If you are diagnosed with glaucoma, treatment is available to save your vision. The primary goal of glaucoma treatment is to lower the intraocular pressure (IOP...also known as fluid pressure in the eye) and stop the optic nerve damage. Several kinds of treatment are available to lower IOP. These include eye drops, glaucoma laser therapy, and surgery. Read about some of our glaucoma treatments below or click on the links to the left. For more information regarding types of glaucoma you can visit other pages in our glaucoma section.
Eye Drops (The first approach…)
Eye drop medications lower IOP by either reducing the amount of fluid entering the eye or increasing the amount of fluid exiting the eye. There are several different kinds of glaucoma medications, and each differs in terms of both its ability to lower IOP and its potential side effects. Laser therapy often is used when medications fail to lower IOP; it is also used for patients who cannot tolerate medications due to side effects. Recent advances in laser therapy have produced lasers so safe and effective that, for some patients, laser therapy is used instead of medications. If medications and/or laser therapy fail to bring the IOP down to a safe range, surgery is available to lower IOP.
Argon Laser Trabeculoplasty (ALT)
Argon Laser Trabeculoplasty (ALT) is a type of laser glaucoma surgery that helps aqueous fluid drain out of the eye to lower the intraocular pressure. Our glaucoma specialist, may suggest this surgery at any time. In most cases eye drops will still be needed after this procedure but hopefully in lesser amounts. Before the surgery, numbing drops will be applied to your eye. As you sit facing the laser machine, your eye doctor will hold a special lens to your eye. A high-intensity beam of light is aimed at the lens and reflected onto the trabecular meshwork inside your eye. You may see flashes of bright green or red light. The laser makes several evenly spaced thermal burns that stretch the drainage holes in the trabecular meshwork. This allows the aqueous fluid to drain better.
Selective Laser Trabeculoplasty (SLT)
Selective laser trabeculoplasty is newer technology that uses a Nd:YAG laser to target specific cells within the trabecular meshwork and create less thermal damage than ALT. SLT shows promise as a long term treatment. In SLT a laser is used to selectively target the melanocytes in the trabecular meshwork. Though the mechanism by which SLT functions is not well understood, it has been shown in trials to be as effective as the older ALT. However, because SLT is performed using a much lower power laser, it does not appear to affect the structure of the trabecular meshwork (based on electron microscopy) to the same extent, so retreatment may be possible if the effects from the original treatment should begin wear off, although this has not been proven in clinical studies.
Trabeculectomy is a surgical procedure performed by an ophthalmologist used to lower eye pressure. By trying to lower the eye pressure damage can be halted from further pressure increases but that damage already done is not reversible. The trabeculectomy procedure involves the surgeon creating a tiny passageway from the inside to the outside of your eye. This helps fluid drain better from the areas it is presently not draining. A trabeculectomy can lower the pressure in your eye and help prevent more damage to the optic nerve.
Minimally Invasive Glaucoma Surgery (MIGS) iStent®
iStent is the first MIGS device that improves your eye's natural fluid outflow to safely lower eye pressure by creating a permanent opening in the trabecular meshwork. Proven safe and effective, the iStent Trabecular Micro-Bypass:
- Is safely implanted during cataract surgery
- Spares important eye tissue that is often damaged by traditional surgeries
- Does not limit treatment options that could help maintain your vision in the future
iStent is the smallest medical device ever approved by the FDA. It is placed in your eye during cataract surgery and is so small that you won't be able to see or feel it after the procedure is over. iStent is designed to create a permanent opening in your trabecular meshwork, and works continuously to improve the outflow of fluid from your eyes to help control eye pressure.
The Hydrus procedure is designed to be less invasive than traditional glaucoma surgery and can be performed during cataract surgery, using the same microsurgical incisions. Roughly the size of an eyelash, the Hydrus Microstent is made from a super-elastic, biocompatible alloy (nitinol®), which is a well-proven biomaterial used in over one million implants in a variety of medical devices to date.
Transcend COMPASS Clinical Study
If you have glaucoma and are considering cataract surgery, you may be a candidate for the Transcend COMPASS Clinical Study. The study is evaluating the CyPass® Micro-Stent - an investigational device designed for open angle glaucoma. The CyPass Micro-Stent is placed during routine cataract surgery, and may offer an alternative to your current glaucoma treatment.
If you can answer "yes" to the following statements, you may be a potential candidate for the COMPASS Clinical Study:
- I am at least 45 years old
- I have glaucoma
- I am considering cataract surgery
- I am able to travel to my local COMPASS study center for my cataract surgery and approximately 10 follow-up visits over a 2-year period.To learn more about the COMPASS Clinical Study, click here:
To learn more details about the COMPASS study please click here www.compassclinicalstudy.com, or contact our office at (714) 771-1213.
The Ex-PRESS mini shunt is a device for treating glaucoma, available in USA since 2002. Over 12,000 implantations have been performed worldwide. During this glaucoma procedure, the glaucoma eye doctor diverts the fluid through an extremely small tube to the outside of the eye. You neither cut sclera, nor the iris. Although the device is as small as a grain of rice, it acts just like a heart stent keeping a pathway open so blood (or fluid) can successfully go around the blockage. The Ex-PRESS provides precise control of the amount of fluid that is allowed to flow out helping the eye maintain a healthy level of internal pressure. The Ex-PRESS mini glaucoma shunt provides effective long term control of intraocular pressure, with a success rate of about 94%. If you have been struggling with high intraocular pressure and would like to seek the medical attention of Orange County glaucoma experts our eye physicians are here to help.
Glaucoma Drainage Devices
Glaucoma drainage devices create an alternate aqueous pathway from the anterior chamber by channeling aqueous out of the eye through a tube to a subconjunctival bleb or to the suprachoroidal space. This tube is usually connected to a plate under the conjunctiva. Glaucoma tubes are being used more frequently in the treatment of glaucoma that is not responding to medications and trabeculectomy operations.
Another option for glaucoma that cannot be controlled with medications is an aqueous shunt. There are three main types of aqueous shunts that are in use today.
- Baerveldt Implant
- Molteno Implant
- Ahmed Implant
These implants have a plate that is sewn to the sclera, near the insertions of the eye muscles. The tube, which is connected to the plate, is then placed directly into the eye. As a result of this procedure, the aqueous fluid will drain through the tube into the plate, which then allows the fluid to be absorbed by the tissues behind the eye. Tubes have become an increasingly popular treatment for many types of glaucoma, and are considered by many to be safer and more predictable than trabeculectomy surgery.