Treatment for Glaucoma

Glaucoma may be successfully treated by medication, surgery or both. Treatment depends on the type of glaucoma and its severity, and the underlying medical conditions, age and health of the patient. Patients must work with their doctors to find the most effective treatment.

Medication to Treat Glaucoma

Currently, lifelong, daily medical treatment for open-angle and low-tension glaucoma is necessary. If medication is discontinued, IOP increases.

Glaucoma medications help drain excess fluid from the eye and/or decrease the amount of fluid produced. Medications used to treat glaucoma can be administered topically or orally and include the following:

  • Alpha-adrenergic agonists (topical; reduce amount of aqueous produced, some also increase removal of fluids form the eye)
  • Beta blockers (topical; reduce the amount of aqueous produced)
  • Carbonic anhydrase inhibitors (topical, oral; reduce production of aqueous humor)
  • Epinephrine compounds (topical; increase removal of fluid)
  • Miotics (topical; increase the removal of aqueous humor from the eye)
  • Osmotic diuretics (oral; draw fluid away from the eyes)
  • Prostaglandin analogs (topical; increase secondary route for aqueous humor to drain)

Most glaucoma drugs produce side effects, including these:

  • Blurred vision
  • Decreased sex drive (beta blockers)
  • Drowsiness
  • Headaches
  • Loss of appetite
  • Mood changes
  • Slowed heart rate (beta blockers)
  • Stinging in the eyes

Patients with light-colored eyes who take prostaglandin analogs may experience a change in eye color. Most side effects are mild and lessen or disappear after a few weeks. The physician should be notified if they cannot be tolerated or are severe. Lowering the dosage or changing the medication usually eliminates or diminishes side effects.

In October 2007, the U.S. Food and Drug Administration (FDA) approved brimonidine tartrate/timolol maleate ophthalmic solution (Combigan) to treat IOP in patients who have glaucoma. Combigan is a combination of two types of eye drops previously approved to treat this condition (Alphagan and timolol ophthalmic solution [Timoptic]). Patients who have certain lung conditions, such as a history of asthma or severe COPD (chronic obstructive pulmonary disease), should not use this medication.

In February 2012, the FDA approved tafluprost ophthalmic solution (Zioptan) to reduce eye pressure in people with open-angle glaucoma and those with elevated eye pressure (who are at increased risk for developing glaucoma). This eye drop medication is administered once daily, in the evening. Side effects include darkening of the iris (may be permanent), darkening of the eyelid (may be reversible) and eyelash growth.

In June 2012, the first stent was approved to treat open-angle glaucoma in combination with cataract surgery. This device, called the iStent Trabecular Micro-Bypass Stent System, is approved to reduce intraocular pressure in adults with mild or moderate open-angle glaucoma and a cataract who are currently being treated with glaucoma medication.

The procedure involves placing a small titanium tube through the meshwork of tissue along the outer edge of the iris, where the iris and cornea meet, and into a canal called Schlemm’s canal to create an opening between the eye’s anterior chamber and Schlemm’s canal that allows fluid to drain and reduces intraocular pressure.

More research about the benefits and risks of iStent implantation is being conducted. Complications linked to the device include unsuccessful or difficulty implanting the stent, poor positioning of the stent and blockage of the stent following the procedure.

Laser Surgery to Treat Glaucoma

Laser surgery is recommended for those who have not experienced favorable results from medication. A laser is used to make a small opening in the eye to drain fluid. There are different types of laser surgery and the choice is based on the type of glaucoma and the health of the eye. Laser surgery is usually done on an outpatient basis.

In narrow-angle glaucoma, a YAG laser is used to make a small opening in the eye to drain fluid.

Laser peripheral iridotomy is often used to treat angle-closure glaucoma. The laser creates a small hole in the iris, allowing the aqueous to flow more freely within the eye.

Argon laser trabeculoplasty is used to treat primary open-angle glaucoma. The laser makes tiny openings which open the fenestration of the trabecular meshwork (drainage area of the eye) improving aqueous drainage and lowering IOP.

YAG laser cyclophotocoagulation is used in advanced or aggressive cases of glaucoma. It works by destroying selected areas of the ciliary body that produce aqueous humor, reducing fluid production.

Laser Surgery Complications

Most patients obtain good results with laser surgery, but the procedure carries some risks. There may be a temporary increase in IOP and this type of laser surgery can occasionally decrease IOP to levels that are too low. The use of glaucoma medication before and after surgery reduces surgical risks.

Laser surgery lowers IOP, but the length of time that it remains stable depends on the type of surgery, the type of glaucoma, age, race, and severity of disease. Some patients need additional surgery. Medication is usually necessary to control IOP following laser surgery, but many patients are able to reduce the dosage.

Filtering Microsurgery to Treat Glaucoma

When medication and laser surgery are unsuccessful, or if vision loss occurs very rapidly, the doctor may perform filtering microsurgery. This procedure is performed in a hospital or outpatient surgical center. Local anesthesia is often used with intravenous sedation. The surgeon makes a tiny drainage hole in the sclera. Fluid flows through this opening and is reabsorbed into the bloodstream, and eye pressure is lowered.

Alternatively, a small tube or valve may be placed through the sclera incision to regulate IOP. When the pressure rises to a certain level, the valve opens and allows fluid to pass out of the eye. When pressure returns to normal, the valve closes. This procedure has a 70-90 percent success rate over 1 year.

Microsurgery Complications

Sometimes the surgical opening closes, causing pressure to rise. This happens because the body tries to heal the opening. Patients may also experience blurred vision for about 6 weeks. Vision usually returns to what it was prior to the operation, although in some cases, vision is improved. In a few cases, vision may worsen due to very low IOP which results in the accumulation of fluid in the macula.

Lifestyle and Nutrition & Glaucoma

Exercise may reduce intraocular eye pressure and is known to have a beneficial effect on glaucoma risk factors such as high blood pressure and diabetes. Results of a study indicate that riding a stationary bicycle for 40 minutes, four times a week reduces IOP by 20 percent. In a second study, still in progress, brisk walking for 40 minutes, four times a week has eliminated the need for beta blockers.

Some forms of glaucoma, such as angle-closure, do not respond to exercise, and in some cases IOP may increase temporarily following vigorous exercise. So, it is important to discuss any new exercise program with a physician before you start.

Severalvitamins and minerals are essential for good eye health, including vitamins C, E, and A, and the minerals zinc, copper, and selenium. A large intake of caffeine over a short time can temporarily raise IOP, and glaucoma patients are advised to limit their caffeine intake.

Glaucoma Prognosis

Laser surgery lowers IOP, but the length of time that it remains stable depends on the type of surgery, the type of glaucoma, age, race, and severity of disease. Some patients need additional surgery. Medication is usually necessary to control IOP following laser surgery, but many patients are able to reduce the dosage.

Glaucoma Prevention

Glaucoma cannot be prevented. Early detection can prevent vision loss and control the disease. Regular eye examinations are recommended, especially for people over the age of 35. After age 40, eye exams should be done every 2 to 4 years, and after age 60, every 1 to 2 years. Glaucoma testing is recommended every 1 to 2 years after the age of 35 for those at high risk.

Eating vitamin-rich fruits and vegetables, taking a vitamin supplement, protecting eyes from injury, and getting medical treatment for systemic illnesses promote good eye health.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 01 Jan 2002

Last Modified: 17 Sep 2015