Glaucoma Treatment

There is no cure for glaucoma—there are only treatments to check its progress and preserve your sight. Once you have been diagnosed with glaucoma, it is important that you follow all your doctors' instructions regarding treatment to ensure that you do not suffer further permanent vision loss or blindness.

Types of treatments

Currently, there are several treatment alternatives for glaucoma:

• Eye Drops
• Laser surgery, including Peripheral Iridotomy (for Angle Closure Glaucoma) and laser trabeculoplasty (for open angle glaucoma)
• Filtering microsurgery
• Canaloplasty

Eye Drops are the most common first line treatment for open angle glaucoma.  Eye drops are used to control elevated intraocular pressure (IOP), which is a necessary step in the development of open angle glaucoma.  Although there are potential side effects including interaction with other medications from glaucoma eye drops, there are many different options available so most people can use them. 

Laser Surgeries are used to increase the drainage of fluid in the eye.  Laser peripheral iridotomy (LPI) is used for the treatment of angle closure glaucoma in which the iris is blocking the angle.  The laser makes a small hole near the edge of the iris, allowing fluid to drain through.  Argon Laser Trabeculoplasty (ALT), Selective Laser Trabeculoplasty (SLT), and Micropulse Laser Trabeculoplasty (MLT) all seek to open up the drainage channels in the eye using a laser.  ALT is common, but SLT may have the advantage of being safely repeatable if necessary.  MLT is an investigational treatment that may reduce the incidence of IOP spikes that sometimes occur shortly after laser surgeries.

Filtering Microsurgery is a treatment option typically tried after eye drops and laser surgery have failed to adequately bring down IOP to safe levels.  It may also be used in situations where IOP is very high or damage to the optic nerve must be controlled immediately.  In this surgery, microsurgical tools are used to create new drainage channels for the eyes fluids, allowing the eye to better regulate its IOP.  Sometimes shunts may be placed in the eye to control the rate of fluid drain.

Canaloplasty is a procedure designed to open the eye's natural drainage channel, the canal of Schlemm.  The canal of Schlemm is the drainage route that takes ocular fluid from the angle to the blood stream.  Clogging of the canal of Schlemm is a primary culprit in open angle glaucoma.  Not all ophthalmologists have adopted canaloplasty as a treatment option.

Glaucoma treatments Being Investigated

The puncta are tiny openings in the eyelids that allow fluid to drain from the eye (singular is punctum). There is one in the inner corner of both the upper and lower eyelids and the drainage canals leads to the sinus and nose drainage system. Sometimes punctal plugs are used to treat dry eyes by slowing tear drainage.

Another idea for punctal plugs is to fill them with glaucoma medication and insert them for long-term medication delivery. Tests are currently being conducted, supervised by the Food and Drug Administration (FDA).

In the phase II trial, 61 people were fitted with punctal plugs containing Latanoprost and the plugs were left there for three months. Dosages were at three strengths but all were relatively low because of caution over safety at this early stage. However, IOP was reduced and there were no safety issues.

Steroid injections are also being investigated as a glaucoma treatment option. The injections are made near the eye, and early investigations show that a single injection can help keep IOP low for as long as three months.

Nanotechnology that blocks enzymatic action contributing to elevated IOP is being investigated, but work is still at a very early stage.

Contact lenses could potentially deliver glaucoma medication and a company called Cambridge Eyenovations has patented a method of delivering high doses in a controlled flow for three months or longer. This method could also be used for other treatments, such as moisturizing eyedrops for Dry Eye Syndrome or antibiotics treating an infection. Testing has not begun yet.

Preventing Vision Loss

Since none of these treatments definitively cure glaucoma, vigilance is necessary to prevent a reoccurrence of glaucoma and future damage to the optic nerve.  If you have been prescribed eye drops or other medication, it is essential that you follow your doctor's instructions exactly to prevent surges in IOP and further damage to your optic nerve.

And, of course, early detection and diagnosis of glaucoma is necessary to prevent vision loss.  If you have not been screened for glaucoma, find a local ophthalmologist and schedule a glaucoma screening today.