All glaucoma surgery procedures (whether laser or non-laser) are designed to accomplish one of two basic results: decrease the production of intraocular fluid (aqueous humor) or increase the outflow (drainage) of this same fluid. Occasionally, a procedure will accomplish both.
Currently the goal of glaucoma surgery and other glaucoma treatment is to reduce or stabilize intraocular pressure (IOP). When this goal is accomplished, damage to ocular structures — especially the optic nerve — may be prevented.
No matter the treatment, early diagnosis is the best way to prevent vision loss from glaucoma. See your eye care practitioner routinely for a complete eye examination, including a check of your IOP. People at high risk for glaucoma due to elevated intraocular pressure, family history, ethnic background, age or optic nerve appearance may need more frequent visits to the eye doctor.
When Is Glaucoma Surgery Needed?
Depending on the type of glaucoma you have, different treatment options may be considered.
Non-surgical options include the use of topical eye medications (glaucoma eye drops) or oral medications (pills).
Most cases of glaucoma can be controlled with one or more drugs. But some people may require surgery to reduce their IOP further to a safe level by improving the outflow or drainage of fluids. Occasionally, surgery can eliminate the need for glaucoma eye drops. However, you may need to continue with eye drops even after having glaucoma surgery.
Some recent studies indicate that a laser procedure known as selective laser trabeculoplasty (SLT) may be equally as effective as glaucoma eye drops for lowering internal eye pressure. This laser surgery might be considered a primary treatment, particularly for people who find it difficult to comply with the strict, regular schedule needed for administering eye drops.
Another procedure called a trabeculectomy creates an artificial drainage area. This method is used in cases of advanced glaucoma where optic nerve damage has occurred and the IOP continues to soar. A third common option is a shunt, a device that a surgeon implants in your eye to improve fluid drainage.
To increase outflow of internal eye fluid, an ophthalmologist performs laser trabeculoplasty with a laser that creates tiny holes in the filtration angle of the eye, where the cornea and iris meet.
A newer procedure, selective laser trabeculoplasty, creates minimal heat damage to adjacent tissue, which generally means the procedure can be repeated safely.
Laser trabeculoplasties are usually performed as an adjunct to a patient’s ongoing eye drop therapy.
Studies are now investigating whether SLT could be used routinely as a first-line therapy for treatment of open-angle glaucoma and other types of glaucoma, even before eye drops are used.