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Treatment

It is important to be educated, informed and feel involved in your glaucoma treatment, particularly concerning eye drops; the mainstay of glaucoma treatment. Their use needs to be consistent and generally lifelong. Patients who are educated on the importance and goals of their treatment tend to more successfully adhere to their treatment. If you have glaucoma, your family members are at increased risk of having glaucoma as well and your siblings have about a 20% risk, so they must be checked. It would also be relevant for your children, as they get towards the age you were first diagnosed. It is best if you can tell your family members what specific type of glaucoma you have.
A/Prof Andrew White, Ophthalmologist, Westmead Hospital.


Although there is no cure for glaucoma, with treatment glaucoma can usually be controlled and further loss of sight either prevented or slowed.

Most people with glaucoma are able to manage their condition successfully with the use of eye drops and at times, laser treatment. At the time of diagnosis the information from tests, assessments and lifestyle, along with glaucoma type provides the information which will determine initial treatment. Read more about types of glaucoma

Treatments include:

Medications
Medications help by either reducing the production and inflow of aqueous fluid into the eye, or by increasing the outflow pathways to allow aqueous fluid to drain more effectively from the eye. Some medications have the ability to do both. The critical factor with medications is that it requires co-operation from patients.

  • Eye drops are the most common form of treatment and must be used as prescribed. The drops are varied to best suit the patient and the type of glaucoma. Remember – drops can only work if you use them correctly.
    See How to instil eye drops

  • Oral Medication (Acetazolamide) - a diuretic which may be used to treat open-angle glaucoma. This medication is usually used only for a short period because its effectiveness can reduce over time. 

Laser
Laser surgery may be performed in some cases of glaucoma. Different lasers are used to treat open and closed angle glaucoma. Laser can be applied to the iris or the trabecular meshwork to allow aqueous fluid to flow more effectively within the eye, and drain better by the normal drainage channels within the eye. Laser surgery, unlike incisional surgery, will not create a physical opening between the inside of the eye and the outside of the eye.

  • Laser Peripheral Iridotomy is a treatment used for patients who have or are at risk of developing acute angle closure or who have chronic narrow angle glaucoma 
  • Selective Laser Trabeculoplasty (SLT) is performed when eye drops do not stop deterioration in the field of vision. In many cases eye drops will need to be continued after laser. 
  • Cyclodiode Laser Treatment causes cyclodestruction, destroying a portion of the ciliary body, a structure in the eye which produces aqueous fluid. This can reduce the amount of fluid produced and therefore reduce pressure inside the eye.

Surgery

  • Minimally Invasive (or micro-invasive) Glaucoma Surgery (MIGS) operations, aim to open up the trabecular meshwork or Schlemm’s canal to allow more fluid to drain from the eye.
  • Incisional surgery (trabeculectomy or glaucoma drainage device) Incisional surgery may sometimes be required if the disease cannot be controlled using medications or laser, or the patient is intolerant of the above strategies. The requirement for incisional surgery becomes more urgent the more aggressive or advanced glaucoma becomes. Incisional surgery creates an alternate pathway for aqueous fluid to exit the eye. This fluid is drained by physically creating a pathway from within the eye to the space just under the whites of the eye under the upper eyelid. Aqueous fluid will then be absorbed by the fine blood vessels that are naturally found on the whites of the eye.

    1) Trabeculectomy is performed usually after eye drops and laser have failed to control the eye pressure. A new channel for the fluid to leave the eye is created. 

    2) Glaucoma drainage devices
    A tube–shunt drainage operation is sometimes offered for difficult to control or complex glaucomas, especially where other sorts of surgery may have failed or are likely to fail.

    Tube-shunt surgery (Seton glaucoma surgery) involves placing a flexible plastic tube with an attached silicone drainage pouch in the eye to help drain fluid (aqueous humor) from the eye. This type of surgery is usually done after a trabeculectomy has failed. If a person already has or is likely to form scar tissue in the eye, this type of surgery may be done at the start. There are many sorts of drainage implants. Some of the names include Molteno, Baerveldt and Ahmed. Broadly speaking, they work in a similar manner. 

Treatment can save remaining vision but it does not improve eye sight.