Glaucoma Treatment

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The main goal of glaucoma treatment is to preserve vision and quality of life by preventing further damage to the optic nerve, which can lead to irreversible blindness. Because glaucoma damage is permanent, treatment focuses on slowing or halting progression rather than restoring lost vision.

• The only proven method to slow or prevent glaucoma progression is to reduce IOP, regardless of the initial pressure or type of glaucoma.
• Target IOP is individualized based on disease severity, rate of progression, and patient factors (age, health, life expectancy).
• The target is usually set 20–50% below the baseline IOP and adjusted over time.

• Regular monitoring with optic nerve imaging (OCT) and visual field testing is essential to track progression.
• The aim is to maintain stable optic nerve appearance and visual fields over the patient’s lifetime.

SLT is a gentle, in-office laser that targets the eye’s natural drain (trabecular meshwork) to help fluid exit more easily and lower pressure.

Why it’s often first:

• Effective for many patients with open-angle glaucoma or ocular hypertension
• Reduced  daily medication burden in the LiGHT Study
• Minimal recovery time; usually painless
• Can be repeated if the effect fades over time - depends on initial response 
• Not for every patient and risks exist.  

What to expect:

• 2-3 minute laser session per eye
• Temporary light sensitivity or redness possible
• Pressure recheck the same day or within a week
• Benefit may appear over 1-2 months

Risks
Short-term pressure spike, inflammation, or limited response. Serious complication are rare but possible.  

Main Classes of Glaucoma Drops

Prostaglandin analogs (e.g., latanoprost, bimatoprost, travoprost)

• How they work: Increase fluid outflow
• Typical use: Once nightly
• Common side effects: Redness, eyelash growth, darker iris/skin around eyes, mild irritation

Beta-blockers (e.g., timolol, betaxolol)

• How they work: Decrease fluid production
• Typical use: Once or twice daily
• Common side effects: Burning/stinging, dry eyes
• Systemic cautions: Can slow heart rate, lower blood pressure, worsen asthma/COPD or certain heart conditions—tell your doctor about your medical history

Alpha-agonists (e.g., brimonidine)

• How they work: Decrease production and increase outflow
• Typical use: Two to three times daily
• Common side effects: Redness, dry mouth, fatigue; rare allergy with redness/follicles

Carbonic anhydrase inhibitors (CAIs)

• Drops: dorzolamide, brinzolamide (2–3× daily)
• Oral: acetazolamide, methazolamide (short-term or special cases)
• How they work: Decrease fluid production
• Common side effects (drops): Burning/metallic taste; (oral): tingling fingers/toes, frequent urination, fatigue, kidney stone risk, electrolyte changes—usually short-term use

Rho-kinase (ROCK) inhibitors (e.g., netarsudil)

• How they work: Increase outflow through the trabecular meshwork
• Typical use: Once daily at night
• Common side effects: Redness, small corneal deposits, mild irritation

Combination drops (two medicines in one bottle)

• Improve convenience, increase compliance, and may reduce preservative exposure

A family of procedures that enhance the eye’s natural drainage with procedures which have a lower risk profile, usually through a small opening.

Who it’s for:

• Mild to moderate open-angle glaucoma, especially if you’re already having cataract surgery
• Patients who want to reduce drop burden and lower IOP with a safer profile than traditional surgery

Common MIGS Approaches (examples):

• Trabecular outflow (canal-based): iStent, Hydrus, OMNI canaloplasty/trabeculotomy, goniotomy procedures—aim to bypass or open the trabecular meshwork and Schlemm’s canal.
• Subconjunctival (micro-stent): XEN Gel Stent—creates a tiny channel to drain fluid to a bleb (small reservoir) under the conjunctiva.
• Suprachoroidal (less common today): Enhances uveoscleral outflow.

Benefits:

• Lower risk and faster recovery than trabeculectomy or tube surgery
• Often decreases the number of drops needed

Limitations:

• Pressure lowering is typically modest compared to trabeculectomy/tubes
• May not be enough for advanced disease or very low target pressures

Risks (vary by procedure):
Transient bleeding (hyphema), inflammation, pressure fluctuations, device malposition or failure, need for additional procedures.

A filtering surgery that creates a bypass for fluid to leave the eye under a protective flap, forming a bleb (a small, blister-like reservoir) on the white of the eye, hidden by the eyelid.

Who it’s for:

• Moderate to advanced glaucoma
• When very low target pressures are required or when SLT/drops/MIGS are insufficient

What to expect:

• Outpatient surgery with stitches and anti-scarring medicines (e.g., mitomycin-C) to help the bleb work long-term
• Frequent early post-op visits for pressure checks and adjustments
• Activity restrictions while healing

Benefits:

• Among the most powerful pressure-lowering options

Risks:

• Early: low pressure (hypotony), shallow chamber, bleeding, inflammation
• Late: scarring/bleb failure, infection risk at the bleb (endophthalmitis, rare but serious), cataract progression, needling or revision

A tube shunt implant (e.g., Ahmed valve) channels fluid from inside the eye to a plate placed on the eye’s surface (under the tissues), where the fluid is absorbed.

The Ahmed device has a built-in valve designed to reduce the chance of pressure dropping too low right after surgery.

Who it’s for:

• Moderate to advanced glaucoma
• Eyes at high risk for trabeculectomy failure (e.g., extensive scarring, certain types of secondary glaucoma)
• When prior surgeries or medications are inadequate

What to expect:

• Outpatient surgery
• Post-op drops for inflammation and infection prevention
• Pressure may fluctuate as the eye heals around the plate

Benefits:

• Strong pressure lowering; useful when other options have failed or aren’t suitable

Risks:

• Double vision (uncommon), tube exposure/erosion (rare but serious), corneal touch/edema if tube position changes, scarring around the plate limiting effect, need for future revision

At Inland Glaucoma Center our UCLA Fellowship-Trained Glaucoma Expert will customize an evidence based protect your eye sight while minimizing risks and side effects.  Our goal is to provide a treatment plan with as least impact to you life as possible to maximize your quality of life, vision while maintaining your precious eye sight.  

1. Disease stage & target pressure (how low do we need to go?)
2. Your life & preferences (daily drops vs. laser; recovery time; cost considerations)
3. Anatomy and prior surgeries (angle structure, scarring risk)
4. Safety & durability (balance of pressure control and risk)

A common path is: SLT → drops (as needed) → MIGS (often with cataract surgery) → trabeculectomy or tube shunt (Ahmed valve vs Trab) if lower pressures are still required.

• SLT: Back to normal same day or next day; follow-up within days to weeks.
• Drops: Ongoing use; periodic pressure checks and side-effect review.
• MIGS (with or without cataract surgery): Days to weeks; fewer restrictions than traditional surgery.
• Trabeculectomy / Ahmed Valve: Weeks to months; more visits and activity limits early on; long-term monitoring for bleb/tube health. More complication risk.  

• SLT is a safe, effective first-line option for many.
• Eye drops work well when used consistently; multiple classes exist to tailor therapy.
• MIGS can lower pressure and drop burden with quicker recovery, especially with cataract surgery.
• Trabeculectomy and Ahmed valve offer strongest pressure lowering when needed, with more intensive aftercare.

Your care team will personalize the plan to your eyes, health, and goals—always with the aim of preserving your sight.