How to treat glaucoma?

Treatment for glaucoma is not fully curative and mainly serves to maintain, halt, or slow the progression of the disease. There are a number of modalities, ranging from simple eye drops, to laser and surgery. Each form of treatment has a place and provides specific benefits. It is important that you make your decision regarding treatment choices together with your doctor.

What are the treatments for glaucoma?

The treatment of glaucoma depends on the severity of the condition. In order to maintain the most normal level of vision for the longest time, it is important for a person with glaucoma to have regular check-ups with an eye care professional. There are two types of treatments: medical treatments and surgical treatments.

For early stage glaucoma, a topical ophthalmic medical treatment is recommended. These medications are designed to reduce intraocular pressure and prevent progression of glaucoma. However, with time, the medicine may stop being as effective as it once was. To that end, eye care professionals will want to review the medication and dosage to determine if a new medication should be prescribed.

For an advanced case of glaucoma, surgery may be recommended. Most often, there is a need to perform a trabeculectomy or glaucoma drainage implant surgery in order to successfully lower the intraocular pressure in an advanced case. More specifically, a trabeculectomy is a glaucoma procedure that reduces intraocular pressure by creating a hole in the eye's thin outermost layer of tissue and surgically creating a channel for fluid to flow from the eye.

Glaucoma surgery is not a cure for glaucoma; it is instead a medical procedure for lowering intraocular pressure. Surgery may improve vision and reduce the progression of glaucomatous damage in certain eyes. However, certain eyes may have a loss of vision due to this medical procedure. It is always a good idea to discuss with your doctor when surgery is the best option for you.

When it is not appropriate for you to have surgery, your doctor may still want to treat you with glaucoma medications to lower your intraocular pressure. These include medications that you take as eye drops (such as beta-blockers and prostaglandin analogues) or medications that you take by mouth (such as alpha agonists, carbonic anhydrase inhibitors, and beta-blockers). Most glaucoma medications need to be taken daily to be effective.

Glaucoma treatments that may lower your intraocular pressure and slow or halt glaucoma progression include:

  • oral medications
  • injections
  • eyedrops
  • surgical procedures

Glaucoma surgery is usually an option for people who have advanced glaucoma or have not been able to control their glaucoma with other treatments.

Treatment for glaucoma can be divided into medical and surgical.

Surgical treatment options for glaucoma

Intraocular pressure (IOP) reduction by surgery is the most important therapy for glaucoma. A low IOP reduces the risk of the progression of visual field loss and nerve fiber damage. In the past it was believed that the low IOP treatment for glaucoma should be below 13 mmHg. However, recent large scale studies do not recommend such a strict IOP level. The aim of the surgery is to reduce the IOP to normal values without damaging the eye tissues. The maximum pressure which the eye can take is approximately 20 mmHg. A low IOP treatment (10 mmHg or less) is appropriate for patients who are at a high risk of glaucoma progression.

In the early stages of glaucoma, it is possible to lower the IOP without surgery by the use of eye drops and eye medication.

Open-angle glaucoma

Open-angle glaucoma (OAG) is usually treated by surgery. First the disease is tested for progression by an ophthalmologist. Further treatments are as follows:

  • surgical glaucoma filtration (shunt) - surgery is done for creating the pathway trabeculectomy - lower IOP without surgery
  • laser trabeculoplasty - changing the pathway in the eyeball
  • trabeculotomy - lower IOP without surgery

Vascular glaucoma

In the vascular form of glaucoma a laser- or photo coagulation is done, so as to re-build the inner wall of the blood vessels. In both forms a filtering surgery is done.

Closed-angle glaucoma

In this form of glaucoma a laser iridotomy is done. This operation is done without anaesthesia.

Endocyclophotocoagulation

In this procedure the ciliary body is destroyed using heat, so as to lower the IOP. This surgery is usually done under general anaesthesia. This surgery can also be done under local anaesthesia in the doctor's office.

Myrtle oil

In the early stages of glaucoma, a patient can have a drop of myrtle oil. This oil stops the production of fluid in the eyeball. If this doesn't work, further treatments will be discussed with the patient.

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