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Unfortunately, there is no "cure" for glaucoma, but it can be controlled. However, even with effective treatment, patients must have their eyes checked regularly. Quite often, treatment will continue for the rest of the patient's life. Burdensome though this may seem, it is preferable to losing one's sight.
Lowering intraocular pressure (IOP) is the focus of treatment for glaucoma. This is done to the level the ophthalmologist determines will not likely cause further optic nerve damage, referred to as the "target pressure." High IOP may damage the optic nerve, which can lead to vision loss. The level differs from person to person and one's "target pressure" may change during the course of a lifetime.
Types of Medications
For open-angle glaucoma (the most common type) the ophthalmologist may prescribe medication to lower intraocular pressure (IOP). Medications can be topical, such as eye drops, inserts (wafer-like strips of medication that are put in the corner of the eye) or eye ointments; or oral, such as pills or tablets.
Topical medications:
a.. Miotics - increase the outflow of aqueous (liquid) from the eye
b.. Epinephrine compounds - also increase the outflow of aqueous from the eye
c.. Beta-blockers - reduce the amount of aqueous produced in the eye
d.. Carbonic anhydrase inhibitors and Alpha-Adrenergic Agonists - also work to reduce the amount of aqueous the eye produces
e.. prostaglandin analogs - works near the drainage area of the eye to increase the secondary route of outflow aqueous outflow to lower IOP
Oral medication can also help control IOP. The most common are carbonic anhydrase inhibitors, which work to slow production of aqueous fluid in the eye.
Many of the same medications used to treat open-angle glaucoma are also used to treat angle-closure glaucoma. Because this type can cause IOP to rise very quickly, the ophthalmologist may need to lower the pressure rapidly to prevent vision loss by administering a sugar-based medication called a hyperosmotic agent either by mouth or by injection. This drug only lasts six to eight hours, so it is not used for long-term management of glaucoma.
Possible Side Effects
Any medication, including eye drops, may have side effects. Some people taking glaucoma medication may experience:
a.. Stinging or redness of eyes
b.. Blurred vision
c.. Headache
d.. Changes in pulse, heartbeat or breathing
e.. Changes in sexual desire
f.. Mood changes
g.. Tingling of fingers and toes
h.. Drowsiness
i.. Loss of appetite
j.. Change of iris color (in people with light-colored eyes taking prostaglandin analogs)
While most side effects aren't serious and may disappear after a while, not every patient will experience side effects. However, it's very important that people with glaucoma carefully follow recommended treatments, and any side effects should be discussed with the doctor. If serious enough or intolerable, the patient and ophthalmologist may decide to change medications or type of treatment.
Surgery
For some patients, surgery might be best. The ophthalmologist may suggest surgery as a first treatment, or after trying medication to lower IOP. There are several different types of surgery for glaucoma. Type and severity of the glaucoma, other eye problems or health conditions are all considerations that must be factored into the decision of which type is best. It may be performed using a laser (a concentrated beam of light) or conventional surgical instruments.
Laser Surgery
a.. Trabeculoplasty is most often used for open-angle glaucoma. A laser is used to place "spot welds" in the drainage area of the eye-also known as the trabecular meshwork-that allow the aqueous to drain more freely.
b.. Iridotomy is another laser surgery frequently used to treat angle-closure glaucoma. The laser makes a small hole in the iris-the colored part of the eye-which allows the aqueous to flow more freely within the eye so the iris doesn't plug up the trabecular meshwork.
c.. Cyclophotocoagulation - a laser is used to freeze selected areas of the ciliary body-the part of the eye that produces aqueous humor-to reduce the production of fluid. This procedure may be used to treat more advanced or aggressive cases of glaucoma.
Most laser surgeries can be performed in the doctor's office or an outpatient surgical facility. Because there is usually little discomfort, eye drops are used to numb the eye for the duration of the procedure, and is often the only anesthesia needed. Little recuperation is needed afterward. Patients may experience some local eye irritation, but can usually resume normal activities within a day or two.
Laser surgery is not always preferred. When vision loss is rapid, or medication and/or laser surgery fails to lower IOP sufficiently, "conventional" incisional surgery becomes the best option.
Incisional Surgery
Filtering surgery is usually done in a hospital or outpatient surgery center, with local anesthesia, and sometimes, sedation. The surgeon uses very delicate instruments to remove a tiny piece of the wall of the eye (the sclera), leaving a tiny hole. The aqueous can then drain through the hole, reducing intraocular pressure, and be reabsorbed into the bloodstream.
Some situations require placement of a small tube or valve in the eye through a tiny incision in the sclera. The valve then acts a regulator for the buildup of aqueous within the eye. When the intraocular pressure reaches a certain level, the valve opens, allowing the fluid to flow out of the eye's interior, where it is reabsorbed by the body. The procedure may take place in the doctor's office or outpatient surgical center, and can be done under local anesthesia.
Recuperation from incisional surgery is generally short. An eye patch is usually worn for a few days afterward and activities that expose the eye to water, such as showering or swimming, should be avoided. It may also be recommended that heavy exercise, straining or driving for a short time be refrained to avoid complications.
There are risks associated with glaucoma surgery just as with any surgery. Fortunately, complications are unusual, but a patient might experience:
a.. infection
b.. bleeding
c.. undesirable changes in intraocular pressure
d.. loss of vision
There are situations in which a single procedure does not halt the progress of glaucoma. When this occurs, repeat surgery, and/or continued treatment with topical or oral medications may be necessary.
The patient's age, eye structure, type of glaucoma, and other medical conditions are all considerations when deciding how glaucoma should be treated. The ophthalmologist, in partnership with the patient, is best able to make the appropriate treatment decisions.
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