Glaucoma Treatment

February 24, 2018 by S P

Have you been screened for glaucoma?

The recommendation is to be screened every 2-3 years starting at the age 40 for glaucoma if you have no risk factors.  If you have risk factors, you need to be screened starting at a younger age (in your 20s and 30s).  Risk factors include a family history of glaucoma, race (higher risk in black, Latino and Asian patients), trauma to the eye and steroid use.  You should be screened annually after the age of 55 even with no risk factors.  As we learn more, genetic risk factors will also determine our risk analysis for all medical conditions including glaucoma.  How long do you plan on living? Do you want to keep your vision for the rest of your life?  Come in and see Dr. Pradhan for your glaucoma screening exam.

What is the treatment for glaucoma?

Depending on your type and level of glaucoma, the treatment will be different.  Read more about the types of glaucoma on our glaucoma page. We can divide the treatments into medical, laser or surgical.

MEDICAL treatment

With medical treatments, there are different classes of drugs and combination drugs to consider.  Patient adherence to the treatment regimen is a factor in choosing the right treatment as well.  A medication will only work as long as you are taking it.  Therefore, generally treatment is initiated with once daily dose medications which are easy to remember to take daily.

There are classes of drugs with different side effects and different efficiency in each patient as well as dosing regimens required (once daily, twice daily, or three times daily).  Depending on the rest of you (whether you have asthma or sulfa allergy or other factors), your eye doctor can help choose the best treatment for you.  The treatment also needs monitoring however because your body can become resistant to the medication over time (tachyphylaxis).

LASER treatment

For narrow angles and narrow angle glaucoma, the only treatment is with a laser to create a hole in the iris and open your angles.  If that does not work, it may become necessary to do another type of laser (iridoplasty) or remove the lens in the eye to open up your angles.

For open angle glaucoma, there is a laser called the trabeculoplasty which helps open the drain of the eye.  It can be performed with different types of lasers and is named accordingly (SLT or ALT).  Generally, the SLT (selective laser trabeculoplasty) is less traumatizing to the eye tissue and is titrated to a level with no visible damage on examination and equally effective as the ALT (Argon Laser Trabeculoplasty – older style laser treatment).  Some patients are more likely to respond to the laser treatment than others (such as patients with more pigmentation inside their eye, pigmentary glaucoma or pseudoexofoliation glaucoma).

SURGICAL treatment

If your glaucoma is at a level where medical or laser treatments are not effective and your eye disease is progressing, it may be time to consult with a comprehensive ophthalmologist who routinely does glaucoma procedures or a “glaucoma specialist” (a physician who did fellowship training in glaucoma surgery).  There are many surgical options for glaucoma treatment including the newer MIGS procedures (minimally invasive glaucoma surgery) like the “istent” or “cypass” and the traditional and effective procedures like trabeculectomy (sometimes called filtration surgery or a “bleb”) or Ahmad or Baerveldt implant (sometimes called a “tube” or “tube shunt” surgery).

Monitoring your glaucoma and treatment with your ophthalmologist is important to help you keep your vision for the rest of your life.  Come in and see Dr. Pradhan for your glaucoma screening exam.