Glaucoma is a chronic optic nerve disease, often linked to elevated intraocular pressure (IOP), and is a leading cause of irreversible blindness globally. Glaucoma treatment primarily aims to reduce IOP and preserve vision. When medications prove insufficient, both laser and traditional surgical approaches are considered. Each surgical approach offers specific benefits depending on the severity, glaucoma type, and patient profile.
Laser Treatment for Glaucoma
Laser trabeculoplasty enhances aqueous drainage through the eye’s trabecular meshwork, helping reduce IOP in patients with open-angle glaucoma.
Selective laser trabeculoplasty (SLT) is one of the most commonly performed laser treatments for open-angle glaucoma. It works by targeting the trabecular meshwork to enhance aqueous outflow, thereby reducing IOP. The procedure is typically conducted in an outpatient setting and does not require any incisions or sutures.
Laser treatments offer a favourable safety profile and, in the case of SLT, can be repeated if needed. They are often used as standalone treatments or in conjunction with medications or surgery to manage glaucoma effectively.
Pros:
- Minimally invasive, performed without incisions or sutures
- Quick recovery, with many patients resuming normal activities the same day or shortly after
- May reduce or delay the need for more invasive surgery
Considerations:
- May be less effective for advanced or rapidly progressing glaucoma
- IOP-lowering effect can reduce over time, so repeat treatment may be necessary
Surgical Treatment for Glaucoma
Traditional glaucoma surgery involves creating a new drainage channel to effectively reduce intraocular pressure (IOP).
Trabeculectomy remains the gold standard for managing moderate to advanced glaucoma, particularly when other treatments have proven inadequate. The procedure entails forming an alternative pathway for aqueous fluid to exit the eye, thereby achieving significant and sustained IOP reduction. These surgical approaches typically require incisions in the eye and may include the implantation of drainage devices.
Pros:
- Can provide strong and lasting IOP control, especially in moderate to advanced disease
- Effective option when medications and laser treatments are insufficient
Considerations:
- Requires a longer recovery period and close post-operative follow-up
- Some patients may experience temporary visual changes or discomfort during healing
- As with any eye surgery, there is a small risk of complications such as infection, bleeding, or cataract formation over time
Minimally Invasive Glaucoma Surgery
Minimally invasive glaucoma surgery (MIGS) serves as an intermediate option between laser and traditional glaucoma surgery. It is generally recommended for patients with mild to moderate glaucoma, offering a favourable safety profile and faster recovery with less tissue disruption. However, the degree of intraocular pressure (IOP) reduction is typically more modest compared to conventional surgery.
Choosing the Right Approach
Laser procedures, MIGS, and traditional surgery each play distinct roles in glaucoma treatment. The best choice always depends on disease severity and individual patient characteristics.
At Eye & Glaucoma Surgeons, Dr Daniel Su Hsien Wen provides tailored treatment plans based on a comprehensive evaluation of your IOP levels, optic nerve condition, lifestyle, and past treatment responses. We often adopt a stepwise strategy, beginning with laser, progressing to MIGS, and considering traditional surgery when necessary. Schedule an appointment to explore the most suitable treatment for your condition.