In order to preserve eyesight, it is critical to decrease and control the elevated intraocular pressure associated with glaucoma. Depending on your individual situation, there are several treatment options available:
Drug therapy (eye drops) are the most common form of treatment for glaucoma; however, there are side effects, and medications aren’t effective for all patients – and you have to remember to take your medication every day. There are a number of different categories of eye drops, but all are used to either decrease the amount of fluid (aqueous humor) in the eye or to improve the outflow of this fluid in order to stabilize or reduce intraocular pressure. Your doctor will decide which medications are best suited to you based on a number of considerations, including: medical history and current medication regimen. Your doctor may also elect to prescribe a combination of eye drops.
SLT or Selective Laser Trabeculoplasty
SLT or Selective Laser Trabeculoplasty, is a gentle, low-energy laser therapy, which triggers a natural healing response in the eye in order to reduce the intraocular pressure associated with glaucoma. SLT effectively lowers eye pressure in the majority of patients, but the length of time that pressure remains low depends on many factors, including: age of the patient, the type of glaucoma, and other medical conditions that may be present. In many cases medication may still be necessary, but in reduced amounts. Click here for more information in SLT.
Note: Previously, Argon Laser Trabeculoplasty (ALT) was used to treat glaucoma. ALT uses a high-energy laser to “open” the clogged areas of the trabecular meshwork (the eye’s drainage system), allowing fluid to bypass this drainage system and flow out of the eye. However, unlike SLT, ALT causes permanent coagulative damage to the eye and cannot be repeated.
Canaloplasty is an advanced treatment for your glaucoma. It uses breakthrough microcatheter technology, similar to angioplasty, to enlarge your eye’s natural drainage system, both proximal and distal. It is the next step in the evolution of glaucoma surgery and is less invasive than some surgical treatments.
How is Canaloplasty performed?
First, your doctor will make a small incision in the eye. The advanced Canaloplasty microcatheter will be inserted into the eye’s drainage system canal. Using the microcatheter, your doctor will circle the canal and enlarge it via visco-dilation, which will help the aqueous fluid drain properly.
The microcatheter is then removed and a suture is placed within the canal to keep it open. By restoring your eye’s natural drainage system, the pressure inside your eye is usually lowered.
Canaloplasty can also be performed when other surgeries have failed (even those offered for late-stage disease) and with a very good success rate.
Click here to learn more about Canaloplasty.
There are multiple areas of outflow resistance: trabecular meshwork, Schlemm’s Canal and the Collector Channel system that lead to additional outflow vessels. There are new devices available or under development that are used to address one or two of the areas of outflow resistance; typically implanted during cataract surgery. Long-term efficacies of these new devices have yet to be determined.
Surgery may be attempted to create a new drainage channel, by-passing the natural outflow pathways, if very low intra-ocular pressure is required to prevent glaucoma progression. Such surgery is generally used to treat more aggressive or advanced stage open-angle glaucoma:
Trabeculectomy is normally performed with local anesthetic and on an outpatient basis, but may require an overnight stay in a hospital. During the surgery the ophthalmologist will cut a flap in the white part of the eye (sclera) and remove a piece of trabecular meshwork, creating a new opening through which the eye’s fluid will flow. Potential side effects include blurred vision, bleeding in the eye, infection and discomfort.
Tube/shunt surgery involves placing a tube through which the aqueous will exit the eye and a valve placed on the eye’s surface to regulate the flow.
Laser surgery may be attempted through the sclera, targeting the ciliary processes, in order to reduce the production of aqueous (trans-scleral cyclocoagulation).