Treating glaucoma

As the information above suggests, diagnosing and treating glaucoma requires assessment of different test results and subjective examination of the optic nerve.  Because generally glaucoma advances over many years, many patients may have a diagnosis of ‘glaucoma suspect’ for several years based on family history, race, borderline high pressures or other suspicious test results.  Only when a patient demonstrates consistently high intraocular pressures, significant optic nerve changes or vision loss can your eye doctor definitively make a glaucoma diagnosis.

Your eye doctor has the following treatment options available for patient diagnosed with glaucoma or as ‘glaucoma suspect:’

  • Observation: Patients deemed to be at risk for glaucoma may simply be asked to return for an eye exam every six months so the doctor can monitor changes in the eye.  The doctor may also order baseline tests – visual fields, nerve fiber layer analysis (OCT) or disc photos – to use as a reference during subsequent visits.  Even if the doctor decides to begin treatment, most patients will need to be seen at least every six months to ensure that their glaucoma treatment plan is effective.
  • Medication:  There have been significant improvements in the last ten years in terms of glaucoma medications.  The glaucoma medications typically are in the form of eye drops, but they may vary in terms of effectiveness and side effects for each patient.  Your doctor may have you use one drop for one or two months to assess how your intraocular pressure responds; the doctor will also assess whether the patient has any side effects.  Once a patient begins taking drops for glaucoma, they generally will continue to do so for many years.

 

Medication treatment can vary in terms of medication strength and frequency of use, and more than one glaucoma medication may be prescribed for use at the same time.  Because of the substantial cost of the medications, long-term use and the potential side effects, eye doctors may not prescribe medication at first diagnosis.

With each new medication that your ophthalmologist prescribes, make sure you understand the following:

  • The name of the medication
  • How to take it
  • How often to take it
  • How to store it (some medications must be refrigerated)
  • If you can take it with your other medications (make sure each of your doctors knows about all the different medications you take including non-prescription medications)
  • What the possible side effects may be
  • What you should do is you experience side effects
  • What you should do if you miss a dose

 

If you are unclear what medication to take or how often to take it, your doctor can provide written medication instructions for your convenience.

  • Laser treatment:  Laser treatment is typically used to treat angle-closure glaucoma; the laser is used to remove the obstruction so aqueous fluid can resume exiting the eye.   Laser treatment may also be used for open-angle glaucoma to reduce aqueous production or to provide new or larger channels for aqueous outflow.
  • Trabeculectomy surgery:  When medication or laser treatment fails to provide adequate reductions in intraocular pressure, an ophthalmologist may recommend trabeculectomy surgery.  The surgeon makes an incision in the white portion (sclera) of the eye hidden by the upper eyelid.  A surgical drain is created in the eye, and then covered by a small flap of the sclera to create a valve that opens as fluid is forced out by pressure within the eye.  A trabeculectomy is a delicate procedure, but approximately 80% of surgical patients can go off glaucoma medications after surgery.  Approximately 10% of patients will need another trabeculectomy due to continued elevated pressures.