Damage to one’s vision from glaucoma cannot be reversed. The goal of glaucoma treatment is to slow and hopefully halt the progression of the damage. There are numerous treatment options available today.
Glaucoma is treated by lowering the pressure within the eye. This is accomplished by increasing the outflow of fluid from within the eye or slowing the production of fluid within the eye. The doctor will determine what eye pressure is appropriate for each individual patient based on the stage of disease the patient has, the level of eye pressure when they presented with glaucoma, as well as other factors.
Treatments consist of eye drops, laser procedures, minimally invasive surgery, filtering surgery and drainage tube surgery. Below we will break this down in more detail.
With eye drops, using the medications as prescribed by your doctor is extremely important. Missing a dose will result in the pressure within the eye bouncing back up.
Prostaglandins – This is a class of medications that are typically dosed 1 drop at night. They work by increasing the outflow of fluid from within the eye. Examples include: latanoprost, Lumigan, Travatan Z, Zioptan, Vyzulta and Xelpros.
Beta blockers – This is a class of medications that typically dosed 1 drop in the morning. They work by decreasing the production of fluid within the eye. Examples include: timolol, Betimol, Istalol and Betoptic.
Alpha-adrenergic agonists – This is a class of medications that are typically dosed 2-3 times per day. They work by both decreasing the production of fluid within the eye and increasing the outflow of fluid from within the eye. Examples include: Alphagan P and Iopidine.
Carbonic anhydrase inhibitors – This is a class of medications that are typically dosed 2-3 times per day. They work by decreasing the production of fluid within the eye. Examples include: dorzolamide and Azopt.
Rho kinase inhibitors – This is a class of medication that is typically dosed 1 drop at night. This medication works by increasing the outflow of fluid from within the eye. Rhopressa is the only medication within this class that is currently available.
Miotics – This is a class of medication that is typically dosed 1 drop 4 times per day. This medication works by increasing the outflow of fluid from within the eye. Pilocarpine is an example of this class of medication.
Trabeculoplasty – This is a laser procedure done in your doctor’s office that unclogs the drainage channels within the eye. It may take 4-6 weeks for it to reach its full effect.
Peripheral iridotomy – This is a laser that is done in patients with a narrowed drainage area to reduce the risk of developing acute angle closure glaucoma.
Minimally Invasive Glaucoma Surgery (MIGS)
This is a group of procedures that have been developed recently with lower risk to the patient than filtering and drainage tube glaucoma surgeries. With around 50% of glaucoma patients requiring 2 or more medications to control their eye pressure, MIGS procedures offer a surgical alternative with a good safety profile to minimize the number of medications a patient needs. Examples of MIGS procedures include, but are not limited to the following.
iStent Inject – With this procedure, the surgeon implants 2 stents that allow fluid to bypass the trabecular meshwork, which is the first tissue through which fluid must pass as it exits the eye. It directs the fluid into Schlemm’s canal, where it then migrates through the natural outflow pathway from the eye to the systemic circulation. This device is the smallest medical device known to be implanted in the human body.
Hydrus Microstent – This procedure involves implanting a stent within the drainage system of the eye. This stent provides an opening within the trabecular meshwork, the first tissue through which fluid passes as it exits the eye. It also stents open ¼ of Schlemm’s canal, which is the next structure through which fluid passes. The goal is to enhance the natural outflow of fluid from the eye to the systemic circulation.
Ab-Interno Canaloplasty – With this procedure, the surgeon enters the eye with an incision similar to cataract surgery. He then dilates Schlemm’s canal, which is a structure that circles the eye in an area near where the white part of the eye and colored part of the eye meet. It is responsible for draining fluid from the eye into the systemic circulation. Dilation of Schlemm’s canal acts like angioplasty, opening the structure, enhancing the flow of fluid through it.
Trabeculectomy is a surgical procedure that lowers eye pressure in patients with glaucoma by creating a pathway for fluid that bypasses the natural outflow channels of the eye. With trabeculectomy, a small hole is created in the white part of the eye to bypass the eye’s natural drainage pathway.
Drainage Tube Surgery
With glaucoma tube surgery, a tube shunt is placed within the eye, extending to an area overlying the white part of the eye. This shunt bypasses the eye’s natural drainage pathway to help lower one’s eye pressure.
As you can see, there are numerous treatment options for glaucoma. Your doctor will determine what treatment is best for you based on the following:
• Monitoring the optic nerve through dilated examination
• Monitoring the eye pressure over time
• Monitoring visual field testing to determine any progression of the disease process
• Monitoring of the retinal nerve fiber layer and ganglion cell complex within the retina for any signs of progression of the disease process