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What are the treatments for glaucoma?

Eye & LASIK

What are the treatment options available for glaucoma? My family is trying to understand all the options so that we can explain it to our uncle.

DOCTOR’S ANSWER (3)

Hi there! 

The treatment options for glaucoma can be broadly divided into 3 categories -- medications, lasers, and surgeries. All these treatment options have the common aim of lowering eye pressures so that the optic nerve does not continue to be damaged, and vision can be preserved.

Medications are usually in the form of eyedrops. There are 5 classes of eyedrops (4 commonly used, 1 less common), which can be used either singly or in combination. Oral tablets/ liquids are reserved for selected cases in which the pressures are extremely high or rapid lowering of eye pressures are required, or when eyedrops no longer work. Medications lower the eye pressure by either reducing the amount of fluid (aqueous) produced, or increasing the rate of outflow of aqueous out of the eye.

Lasers can be used to treat both open and closed angle glaucoma. In open angle glaucoma, SLT (Selective Laser Trabeculoplasty) is a form of laser therapy that targets the drainage angle of the eye to increase the drainage of fluid (aqueous) out of the eye, resulting in lower pressures. LPI (Laser Peripheral Iridotomy) is another laser procedure that is the first line of treatment for angle closure glaucoma; it creates an alternative pathway within the eye for the flow of aqueous, which prevents the sudden dramatic rise in pressure that happens in acute angle closure. TCP (Trans-scleral Ciliary Photocoagulation) and its newer partner, MicroPulse TCP (mpTCP) can be used in more severe cases of both open and closed angle glaucoma, to destroy the cells producing aqueous within the eye so that eye pressures can be lowered.

Surgery is usually reserved for cases that do not respond to medications or lasers, or if medications cannot be tolerated due to unacceptable side effects. Trabeculectomy is a form of glaucoma surgery in which an alternative route of drainage of aqueous is created, such that fluid within the eye is diverted to a reservoir or bubble (bleb) outside the eye, resulting in lowering of pressures within the eye. Tube shunt surgery is another way in which aqueous can be diverted out of the eye, via a tube, to a bleb usually located under the upper eyelid. Newer, less invasive forms of glaucoma surgery, aptly named MIGS (Minimally Invasive Glaucoma Surgery) can be used to control mild to moderate glaucoma, and is usually done together with cataract surgery. These are usually stents or micro-tubes that are inserted into the drainage angle of the eye, to increase the flow of aqueous out of the eye, such that eye pressures are lowered, and glaucoma eyedrops can be reduced or stopped after the procedure.

In summary, there are numerous options for treatment of glaucoma -- medications, lasers, and surgeries, all with the goal of lowering eye pressures. Your uncle may require one or more types of treatment in order to control his glaucoma. It is important to remember that all forms of treatment cannot recover vision that has already been lost, but rather only preserve his remaining field of vision to prevent further visual loss and blindness.

Hope this helps!

Regards,

DQ

297 views 10 Jan 2019

There are 2 main types of glaucoma; acute angle closure glaucoma and chronic open angle glaucoma.

As the name suggests, acute angle closure glaucoma has an acute onset where eye pressure suddenly shoots up. Such cases are considered medical emergencies and patient has to be admitted into A&E to bring the eye pressure down as quickly as possible. Medications are usually administered intravenously to allow them to take effect in the shortest possible time.

For chronic open angle glaucoma, the first line of treatment would usually involve topical eyedrops. These eyedrops are aimed to control eye pressure and to prevent further nerve loss. These medications are a lifelong treatment and patient needs to be monitored over the years should modification of medications be needed. We advise you to work closely with your eye doctor on this.

Once the medications fail to work, which may occur years down the road, surgical options would then have to be considered to control the eye pressure.

51 views 18 May 2019
This sounds like a simple question, but is actually terribly complicated!
 
The treatment for glaucoma depends on many factors, including the diagnosis (Underlying cause of the glaucoma), severity of the glaucoma and the target intraocular pressure (in comparison with the opening pressure before any treatment).
 
This should be discussed in depth with your attending Ophthalmologist. 

In general, the treatments for primary glaucoma vary from 
 
a. laser treatments, including peripheral iridotomy / iridoplasty for patients with occludable angles, angle closure glaucoma
b. selective laser trabeculoplasty for open angle glaucoma. Usually used as an adjunctive procedure to replace 1 eye-drop.
c. eye-drops and oral medications: the most common treatment modality due to the wide-range of options available. May be used in isolation or in combination to achieve the target pressure. Multiple modes of action, and hence have different side-effects.
d. surgery including minimally invasive glaucoma surgery (usually performed as an adjunct to cataract surgery - the equivalent to replacing one eye drop), and glaucoma-drainage surgery including trabeculectomy / tube-surgery. 
 
As you can imagine the options and permutations are incredible. Its best you have a targeted and detailed discussion with your attending Ophthalmologist as all options have inherent advantages and potential side-effects. Best of luck in your deliberations!
 
ESG
257 views 11 Jan 2019
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