Treating Glaucoma

Most forms of glaucoma are chronic conditions that cannot be cured. Open-angle glaucoma can often be treated safely and effectively with medication or surgery, but lifelong use of medication is almost always necessary. Decisions on when to initiate treatment are based on the amount of optic nerve damage and visual field loss as well as risk factors such as elevated IOP, increasing age, and racial or ethnic background.

Acute closed-angle glaucoma is a medical emergency. If you experience symptoms of closed-angle glaucoma (severe pain in the eye, nausea and vomiting, blurred vision, and rainbow-colored halos around lights), contact your ophthalmologist immediately.

The overall aim in treating glaucoma—whether open- or closed-angle—is to prevent damage to the optic nerve by lowering IOP and maintaining it at a level that is unlikely to cause further nerve damage. Treatment for people with normal-pressure glaucoma is similar to that for people with elevated IOP levels.

An appropriate and typical target is to lower IOP by 25% below the level noted when you are diagnosed, although the target is even lower in people with extremely high IOP levels (above 35 mm Hg). Once the target IOP is achieved, you will be monitored to make sure that damage to the optic nerve is not progressing. If there is progressive damage at the target IOP, a lower target will be set. Unfortunately, treatment cannot reverse optic nerve damage once it has occurred and cannot improve vision.

Choosing a treatment for glaucoma involves weighing the health benefits and risks of each option while trying to minimize overall inconvenience and financial costs. Both medication and surgery are first-line treatments for glaucoma, and each has its own set of complications and possible side effects.

In some cases, medication does not stop the progression of optic nerve damage or visual field loss, possibly because the doctor has selected a target IOP that is not low enough or the target IOP is not reached (if a person does not take the medication as prescribed, for example). Surgical complications, such as the development of cataracts, occur in only a small number of people, and the risk is lower with laser trabecular surgery than with traditional filtration surgery.

Publication Review By: Susan B. Bressler, M.D., Harry A. Quigley, M.D., Oliver D. Schein, M.D., M.P.H.

Published: 02 Mar 2011

Last Modified: 22 Jun 2011