Glaucoma is a chronic eye disease that affects millions of people. This condition is traditionally treated with eye drops but there are multiple surgeries that can be treatment options.
The Basics of Glaucoma
The condition of glaucoma is based on the increased pressure inside of the eye which can cause damage to the eye.
The increase in eye pressure can be caused by too much fluid produced in the eye or a reduced drainage of the fluid in the eye.
Since glaucoma is a disease of increased pressure, treatment of glaucoma is based on reducing the eye pressure either by medications or surgery.
Benefits of Surgery vs Eye Drop Treatment
Any surgery is considered an invasive procedure and in most cases a less invasive treatment like eye drops would be preferred.
However, there are specific cases when a surgical treatment may be more beneficial than traditional eye drops.
If a patient with glaucoma cannot physically put the drops in their eyes or easily have another person assist them with the medication, a surgical treatment may be better suited for the patient.
Also, if there is difficulty obtaining eye drops consistently, such as travelling for work or living in a remote area, a surgical treatment may be beneficial.
The most common use of a surgical treatment is in addition to the use of eye drops. If medication is not sufficiently lowering the eye pressure, a surgery may be considered to supplement the treatment.
The Types of Surgery for Glaucoma
There are multiple surgery options for glaucoma treatment. The most common surgeries performed to treat glaucoma are selective laser trabeculoplasty, argon laser trabeculoplasty, laser peripheral iridotomy, and crystalline lens removal.
The surgery that is the best option depends heavily on the type of glaucoma and the other factors causing the high eye pressure.
Argon and Selective Laser Trabeculoplasty (ALT, SLT)
Selective laser trabeculoplasty and argon laser trabeculoplasty are each minimally invasive procedures that are used to treat open angle glaucoma.
Open angle glaucoma is the predominant form of glaucoma and does not have any eye structures which are blocking the outflow of fluid.
In open angle glaucoma, the first line therapy is usually eye drops but some doctors may consider selective laser trabeculoplasty as an initial treatment.
Argon laser trabeculoplasty is less commonly performed as selective laser trabeculoplasty has become the preferred surgical intervention.
In these surgeries, a laser is fired into the trabecular meshwork which is the drainage system of the eyes. The laser causes inflammation and initiates a healing process which results in the opening of the drain.
Laser Peripheral Iridotomy (LPI)
A laser peripheral iridotomy is a surgery in which a laser creates a hole in the iris to allow fluid to flow from behind the iris to in front of the iris.
This procedure is used in narrow angle glaucoma to prevent the iris from being pushed forward and blocking the drainage of fluid.
A laser peripheral iridotomy may also be used as a preventative treatment if there is sufficient risk of glaucoma from a narrow angle.
Removal of the Crystalline Lens
Removing the crystalline lens from the eye is the procedure done during cataract surgery. However, in some cases, it may also be used as a treatment for narrow angle glaucoma.
By removing the natural lens and replacing it with an artificial lens that is much thinner, the eye is less likely to have an angle closure from the structures of the eye pushing forward.
This is an option that is especially useful if a cataract surgery is imminent already. If the cataract surgery will be required due to the cataract changes, then it can also benefit the progressing glaucoma.
Glaucoma Surgery Summary
In many ways, the treatment of glaucoma is advancing to include more surgery options than in years past.
The surgeries are more effective and less invasive than previously, and evidence of the benefit is continually developing.