9 Things to Know About Glaucoma Surgery and Other Treatments
There's no cure for glaucoma yet, but there are treatments that can help save your vision.
Glaucoma treatment options
Glaucoma snatches the sight of millions of people every year, especially elderly people. In the United States, the disease is the second leading cause of blindness.
Although glaucoma is associated with elevated eye pressure, experts have not happened upon an exact cause or causes.
Right now, there’s no cure for the disease and no way to reverse the damage. The bright side is that treatments are available to stabilize vision loss.
Learn about the three main types of glaucoma treatments and therapy: eye drops, laser treatment, and surgery.
Glaucoma damages the optic nerve
Over time, glaucoma damages your optic nerve, the superhighway shuttling signals from your eye to the brain and back again.
“If the optic nerve is damaged, you can’t see,” explains Rahul T. Pandit, MD, associate professor of clinical ophthalmology at the Blanton Eye Institute, Houston Methodist Hospital. “High eye pressure is one of the strongest risk factors.”
The most common form of glaucoma is primary open-angle glaucoma, which is largely a drainage problem. Normally, fluid or the aqueous humor flows through your eye unobstructed. With glaucoma, the fluid has trouble draining, increasing the eye pressure.
Acute angle-closure glaucoma is less common and usually comes on suddenly, bringing with it intense eye pain, nausea, blurry vision, and eye redness. This type of glaucoma is from a blockage in the eye’s drainage system.
(Here are 7 signs you’re at high risk for glaucoma.)
Treatments aim to lower eye pressure
“Not all people with glaucoma have high eye pressure, and not all people with high eye pressure get glaucoma. But all treatment is focused on lowering eye pressure,” says Andrew Iwach, MD, clinical spokesperson for the American Academy of Ophthalmology (AAO).
Easing up on eye pressure relieves strain on the optic nerve. And while this can’t reverse the damage already done, it can minimize future damage.
(You may want to know about 11 signs your eyes could be in danger.)
Eye drops are a first choice
Doctors usually start glaucoma treatment with prescription eye drop medications. These daily drops are one of the least disruptive options.
The drugs reduce eye pressure either by reducing the fluid your eye makes or by helping the fluid drain better.
The U.S. Food and Drug Administration approved two new glaucoma eye drops in 2017: Vyzulta and Rhopressa, which lower eye pressure through several different mechanisms.
“There are certain drops that may have additional effects,” Dr. Pandit says.
Bear in mind these medications can have side effects, including stinging, itching, eyelash growth, dry mouth, and changes in your heartbeat.
Laser therapy is safe and easy
Laser therapy can be either a first-line treatment (especially if a person doesn’t like eye drops) or a second-line treatment. A selective laser trabeculoplasty (SLT) procedure reduces eye pressure by improving the eye’s drainage angle.
It lacks the side effects of eye drops and is done in a doctor’s office, though the effects usually only last one to five years.
Most glaucoma cases can be controlled with topical eye drops and in-office laser treatments, Dr. Iwach says.
Cataract surgery can lower eye pressure
Vadym Terelyuk/Getty Images
Surgery to repair cataracts can reduce eye pressure. It can also be combined with minimally invasive glaucoma surgery (MIGS). MIGS can reduce eye pressure by creating new drainage pathways or adding shunts.
Overall, about 11 percent of glaucoma patients require more traditional surgery. The most common is a procedure called trabeculectomy, which creates a new drainage channel for eye fluid, according to the Glaucoma Research Foundation.
Another option is to insert a drainage tube in the eye.
(Read about 7 foods that may improve your eyesight.)
The risks of marijuana outweigh the benefits
While it’s true cannabis lowers eye pressure, the effect only lasts for three to four hours, according to the AAO. The potential benefits for glaucoma may therefore only be sustained if you smoke (or otherwise ingest) it six to eight times per day.
There are also potential risks from cannabis use, the AAO points out, such as lung damage from long-term smoking or even damage to the optic nerve.
More treatments are on the way
Researchers are developing new medications to help treat glaucoma and to treat it better. Expect also to see contact lenses that deliver drugs and implantable pumps that would dispense the eye drops as you need them, much like an insulin pump for diabetes.
Scientists are also working on ways to reverse the damage so your vision will actually improve.
(Learn about 12 signs you need to see an eye doctor.)
Early detection is the only way to save your sight
The earlier you treat glaucoma, the longer you’ll be able to see. The tragedy is that when symptoms like blind spots and losing your peripheral vision show up, the damage is already done.
“With glaucoma, you can have severe damage and have no clue,” Dr. Iwach says. “That’s why it’s imperative to get regular screening.”
The AAO recommends adults get a comprehensive dilated eye exam when you turn 40. “That age is when things start changing, but it’s early enough to catch and do something about it,” Dr. Iwach says.
If you have a family history of eye disease or if you have diabetes or high blood pressure, start earlier. Your doctor will tell you how often you need to get follow-up exams. People 65 and older should schedule eye exams every year or every other year.
See a doctor for check-ups and emergencies
Ideally, make an appointment to see an ophthalmologist for a dilated eye exam when you turn 40, or earlier if you have risk factors. Your doctor will tell you how often to come back.
Seek emergency care if you develop symptoms of angle-closure glaucoma. This can be severe pain in your eye, nausea, red eye, and blurry vision.
You’ll need medication right away to save your eyes.
Now that you know about glaucoma treatment, check out these 20 simple habits that can improve your vision.
- National Eye Institute: "Glaucoma"
- American Academy of Ophthalmology: "Glaucoma Treatment"
- Glaucoma Research Foundation: "New Treatment Options for Managing Glaucoma"
- Harvard Medical School: "Glaucoma: What's new and what do I need to know?"
- Andrew Iwach, MD, clinical spokesperson, American Academy of Ophthalmology
- Rahul T. Pandit, MD, associate professor of clinical ophthalmology, Blanton Eye Institute, Houston Methodist Hospital
- American Optometric Association: "Glaucoma"
- Glaucoma Research Foundation: "The Path To A Cure for Glaucoma"
- Glaucoma Research Foundation: "Selective Laser Trabeculoplasty: 10 Commonly Asked Questions" Glaucoma Research Foundation: "What is MIGS?"
- National Library of Medicine: "Marijuana as Medicine? The Science Beyond the Controversy"
- Glaucoma Research Foundation: "Should You Be Smoking Marijuana To Treat Your Glaucoma?"
- American Academy of Ophthalmology: "Does Marijuana Help Treat Glaucoma or Other Eye Conditions?"
- American Academy of Ophthalmology: "Eye Exam and Vision Testing Basics"
- American Academy of Ophthalmology: "Get an Eye Disease Screening at 40"