How is Glaucoma Treated?

After the diagnosis of glaucoma disease is made, the goal of treatment today is to lower the eye pressure to stop the damage to the optic nerve and prevent the progression of vision loss. The methods that can be applied for this purpose can be divided into three: medication treatment, laser treatment, and surgical treatment.

Medication Treatment In open-angle glaucoma, the aim is to prevent nerve fiber destruction by reducing intraocular pressure. There are many drops used in the medical treatment of glaucoma. These drops lower the intraocular pressure through various mechanisms. While some glaucoma medications reduce the production of intraocular fluid, others facilitate the drainage of intraocular fluid from the eye. The effectiveness of the treatment is monitored by visual field tests and the tracking of optic nerve head cupping. Medical treatment is continued as long as the destruction in the visual field is stopped.

If it is not successful, a second drop is added. If the eye pressure still does not drop, a third drop is added according to the discretion of the treating doctor. Before starting drop treatment, it should be investigated whether the patient has heart-lung diseases. Because some of the drops used in glaucoma treatment can lead to breathing difficulties and heart rhythm disorders. Therefore, such medications should be used carefully. Also, some types of glaucoma drops can cause blurred vision, eye pain, headaches, and allergic reactions.

There are also some oral medications (tablets) used to lower intraocular pressure. However, these medications are used for a few days to lower the intraocular pressure in a short time. If they are used long-term, side effects such as the disruption of the blood electrolyte balance (especially potassium loss), numbness in the hands and feet, and the formation of kidney stones in the long run occur. If the intraocular pressure in a patient with glaucoma remains at a normal level with drop treatment and this level is constantly maintained, the patient must use these drops continuously and regularly for life.

Laser Treatment: In glaucoma treatment, for patients who do not respond adequately to medication, laser is a treatment option that can be applied before surgery. The application of an argon laser to the trabecular meshwork in glaucoma is also among the glaucoma treatment options. Laser treatment can reduce intraocular pressures that are not very high to normal levels. This application can reduce eye pressure by up to 30 percent. The duration of its effect is generally about 2-3 years, and its effect decreases significantly within 5 years. Then the intraocular pressure may rise again. Therefore, the laser is a more appropriate option to buy time in patients with pressures up to 26 mmHg who do not comply with medication treatment but cannot be operated on either.

Surgical Treatment: If the intraocular pressure in a glaucoma patient cannot be reduced to a normal level despite all the medications used, and if optic nerve destruction is progressively advancing and the visual field is steadily worsening, surgery becomes necessary. Furthermore, the doctor may feel the need to perform early glaucoma surgery on patients who are difficult to follow up, disrupt their medication use and do not comply, or do not attend check-ups. If surgery is necessary but delayed, the patient loses their vision day by day. Glaucoma surgeries are performed under general anesthesia if the patient is a baby or child, and under local anesthesia in adult patients. The procedure performed in the surgery is to facilitate the outflow of the intraocular fluid, which has difficulty leaving the eye and thus causes an increase in intraocular pressure.

There are various techniques for this. The surgical methods used in open-angle glaucoma are trabeculectomy and viscocanalostomy. In both methods, the goal is to open a channel that will allow the intraocular fluid to easily leave the eye. The patient does not need to be hospitalized after the surgery. Sometimes after surgery, the intraocular pressure can rise again. Then it may be necessary to perform a second glaucoma surgery. In some stubborn types of glaucoma, it is not possible to achieve results with standard surgical techniques. In this case, an attempt is made to lower the high intraocular pressure by inserting some tubes (valves) into the eye. Visual field follow-up is also very important after the surgery. After both laser and normal surgery, some patients may still need to continue using medication or may require repeated surgeries.

Treatment of Closed-Angle Glaucoma

The acute attack can be stopped with medications that constrict the pupil and reduce the secretion of intraocular fluid. When the intraocular pressure drops to its normal level, a laser iridotomy must be performed. That is, a hole is made in the iris with a laser. Thus, the fluid in the posterior chamber can easily pass into the anterior chamber. This procedure is performed after the eye is numbed with drops and takes a few minutes. It can also be performed on the other eye as a precaution. Because when the angle in one eye is narrow, there is a high probability that the other will be narrow too. Whether the angle is narrow or wide can be understood with a technique called gonioscopy.