Glaucoma treatment

Prescription eye drops are commonly used to lower eye pressure. Regularly using your prescribed drops is crucial for preventing further vision loss. Although it may take time to establish a routine, consistent use is essential for managing glaucoma.

• drops to improve fluid drainage: certain drops, such as prostaglandin analogues and rho-kinase inhibitors, help increase fluid drainage to reduce eye pressure
• drops to reduce fluid production: other drops, like beta-blockers, carbonic anhydrase inhibitors and alpha-adrenergic agonists, reduce fluid production in the eye

Most drops are well tolerated, but side effects can vary depending on the type. Our experienced ophthalmologists will discuss any potential concerns with you.

Allergic reactions, often caused by preservatives, are possible, but preservative-free alternatives are available.

The recovery timelines and aftercare are different depending on which treatment options you undergo.

Recovery and aftercare

If you’ve been prescribed eye drops or oral medication and they’re working to slow the progression of your condition, you should be able to continue using them without the need for further treatment.To monitor your condition, you will need to see your ophthalmologist regularly – around once every three to six months.

Selective laser trabeculoplasty (SLT)

SLT treats chronic open-angle glaucoma and helps improve fluid drainage to lower eye pressure. The procedure is quick and painless, but results take one to three months.

• benefits: reduces eye pressure by about 30% for one to five years and can be repeated if necessary
• risks: minor inflammation and a temporary rise in eye pressure, both manageable with drops

Laser iridotomy

This straightforward procedure creates a small hole in the iris under local anaesthetic to improve fluid drainage for patients with angle-closure glaucoma.

• benefits: in the early stages, laser iridotomy can effectively resolve angle-closure glaucoma and, in many cases, prevent the need for additional treatments or medications
• risks: temporary increases in eye pressure and mild inflammation may occur but are usually treated with drops. Rarely, some patients experience slight vision changes, such as glare or ‘ghosting’, though permanent side effects are uncommon and affect about 1% of patients

Cyclodiode laser

This procedure is used to reduce fluid production in patients with advanced glaucoma, where other surgeries may not be suitable. The laser targets the gland that produces eye fluid, lowering eye pressure. The quick procedure is performed under local anaesthetic.

• benefits: effective in lowering eye pressure in about 85% of cases, making it useful for advanced glaucoma
• risks: temporary changes in eye pressure, inflammation or a need for repeat treatments are possible and your vision may be reduced temporarily after the procedure, but permanent changes are rare

Recovery and aftercare

Immediately after laser treatment, your eye may be irritated and you may have some blurred vision, so you’ll need someone to drive you home from the clinic. Your eye may also be very dry during the recovery process, but this is temporary. It may then be a few weeks before you notice any significant differences in your vision.

Depending on the effectiveness of the treatment, you may need to combine laser treatment with the use of eyedrops. The results of laser treatment can last for many years and can be repeated if necessary.

Glaucoma surgery is a more invasive treatment method than medication or laser therapy, but it may also help to slow the progression of your condition more quickly by improving fluid drainage. The surgery your consultant recommends will depend on the type of glaucoma you have.

Trabeculectomy

This procedure creates a small flap in the eye to drain fluid and lower pressure by allowing it to seep out gradually. It is typically performed under a microscope and the fluid drainage can be adjusted by adding or removing stitches as the eye heals.

• benefits: about 75% of procedures remain effective for seven to eight years, with many patients no longer needing medication, while others may only need occasional eye drops
• risks: risks include infection or scarring, which your surgeon will discuss, but these are typically managed with careful post-operative care

Glaucoma tube surgery

A tiny transparent tube is placed in the eye to help drain fluid and lower pressure, often recommended for patients at higher risk of trabeculectomy failure due to scarring or previous cataract surgery. The fluid is absorbed naturally by surrounding tissues.

• benefits: the pressure-lowering effect may last longer than trabeculectomy for some patients, particularly those at risk of scarring, and it is often more effective in patients who wear contact lenses or have had cataract surgery
• risks: minimal risks, such as infection or tube-related issues, are managed by your surgeon, and the procedure generally has a success rate of 75–85% over five years

Recovery and aftercare

If you have surgery for your glaucoma, you’ll be able to go home on the same day. though you will need someone to drive you home from the clinic. During your recovery, you will need to avoid strenuous activities for two to four weeks. Your eye is likely to be swollen and sore for a while.

Following your procedure, you’ll need to see your ophthalmologist for follow-up exams. You may eventually need to have additional treatment if your eye pressure begins to rise again.

MIGS procedures are less invasive than traditional glaucoma surgeries, offering quicker recovery times and fewer complications.

iStent

A tiny titanium stent is inserted into the drainage angle to improve fluid drainage. The procedure usually takes 15–20 minutes and is often performed alongside cataract surgery.

• benefits: particularly useful for patients with mild glaucoma or ocular hypertension undergoing cataract surgery, as it can lower eye pressure and may reduce the need for eye drops
• risks: the risks are minimal, but it may be less effective in more advanced glaucoma cases

PreserFlo MicroShunt

A small tube is placed under the eye’s outer membrane to improve fluid drainage.Anti-scarring medicine is applied to enhance the procedure’s success.

• benefits: faster recovery and fewer risks compared to traditional surgery. It carries a lower risk of complications like infection and scarring
• risks: it is slightly less effective than trabeculectomy, but if it fails, other surgeries, like Baerveldt tube surgery, can be considered

Other MIGS options include the Hydrus Microstent and iStar MINIject devices, all of which are available through specialists at the clinic.