Open-Angle Glaucoma Treatment

After the diagnosis of glaucoma is made, the goal of treatment today is to lower intraocular pressure and prevent further damage to the optic nerve, thus preventing the progression of vision loss. The treatment options for glaucoma can be divided into medication therapy, laser treatment, and surgical treatment.

Medication Therapy

The aim of medication therapy for open-angle glaucoma is to reduce intraocular pressure and prevent damage to the nerve fibers. There are many eye drops available for the medical treatment of glaucoma. These eye drops lower intraocular pressure through different mechanisms. Some medications reduce the production of aqueous humor inside the eye, while others facilitate its outflow. The effectiveness of the treatment is monitored through visual field tests and the follow-up of the optic nerve head cupping. Medical treatment is continued as long as the damage to the visual field is halted. If success cannot be achieved, a second eye drop is added. If eye pressure still doesn’t decrease, a third eye drop may be added based on the doctor’s understanding. Before starting eye drop therapy, it is important to investigate whether the patient has any heart or lung conditions, as some glaucoma medications can cause respiratory difficulties and heart rhythm disturbances. Therefore, these types of medications should be used with caution. Some types of glaucoma eye drops can also cause blurred vision, eye pain, and allergic reactions. There are also oral medications (tablets) available for lowering intraocular pressure. However, these medications are used for a short duration of a few days to rapidly reduce intraocular pressure. Prolonged use of these medications can lead to imbalances in blood electrolytes (especially potassium loss), numbness in the hands and feet, and the formation of kidney stones in the long term. If the intraocular pressure in a glaucoma patient is maintained at a normal level with eye drop therapy and consistently monitored, the patient must use these eye drops continuously and regularly throughout their life. Laser Treatment: In cases where an adequate response is not achieved with medication therapy, laser treatment is an option that can be applied before surgery. Argon laser application to the trabecular meshwork is one of the treatment options for glaucoma. Laser treatment can reduce moderately elevated intraocular pressure to normal levels. It can decrease eye pressure by about 30%. The duration of the effect is usually around 2-3 years, and the effect diminishes significantly within 5 years. Afterward, intraocular pressure may increase again. Therefore, laser treatment is a suitable option in patients with pressures up to 26 mmHg who do not respond to medication therapy but are not suitable for surgery, with the aim of gaining time. Surgical Treatment: If, despite the use of all available medications, the intraocular pressure in a glaucoma patient cannot be reduced to normal levels, optic nerve damage is progressing, and the visual field is deteriorating, surgery becomes necessary. Additionally, in patients who have difficulty with follow-up, noncompliance with medication use, or failure to attend appointments, early glaucoma surgery may be required. If surgery is delayed when it is necessary, the patient gradually loses their vision. Glaucoma surgeries are performed under general anesthesia in infants or children and under local anesthesia in adult patients. The surgical procedure aims to facilitate the outflow of aqueous humor, which is obstructed and thus increases intraocular pressure. Various techniques are available for this purpose. The surgical methods used in open-angle glaucoma are trabeculectomy and viscocanalostomy. Both techniques aim to create a channel that allows the aqueous humor to exit the eye easily. After the surgery, it is not necessary for the patient to lie down. Sometimes, after the surgery, intraocular pressure may rise again, requiring a second glaucoma surgery. In some stubborn types of glaucoma, it is not possible to achieve results with standard surgical techniques. In such cases, tubes (valves) are placed in the eye to reduce high intraocular pressure. Post-operative monitoring of the visual field is crucial. Even after laser or standard surgery, some patients may need to continue using medication or undergo repeated surgeries. Closed-Angle Glaucoma Treatment In the case of an acute attack, medication that constricts the pupil and reduces the production of intraocular fluid can be used to stop the attack. When the intraocular pressure returns to normal, laser iridotomy is necessary. This procedure involves creating a hole in the iris using a laser so that fluid can easily pass from the posterior chamber to the anterior chamber. This procedure is performed after applying numbing eye drops and takes a few minutes. It can also be performed preventively on the other eye, as the likelihood of a narrow angle in one eye increases the possibility of the other eye having a narrow angle as well. Gonioscopy, a technique used to determine whether the angle is narrow or wide, can provide information about the angle. Laser Treatment for Creating a Hole in the Iris Ensuring Fluid Passage through the Hole Created by Laser Treatment Translation of the above text with HTML tags is as follows: Open-Angle Glaucoma Treatment After the diagnosis of glaucoma is made, the goal of treatment today is to lower intraocular pressure and prevent further damage to the optic nerve, thus preventing the progression of vision loss. This can be achieved through medication therapy, laser treatment, or surgical treatment. Medication Therapy The aim of medication therapy for open-angle glaucoma is to reduce intraocular pressure and prevent damage to the nerve fibers. There are many eye drops available for the medical treatment of glaucoma. These eye drops lower intraocular pressure through different mechanisms. Some medications reduce the production of aqueous humor inside the eye, while others facilitate its outflow. The effectiveness of the treatment is monitored through visual field tests and the follow-up of the optic nerve head cupping. Medical treatment is continued as long as the damage to the visual field is halted. If success cannot be achieved, a second eye drop is added. If eye pressure still doesn’t decrease, a third eye drop may be added based on the doctor’s understanding. Before starting eye drop therapy, it is important to investigate whether the patient has any heart or lung conditions, as some glaucoma medications can cause respiratory difficulties and heart rhythm disturbances. Therefore, these types of medications should be used with caution. Some types of glaucoma eye drops can also cause blurred vision, eye pain, and allergic reactions. There are also oral medications (tablets) available for lowering intraocular pressure. However, these medications are used for a short duration of a few days to rapidly reduce intraocular pressure. Prolonged use of these medications can lead to imbalances in blood electrolytes (especially potassium loss), numbness in the hands and feet, and the formation of kidney stones in the long term. If the intraocular pressure in a glaucoma patient is maintained at a normal level with eye drop therapy and consistently monitored, the patient must use these eye drops continuously and regularly throughout their life. Laser Treatment In cases where an adequate response is not achieved with medication therapy, laser treatment is an option that can be applied before surgery. Argon laser application to the trabecular meshwork is one of the treatment options for glaucoma. Laser treatment can reduce moderately elevated intraocular pressure to normal levels. It can decrease eye pressure by about 30%. The duration of the effect is usually around 2-3 years, and the effect diminishes significantly within 5 years. Afterward, intraocular pressure may increase again. Therefore, laser treatment is a suitable option in patients with pressures up to 26 mmHg who do not respond to medication therapy but are not suitable for surgery, with the aim of gaining time. Surgical Treatment If, despite the use of all available medications, the intraocular pressure in a glaucoma patient cannot be reduced to normal levels, optic nerve damage is progressing, and the visual field is deteriorating, surgery becomes necessary. Additionally, in patients who have difficulty with follow-up, noncompliance with medication use, or failure to attend appointments, early glaucoma surgery may be required. If surgery is delayed when it is necessary, the patient gradually loses their vision. Glaucoma surgeries are performed under general anesthesia in infants or children and under local anesthesia in adult patients. The surgical procedure aims to facilitate the outflow of aqueous humor, which is obstructed and thus increases intraocular pressure. Various techniques are available for this purpose. The surgical methods used in open-angle glaucoma are trabeculectomy and viscocanalostomy. Both techniques aim to create a channel that allows the aqueous humor to exit the eye easily. After the surgery, it is not necessary for the patient to lie down. Sometimes, after the surgery, intraocular pressure may rise again, requiring a second glaucoma surgery. In some stubborn types of glaucoma, it is not possible to achieve results with standard surgical techniques. In such cases, tubes (valves) are placed in the eye to reduce high intraocular pressure. Post-operative monitoring of the visual field is crucial. Even after laser or standard surgery, some patients may need to continue using medication or undergo repeated surgeries. Closed-Angle Glaucoma Treatment In the case of an acute attack, medication that constricts the pupil and reduces the production of intraocular fluid can be used to stop the attack. When the intraocular pressure returns to normal, laser iridotomy is necessary. This procedure involves creating a hole in the iris using a laser so that fluid can easily pass from the posterior chamber to the anterior chamber. This procedure is performed after applying numbing eye drops and takes a few minutes. It can also be performed preventively on the other eye, as the likelihood of a narrow angle in one eye increases the possibility of the other eye having a narrow angle as well. Gonioscopy, a technique used to determine whether the angle is narrow or wide, can provide information about the angle. Laser Treatment for Creating a Hole in the Iris Ensuring Fluid Passage through the Hole Created by Laser Treatment