Glaucoma
Treatment Overview
Treatment for glaucoma focuses on preserving eyesight by slowing the damage to the nerve located in the back of the eye (optic nerve). In adults, treatment cannot restore eyesight that has already been lost as a result of glaucoma. However, in certain children, some of the damage caused by congenital glaucoma can be reversed.
Currently, most treatment for glaucoma is directed at lowering the pressure in the eyes (intraocular pressure, or IOP). Optic nerve damage can occur at any level of eye pressure, even within the normal range. Lowering the IOP often can help protect the optic nerve from further damage.
Treatment options include medications, laser treatments, and surgery. In Canada, treatment usually begins with medications. When treatment with medications does not successfully lower pressure in the eyes, laser or surgery treatments need to be considered. However, in some instances it may be appropriate to use laser or surgical treatments first, particularly in moderate to severe cases. Studies indicate that treatment with medication or surgery are both effective, but the risks and benefits may differ depending on the type of glaucoma, age, race, and other factors.8 If you have glaucoma, ask your doctor about all the possible treatment options and which treatments may be better for your particular condition.
Initial treatment
If you are diagnosed with glaucoma, a target eye pressure for each eye is established. The target is based on the amount of damage to the optic nerve and the pressure in the eyes (intraocular pressure, or IOP) at which the damage occurred. The target eye pressure level is approximately 20% to 30% less than the prior eye pressure. During treatment, the target eye pressure is adjusted as needed to prevent damage to the optic nerve.
If you have high IOP but no other signs of glaucoma, you will need to be checked regularly by an eye specialist (ophthalmologist). If the pressure is high enough, you may be treated with medications to lower the pressure and prevent vision loss. However, the decision to start treatment in the absence of optic nerve damage is a serious one, as it exposes you to the risks and expenses of long-term treatment.
Treatment for open-angle glaucoma may involve medications (eyedrops) that lower the pressure inside the eye, laser treatment, or other surgery. In Canada, eyedrops that lower the IOP are usually tried first. Decreasing eye pressure in open-angle glaucoma slows the progression of the disease and helps prevent further vision loss. However, other treatments (laser or surgery) may sometimes be considered as an initial form of treatment if you have moderate or severe open-angle glaucoma.
Closed-angle glaucoma can be an emergency situation (acute closed-angle glaucoma) because blockage of fluid in the eye causes a sudden increase in pressure, resulting in rapid damage to the optic nerve. Acute closed-angle glaucoma usually causes significant pain in the eye. Acute closed-angle glaucoma needs immediate care, including medications to lower IOP, monitoring of the drainage angle, and often surgery. If it is not treated immediately, blindness can develop rapidly.
Congenital glaucoma almost always requires surgery to correct the defect. Medication may sometimes be used, but it usually does not work over time.
If you have already experienced a significant vision loss from glaucoma, your doctor will also conduct a low-vision evaluation. The evaluation will help you and your doctor find ways to make the best use of your remaining vision. It also can include suggestions for counselling and training on dealing with reduced vision.
Because glaucoma can lead to a significant loss of vision before it is detected, learning that you have glaucoma can be difficult. You may feel saddened and become depressed. Your doctor can refer you to counsellors who specialize in helping people adjust to living with low vision.
Ongoing treatment
Once you start treatment for glaucoma, you will need regular eye examinations by an ophthalmologist. During these examinations, the pressure inside the eyes (intraocular pressure, or IOP) is usually measured. You may need to see the doctor every day until the target eye pressure is reached. Once the target pressure is reached, you may need to see the doctor every 3 to 6 months. The ophthalmologist will examine your eyes for changes in the optic nerve that indicate the disease is getting worse despite treatment and will adjust the target eye pressure if needed.
If the pressure in the eye continues to be high or if damage to the optic nerve gets worse despite treatment with eyedrops, laser treatment may be done.
If you have narrow drainage angles, you are more likely to develop closed-angle glaucoma. If you are diagnosed with closed-angle glaucoma, you will need regular evaluations to check your drainage angles and eye pressure. You may need laser treatment to prevent sudden closure of the angle.
Medications, usually eyedrops, are used to lower IOP by either decreasing the amount of fluid produced by the eye or increasing the amount of fluid that drains out of the eye. It is important to understand that treatment for glaucoma will most likely continue for the rest of your life.
Home treatment can help you live with the effects of glaucoma. You can use vision aids and adaptive technologies, such as video enlargement systems and large-print items, to help you function better with reduced vision; develop a support network of people who can help you with difficult tasks; and receive counselling and training to help you cope with reduced vision and maintain your quality of life.
Treatment if the condition gets worse
Surgery for glaucoma usually is needed only if you continue to lose vision and the pressure in your eyes (intraocular pressure, or IOP) cannot be lowered with medications or laser treatment. In some countries, such as Great Britain, surgery is done early in the disease process.
Surgery may be done to make another opening for fluid to leave the eye. Sometimes, surgery to destroy part of the eye that produces the fluid (ciliary body) may also be used to decrease fluid production. This type of surgery is usually done only for advanced cases of glaucoma in which other forms of treatment have not been effective.
What To Think About
Glaucoma cannot be cured, but the pressure inside the eye (intraocular pressure, or IOP) can be controlled with medications, surgery, or both. In adults, treatment for glaucoma cannot restore eyesight that has been lost because of the condition, but it can prevent further damage to the optic nerve and save remaining eyesight. In certain children with congenital glaucoma, some of the optic nerve damage caused by the disease can be reversed with treatment.
Medications (most often eyedrops) are usually needed to treat glaucoma. In most cases, they have to be used every day for the rest of your life. Putting eyedrops in the eye at specific times of the day may be inconvenient. For some people, eyedrops can also cause discomfort. You will need to follow the prescribed daily schedule for your eyedrops in order for them to work properly.
Unlike some chronic diseases in which failure to take medications causes noticeable symptoms, not using your glaucoma medications as prescribed will not usually cause any obvious symptoms. However, it may cause slow, often unnoticed loss of eyesight that is permanent and that could eventually lead to blindness.
Because glaucoma can't be cured and treatment does not always prevent further loss of vision, people may try alternative unproven treatment methods, such as acupuncture or marijuana. However, most of these alternative treatments either have not been studied or have not been proven to work. Such treatments may be expensive, and some can be hazardous to your health.
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| Author: | Carrie Henley Robin Parks, MS | Last Updated: August 31, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Tom Bailey, MD - Family Medicine Carol L. Karp, MD - Ophthalmology | |
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