Treating Glaucoma and the Glaucoma Surgery Options

Treating Glaucoma

Before resorting to glaucoma surgery, the most common method of treating glaucoma is with prescription eye drops.

Newer medications only need to be put in once a day, but we often must add some other drops when the eye pressure is not sufficiently lowered.

Using Glaucoma Eye Drops

Some of the important considerations for glaucoma eye drops are:

• Remember to put your drops in every day. This is the single most important thing you can do to preserve your vision.
• We recommend you use artificial tears 3 or 4 times per day when taking glaucoma eye drops. This will reduce or eliminate the dry eye symptoms many patients get from the prescription medications.
• Do not take any other eye drops, such as artificial tears, within 10 minutes of the glaucoma eye drops. This will prevent the dilution of the prescription drops.

The Punctual Occlusion Technique

Use the Punctal Occlusion Technique when you put in any prescription eye drops.

• To do this put gentle pressure with your finger in the corner of your eye next to your nose and hold it there for at least 30 seconds.
• Do this as soon as the drop goes into your eye and it will minimize the drops leaving your eye through your tear drains into your throat.
• This both increases the amount of medicine getting into your eye and reduces the risk of medicine being absorbed into your general circulation.

Important: Keep your appointments to monitor your eye pressure. Sometimes the glaucoma medication loses effectiveness. When it does you won't know unless you keep your appointment.

When is Glaucoma Surgery Necessary?

Sometimes, despite low eye pressures, glaucoma continues to progress and threatens vision. In cases like this there are two types of glaucoma surgery we can utilize.

Laser Trabeculoplasty (LT)

• These procedures utilize laser energy to improve the outflow of fluid by treating the drainage area, or trabeculum, of the eye. It's sort of like a "laser roto-rooter".
• The ability to utilize this procedure depends on how open the trabeculum of the patient is. It must be open enough for the surgeon to see it in order to treat it with a laser.
• The trabeculum is evaluated for suitability by a procedure called gonioscopy. A contact lens is placed on the eye in order to see the structure.
• Laser trabeculoplasties are usually more effective if the patient has a significant amount of pigment in the trabeculum. Pigment (melanin) absorbs the laser energy and improves the outcome.
• Two types of lasers are used, an argon laser (argon laser trabeculoplasty or ALT) and a selective laser (selective laser trabeculoplasty or SLT).
• Unfortunately these procedures don't always work, and when they do they are temporary. Both tend to last from three to five years.
• SLT is felt to be more repeatable than ALT, but more studies need to be done to address this issue.

Trabeculectomy/Tube Shunt Drainage Device

Trabeculectomy is a surgical procedure that makes a new drainage canal, allowing the fluid in the eye to exit easier.

Tube Shunt Drainage Devices are various types of tubes that are surgically placed in the eye to facilitate the flow of fluid out of the eye.

• Both of these procedures are major incisional surgeries, meaning incisions are made into the interior of the eye.
• Both of these procedures usually reduce the eye pressure and reduce the diurnal (nighttime) elevation of eye pressure that normally occurs.
• Both of these procedures sometimes fail after time and no longer control eye pressure.
• Repeated procedures are less effective and more risky.
• Both of these surgeries have serious risks and are reserved for uncontrolled, progressive glaucoma that threatens vision or for younger patients who are at increased risk for future vision loss.

For a deeper understanding of eye diseases like glaucoma, be aware of the roles of epigenetics and good nutrition plays in the prevention and treatment of these diseases.

Follow the key Nutritional Principles, to reduce the long term health consequences, and better still, avoid the risks of glaucoma surgery!

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