Treatment of open-angle glaucoma -- the most common form of the disease -- requires lowering the eye's pressure by increasing the drainage of aqueous humor or decreasing the production of the fluid. Medications can accomplish both of these goals. Surgery and laser treatments are directed at improving the eye's aqueous drainage.
If not diagnosed early, open-angle glaucoma may significantly damage vision and even cause blindness. That is why it's so important to have your eye doctor test you regularly for glaucoma. Once diagnosed, glaucoma is usually controlled with eye drops that reduce eye pressure. Glaucoma is a life-long condition and needs continual follow-up with your eye doctor.
Both drugs and surgery have high rates of success in treating chronic open-angle glaucoma, but you can help yourself by carefully following the doctor's treatment plan. Some patients may find it difficult to follow a regimen involving two or three different eye drops. Be candid and tell the doctor if you cannot follow the medication schedule or if the eye drops cause unwanted side effects. There are frequently alternative treatments. Because of potential drug interactions, be sure to tell your doctor about any other medical problems you have or other medications you take. If glaucoma drops causes the eyes to become chronically red, consult your doctor about switching to preservative-free glaucoma drops that may alleviate the redness from preservatives.
Acute closed-angle glaucoma is different from chronic open-angle glaucoma in several important ways: The symptoms usually occur with relative suddenness; the eye is painful and red. If the high pressure in the eye is not relieved quickly, blindness can occur. On the other hand, treatments for acute closed-angle glaucoma -- usually laser treatment -- are usually permanent and do not require long-term therapy. For this type of glaucoma, making a hole to allow fluid to drain, called an iridectomy, is the standard treatment to cure it. The unaffected eye also is usually treated to prevent a future attack. However, it's important to get your eyes checked regularly, as some people may develop a case of chronic angle-closure glaucoma later in life, even after laser treatment.
Appropriate treatment depends on the nature and stage of the glaucoma. Your eye doctor may not prescribe any treatment for ocular hypertension -- when increased pressure in the eye is minimal and no nerve damage is present. Routine monitoring of your peripheral vision and of the appearance of the optic nerve may be sufficient.
If the glaucoma does not respond to medication, or if you cannot tolerate the side effects, your doctor may change medications or recommend one of several surgical techniques:
Laser trabeculoplasty creates small laser burns in the area where the fluid drains, improving the outflow rate of aqueous fluid. This relatively brief procedure can often be done in an ophthalmologist's clinic.
Trabeculectomy is a surgical procedure that creates a new channel for fluid outflow in cases in which the intraocular pressure is high and the optic nerve damage progresses. Long-term results vary, but generally, the success rate is good.
Surgical implants that shunt fluid out of the eye may also be used to decrease pressure in the eye.
Remember, all forms of medical or surgical treatment have potential benefits and risks. Before giving your consent, always ask the surgeon to clearly explain any treatment or surgery as well as the proposed benefits, effective alternatives, and potential risks or complications.
SOURCES: American Glaucoma Society. Weinreb, R. Lancet, 2004. Curcio, C. Journal of Comparative Neurology, Oct. 1, 1990. American Academy of Ophthalmology. Glaucoma Research Foundation. U.S. Preventive Services Task force: "Screening for Primary Open-Angle Glaucoma in the Primary Care Setting." Mayo Clinic. Distelhorst, J. American Family Physician, May 1, 2003.