The goal of glaucoma treatment is to lower the pressure in the eye. By lowering the eye pressure, we are able to slow the progression of glaucoma, often to the point where we see no noticeable worsening of vision.
The target level of eye pressure varies from person to person and may change over time. The eye pressure may be lowered using medication eye drops, laser procedures, or surgery.
Laser Surgery for glaucoma
SLT (Selective Laser Trabeculoplasty) is a commonly performed laser surgery to treat glaucoma. In this procedure, a low power laser is used to treat the drainage area inside the eye called the trabecular meshwork. This treatment causes changes in the drain that allow the fluid in the eye to drain more easily, resulting in lower eye pressure. Laser trabeculoplasty has been performed for over 40 years in millions of patients. Most patients feel no pain during the procedure, which is performed in the office. Many patients choose Selective Laser Trabeculoplasty as first line therapy for treating glaucoma.
Iridotomy is a laser surgery to relieve or prevent angle closure glaucoma. The surgeon uses a laser to create a small hole in the iris, which allows the aqueous fluid in the eye access to the drain of the eye.
Cyclophotocoagulation is a laser surgery performed in the operating room in patients with more advanced or aggressive forms of glaucoma. In this procedure, the laser energy passes through the outer layers of the eye to treat the ciliary body, the muscle that creates the fluid that fills the eye. This treatment reduces the amount of fluid produced by the ciliary body, which results in lower eye pressure.
Incisional glaucoma surgery
For some patients, glaucoma treatment requires incisional surgery to adequately lower the eye pressure. The two primary types of incisional surgery are angle surgery and filtration surgery. Glaucoma surgery is frequently performed along with cataract surgery in patients who need treatment for cataracts and glaucoma.
Angle Surgery. When performing angle surgery, the goal is to rehabilitate the patient’s trabecular meshwork drain that is located in a position in the eye called the angle. Angle surgery helps many patients lower the pressure in their eye by improving the function of their eye’s natural drainage area, the trabecular meshwork. We commonly perform angle surgery including ABIC (Ab Interno Canaloplasty) and iStent implantation.
ABIC (Ab Interno Canaloplasty) is an angle surgery performed in the operating room that attempts to restore the function of the eye’s natural drainage system. Using a small incision in the front part of the eye, a small needle enters the drainage canal behind the trabecular meshwork. A microscopic catheter is then advanced through the drainage canal to open the canal and clear small areas of scarring and obstruction. As the catheter is retracted, a thick gel is expressed from the tip of the catheter to inflate the drainage canal. The catheter and needle are both removed and the eye is closed. Most patients experience minimal symptoms with this procedure.
Filtration surgery. For some patients, the trabecular meshwork is damaged or cannot be rehabilitated. These patients may need a filtration surgery, which involves the creation of a new drain for the eye. The most common filtration surgeries are trabeculectomy and aqueous shunt surgery.
