Do you have glaucoma? Do you want to stop your glaucoma drops?
There are multiple treatment options available that can eliminate or reduce your need for glaucoma drops.
Glaucoma is an eye condition that damages the optic nerve at the back of the eye. In simple terms the pressure in the eye is too high and damages the nerve resulting in loss of vision. Usually peripheral vision is lost first and there are no symptoms until the disease is moderately advanced. Advanced glaucoma results in tunnel vision and even blindness.
Fortunately, with modern diagnostic techniques and eye screening, most patients are diagnosed with early to moderate disease. Glaucoma is an extremely treatable disease, although treatment is lifelong. It is important that anyone diagnosed with glaucoma sees an eye health professional regularly.
- Glaucoma is a common disease, it’s incidence increases with age.
- 3% of the population over 40 has glaucoma.
- 15% of the population over 80 has glaucoma.
Glaucoma is a genetic disease, if you have a first degree relative with glaucoma you have a 10 fold increased risk of developing glaucoma. Of course, you can still have glaucoma if there is no family history of glaucoma.
Types of Glaucoma
1. Primary open angle glaucoma
This is the most common form of glaucoma. It is caused by elevated pressure in the eye. It occurs when the drainage component of the eye is open, the angle is open. There are several subgroups including pigment dispersion glaucoma and pseudoexfoliative glaucoma. Normal tension glaucoma is a form of primary open angle glaucoma that is associated with normal pressure in the eye.
2. Angle closure glaucoma
This type of glaucoma can be acute or chronic. It is caused by elevated pressure in the eye. It occurs when the drainage of the eye is blocked by the peripheral iris, the angle is closed.
3. Secondary glaucoma
This type of glaucoma is secondary to other eye diseases, such as diabetes, uveitis or trauma.
Diagnosis of Glaucoma
Glaucoma can be diagnosed by an ophthalmologist or optometrist.
How glaucoma is diagnosed
- Eye examination- eye pressure and appearance of the optic nerve
- Photographs- serial photographs of the optic nerves over time
- OCT scans- ocular coherence tomography
- Humphrey visual field testing
Treatment of Glaucoma
Correct treatment can slow or stop the disease and reduce the risk of tunnel vision or even blindness. Treatment of glaucoma is aimed at reducing eye pressure and can be separated into 3 groups.
- Eye drops
Eye drops have traditionally been the main treatment for glaucoma. These drops lower the eye pressure. There are a variety of different eye drops, which work in different ways.
Whilst eye drops are successful for many patients, they can be associated with side effects, including eye redness, irritation and allergic conjunctivitis. One of the big problems with glaucoma drops is that patients often forget to take them and don’t use them as instructed– this has been well documented in many clinical studies.
There is new evidence that suggests that eye drops are not the best form of treatment to use first in glaucoma and that laser may be a better and more cost-effective option in the long run.
Lasers in Glaucoma
Selective laser trabeculoplasty
This laser applies very gentle laser burns to the trabecular meshwork, the part of the eye that drains fluid from the eye.
This very gentle laser does not burn a hole, rather it causes inflammation which the body then targets and heals. It is analogous to hosing a dirty sponge, thereby improving its absorption. SLT is very safe.
It is effective in 75% of patients in lowering the eye pressure. The laser is not a cure for glaucoma, the pressure in the eye can go up again over time. Fortunately, you can have a second laser treatment if you’re eye pressure goes up again.
A recent large study published in The Lancet, the LiGHT trial(2019), showed that 75% of patients initially presenting with glaucoma who had the laser did not need eye drops after three years.
Also none of the patients in the laser group needed glaucoma surgery (trabeculectomy), unlike the eye drop group. It is thought 24-hour eye pressure control is better with the laser than with glaucoma eye drops. SLT is now an accepted first line treatment for primary open angle glaucoma and normal tension glaucoma.
YAG Peripheral Iridotomy
A YAG laser is used to place a small hole in the peripheral iris of the eye. This treatment is used in all patients with angle closure. It creates an alternative pathway for the fluid in the eye to travel, thus changing the anatomy of the drainage angle of the eye and relieving elevated pressure in the eye. It is often a very successful treatment.
For further information about the laser see the above video titled "What are Narrow Eye Angles".
Minimally Invasive Glaucoma Surgery/MIGS
The iStent devices are to two tiny titanium tubes that are placed into the trabecular meshwork, which is the part of the eye that drains fluid from the eye. These are usually placed at the time of cataract surgery. They can cause a moderate reduction in eye pressure, thus reducing the need for glaucoma drops.
Xen Gel Implant
This is a relatively new implant. It is a tiny porcine gel tube that is injected into the eye. It connects the inside of the eye (the anterior chamber) to the surface of the eye (sub-conjunctival space), thus lowering the eye pressure. This device is reserved for patients in whom laser and eye drops are not controlling their eye pressures and their glaucoma is progressing.
This is an operation that creates a bubble, also known as a bleb, on the surface of the eye. Anti- scarring medication is applied at the time of surgery to prevent long term scarring. This operation creates an alternative pathway for the fluid of the eye to flow, thereby lowering the eye pressure.
Many patients can stop their glaucoma drops after trabeculectomy surgery. Trabeculectomy surgery is performed on patients in whom laser and eye drops have been unsuccessful in lowering their eye pressures adequately and their glaucoma is progressing.