Glaucoma Laser Surgery

Glaucoma is currently the leading cause of irreversible blindness worldwide. It is a progressive, multifactorial disease that slowly damages the optic nerve, the connection between the brain and the eye. The most common type of glaucoma is open angle glaucoma. It is caused by a buildup of fluid in the eye because the fluid does not drain correctly. The increased pressure damages the optic nerve causing permanent vison loss.

The goal of treatment is to reduce intraocular pressure (IOP) by suppressing it with drugs or surgery to prevent progression and preserve vision. Traditionally, surgery is not the first option but may be recommended when other options fail to reduce IOP or when the drugs cause significant side effects. However, today the use of Selective laser trabeculoplasty (SLT) as a first line treatment is increasing.

What are the symptoms of glaucoma?

There are no obvious symptoms and many people lose their eyesight before they become aware of any problems. Glaucoma is characterized by elevated intraocular pressure detected during a complete eye exam. The cause is a blockage of the fluid outflow system leading to progressive death of the retina cells damaging the optic nerve.

Medications to treat glaucoma

Some patients do well with only one medication, and others may require more than one medication to control their IOP. While major advancements have been made in managing glaucoma, the success of topical glaucoma medications is limited for various reasons including poor adherence to regular use by glaucoma patients. This is due in part to the frequent dosing needed which can impact quality of life. Additionally, the medicines can produce dangerous side effects such as high blood pressure, rapid heartbeat and impotence.

Laser trabeculoplasty

Laser trabeculoplasty is a procedure designed to unclog the blockage and drain the built-up fluid in the eye to reduce intraocular pressure. Laser treatment is an option for patients who cannot tolerate the medications, or when medication alone is not adequate. However, it may be recommended as a first line treatment in some cases, because it can sufficiently lower IOP without medication. The results are usually not permanent, but the use of medication may be delayed thus avoiding the unpleasant side effects. Each patient is different.

The most common types of laser trabeculoplasty are selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT). They use different lasers, but the procedure is the same. Both can be used as primary treatment for IOP reduction or as an adjunct to medication. SLT is becoming more popular as a first line treatment. The effects of both procedures diminish over time.

The procedure

Laser trabeculoplasty (ALT and SLT) is a short, outpatient procedures with quick recovery and a good safety profile. Both are performed using a topical anesthetic. During the procedure laser energy is applied to the drainage tissues in the eye to improve the function of the eye’s drainage system. Treatment reduces the development of scar tissue and causes only minimal discomfort after treatment. After surgery you may still need medications to control eye pressure, as the results of treatment may take 4-6 weeks to work.

Usually half the eye is treated at one time, and the procedure can be repeated on the other half if necessary. Patients may see a flash of green or red during the procedure. Side effects may be soreness and swelling. The vast majority of patients return to their regular daily activities within 24 hours after their laser procedure. You may need to continue your medication even after surgery. The effects wear off with time, lasting 1-5 years for most patients, but you can undergo another laser procedure or your USEC surgeon may recommend another treatment.

Microinvasive Glaucoma Surgery (MIGS)

When eye drops and laser trabeculoplasty fail to control IOP, MIGS is a group of operations designed to treat high IOP. It may be a miniaturized version of traditional trabeculotomy, a bypass operation, or the insertion of a shunt, an implantable glaucoma drainage device.
The goal is to lower IOP pressure to reduce the risk of damage to the optic nerve. MIGS use microscopic equipment and tiny incisions which reduces the risk of complications. These procedures are reserved for patients with mild to moderate glaucoma with uncontrolled IOP despite eye drops and laser therapy. MIGS have a high safety profile, a quick recovery and longer-term control of glaucoma.
Contact USEC to schedule an appointment with one of our stellar ophthalmologists. We offer state of the art procedures and services to help you see your best.