Glaucoma Treatments & Resources

Selective Laser Trabeculoplasty (SLT)

Selective laser trabeculoplasty (SLT), often a first-line treatment for Open-Angle Glaucoma, can also be effective in patients already on eye drops. SLT uses low levels of laser light to improve drainage of intraocular fluid through the natural drainage pathway out of the eye.

Glaucoma Medications

Open-Angle Glaucoma is often treated with medications (most commonly in the form of eye drops) that either help the eye’s fluid drain better or decrease the amount of fluid being made. Medications must be taken daily to keep eye pressure at a safe level. In most cases, medications can safely control eye pressure for many years.

It is normal for your medication prescriptions to change over time. Changing medications does not necessarily mean that your glaucoma is getting worse. As your body begins to develop a tolerance for a medication, it may slowly lose its effectiveness and may need to be replaced by a stronger version of the same drug or a different medication. Doctors often can return to previously used medications after your body has had a chance to “forget” the old medication.

Incisional Surgery

When laser and medical treatments  do not lower eye pressure to the desired level, your doctor may recommend some form of incisional surgery. This surgery is done in a hospital or surgery center, using a microscope and microsurgery instruments, and includes making a cut (incision) in the eye.

New or Unapproved Treatments for Glaucoma

New forms of glaucoma drug delivery are being developed to improve medication treatment options. One area of interest is “sustained-release” medication. Sustained-release medication evenly releases a drug over a longer time. In this way, medications can be used weekly, monthly, or at even longer intervals. This would make the process of taking medications more convenient and efficient and potentially reduce side effects. There are many sustained-release options being researched and developed.

In addition, new classes of drugs to treat glaucoma are being studied. Researchers are working to find glaucoma medications with fewer side effects, ones that can be taken less often, and drugs that are more responsive to the eye and so more effective at lowering eye pressure.

Unapproved Treatments

There are many unapproved treatments that are promoted on the internet and elsewhere, including marijuana/cannabidiol (CBD), stem cells, herbal medicines, and nutritional supplements. These treatments are not part of the standard of care in glaucoma treatment and may negatively impact your current treatment. You should discuss any additional treatments you are considering with your doctor before starting them.

Treatment of Angle-Closure Glaucoma and eyes at risk for this disease usually involves a laser procedure, laser peripheral iridotomy, to create a small opening in the outer edge of the iris.
If you have Angle-Closure Glaucoma in one eye, your doctor may treat the other eye as a safety measure.

Other treatments are similar to those for Open-Angle Glaucoma and include medications to lower eye pressure, trabeculectomy or tube shunt surgery, and, rarely, Selective Laser Trabeculoplasty. To learn more about these treatments, see the corresponding sections for Open-Angle Glaucoma in the Treating Glaucoma section (above).

Cataract surgery has also been shown to help in the treatment of Primary Angle-Closure Glaucoma. Removing the cataract opens the angle and usually has a favorable effect on the eye pressure.

Treatment of Normal-Tension Glaucoma

Most doctors treat Normal-Tension Glaucoma by reducing the eye pressure as low as possible using medications, laser treatments, and surgery.

Treatment of Pigmentary Glaucoma

The treatment of Pigmentary Glaucoma involves lowering eye pressure using medications, laser treatments, or surgery. Unfortunately, it is difficult to reduce or eliminate the release of iris pigment. Therefore, attention is focused on reducing eye pressure.

Treatment of Congenital Glaucoma

Both medication and surgery are used to treat Congenital Glaucoma. Medications can be in the form of eye drops, pills, or liquids to be taken by mouth. Laser surgery also may be used.

These treatments help to either decrease the amount of fluid made in the eye or increase the amount of fluid out of the eye to lower eye pressure. Surgical procedures that are used to help control eye pressure in Congenital Glaucoma include filtering surgery, aqueous shunt surgery, and goniosurgery, a special procedure that opens canals in the trabecular meshwork. It is sometimes necessary to repeat glaucoma surgery in order to successfully control eye pressure.

Treatment of Exfoliative Glaucoma

Generally, this kind of glaucoma is more difficult to control with medication. Patients with Exfoliative Glaucoma often require a more aggressive, stepwise treatment plan and more often need laser treatment or surgery. Often more frequent visits to their eye doctor are necessary to monitor for disease progression.

Treatment of Neovascular Glaucoma

Treatments for Neovascular Glaucoma often involve decreasing the growth of blood vessels. These treatments include laser treatment to the retina and anti-VEGF drugs which lead to regression of abnormal blood vessels in the eye. Medications used for Open-Angle Glaucoma may be used also, as well as surgery that includes trabeculectomy and drainage implant procedures.

Treatment of Uveitic Glaucoma

To treat elevated eye pressure in Uveitic Glaucoma, doctors use many of the same eye pressure-lowering medications as those used for Open-Angle Glaucoma. Laser treatments typically are not used because they can cause more inflammation. In cases that cannot be controlled with medication, surgical treatment may involve an aqueous shunt. In addition to treatment by an eye doctor, sometimes a rheumatologist will prescribe medication to treat the root cause of the inflammation.

Treatment of Traumatic Glaucoma

The treatment of Traumatic Glaucoma varies depending on when glaucoma develops and the type of eye injury. When glaucoma occurs years after an eye injury, the treatment is similar to Open-Angle Glaucoma except that SLT is usually not effective. When glaucoma develops immediately after eye injury, the treatment is mainly guided by the type of trauma and the extent of damage to the eye.

No matter what the underlying cause may be, there is no cure for glaucoma; but with treatment, it can be controlled. Treatments can slow or halt vision loss, but cannot restore vision which has already been lost. This is why managing glaucoma early is important.

Depending on the underlying cause of your glaucoma, your eye doctor will create a treatment plan aimed at decreasing your intraocular pressure, or IOP. Treatments for glaucoma can range from eye drops and oral medications to surgery and laser treatments.

Your doctor may recommend one or more treatments depending on what is causing your glaucoma. Some treatments are targeted at decreasing the amount of fluid that your eye creates, while others focus on increasing the amount of fluid leaving your eye. The goal of these treatments is to reduce pressure on the optic nerve, and maintain a healthy balance inside the eye. You and your doctor will work together to find the best treatment plan for your condition. The sooner treatment begins, the better you can protect your vision.