) is a popular choice for the treatment of the most common forms of glaucoma. It is often the procedure of choice when eye drops and/or other drugs have failed to reduce internal eye pressure to a sufficient extent or the side effects are very serious.  There is a possibility that it will have to be repeated in the future.

SLT is performed by a glaucoma specialist surgeon, your eyes will become numb with eye drops and a special contact lens placed on the eye. The surgeon uses a high-energy laser to make up to 100 mini scale burns on the trabecular meshwork within the eye. It takes less than 10 minutes to performand there is very little discomfort.

Glaucoma is usually diagnosed during a routine eye examination. Sometimes your doctor may refer you if he thinks you may be at risk. Ifyou are diagnosed with the condition, then your regular monitoring will be necessary. The tests for glaucoma are simple and painless.The specialist will use drops that dilate the pupil, allowing them to examine your optic nerve in detail. Images will be taken so that they can be compared in the future.  You’ll also undergo tests that test your peripheral field of vision and carry out an eye pressure test.The latter is known as tonometry. The first course of action to treat the condition is usually eye drops, medication, or a combination of the two. 

 Eye drops work in one of two ways. They either increase the drainage of aqueous humor from the eye or decrease its formation. Either way, this helps reduce eye pressure. Oral medication can also do the same, with carbonic anhydrase inhibitors or beta-blockers being the most commonly used. This drug route often has unwanted side effects. These include redness and stinging of the eyes, blurred vision and irritation, and allergies.In some cases, the drugs may affect the cardiovascular system. It is important to tell your glaucoma specialist about any other medication you are taking to prevent adverse drug interactions.

If the above-mentioned side effects become excessive or eye drops and medication fail to adequately treat the problem, then the glaucoma specialist is likely to recommend surgery to you. Whether this involves microsurgery or laser surgery it may mean that you no longer need to use drops and/or medication to control the glaucoma. Surgical options all work to reduce the eye pressure by increasing drainage.

  • Trabeculoplasty: To open the drainage of the eye
  • Peripheral Iridotomy: Creates a tiny hole in the iris that helps the aqueous humor to flow freely
  • Cyclophotocoagulation: The middle layer of the eye is treated to reduce the production of aqueous humor
  • Trabeculectomy: A filtering procedure created by the removalof a tiny area of the eye wall
  • Antiglaucoma valve: The placement of a small tube into the eye through which the aqueous humor can flow.

Not all operations are suitable for all types of glaucoma, nor arethey the right option for eachindividual. The glaucomaspecialist will determine the optimal solution in conjunction with you. Whatever option is chosen, you will need regular monitoring afterwards to ensure the treatment is working.