In order to treat glaucoma, intraocular pressure must be lowered, and this can be accomplished with laser surgery, medications, conventional (incisional) surgery, or a combination of these methods. Glaucoma treatment options are grouped below by glaucoma type. Treatment options depend on the type of glaucoma and the individual patient.
Treatment of Primary Open-Angle Glaucoma
SELECTIVE LASER TRABECULOPLASTY (SLT)
Are you one of the millions of people worldwide who suffer from glaucoma? This condition causes pressure to build up in your eye, potentially leading to vision loss or blindness. Fortunately, there are a variety of treatments available for glaucoma, including medications and surgery. One such option is Selective Laser Trabeculoplasty (SLT), a safe and effective procedure that uses laser energy to lower intraocular pressure. In this blog post, we’ll explore what SLT is, how it’s performed, its benefits and risks, who may be a good candidate for the procedure as well as its cost. So let’s dive in!
What is SLT?
Selective Laser Trabeculoplasty (SLT) is a minimally invasive procedure used to treat open-angle glaucoma, one of the most common types of this condition. It involves using laser energy to target specific cells in the trabecular meshwork, which is responsible for regulating intraocular pressure.
During an SLT procedure, a low-energy laser beam is directed at the drainage system of your eye. The light from the laser stimulates cells in the trabecular meshwork, causing them to improve their ability to drain fluid out of your eye naturally. This helps reduce intraocular pressure and can prevent further damage caused by increased pressure.
One significant advantage of SLT over other treatments for glaucoma is that it doesn’t require any incisions or injections. Additionally, patients usually experience minimal discomfort during and after the procedure.
SLT has become an increasingly popular option for treating open-angle glaucoma due to its high success rate and relatively low risk profile compared with other forms of treatment.
How is SLT performed?
Selective Laser Trabeculoplasty (SLT) is a minimally invasive procedure that can help reduce intraocular pressure in patients with glaucoma. The procedure involves using a laser to target specific cells in the eye’s drainage system, allowing for better fluid outflow and thus reducing pressure.
During the SLT procedure, an ophthalmologist will first numb the eye with topical anesthesia before placing a special contact lens on the eye. This lens helps to focus the laser beam onto specific areas of the trabecular meshwork, where it will be most effective.
The laser itself emits short pulses of energy lasting just microseconds each. These pulses are absorbed by pigmented cells within the trabecular meshwork, which then triggers a cellular response that improves fluid flow through this area.
The entire SLT procedure typically takes only 10-15 minutes per eye and does not require any incisions or sutures. Patients may experience some mild discomfort during or after treatment but should be able to resume normal activities right away.
SLT is considered safe and effective for many patients with open-angle glaucoma who have not responded well to other treatments such as medication or surgery.
What are the benefits of SLT?
Selective Laser Trabeculoplasty (SLT) is a highly beneficial procedure for individuals suffering from open-angle glaucoma, as it helps to reduce the intraocular pressure that can cause vision loss. One of the most significant advantages of SLT over other treatments is that it does not damage surrounding tissues or require any incisions.
The non-invasive nature of this treatment facilitates quick and painless recovery times, making it an ideal choice for those seeking a minimally invasive solution for their eye condition. Additionally, SLT has been found to be highly effective in managing intraocular pressure without causing any significant side effects.
Another benefit of SLT is its long-term efficacy. Unlike medications which may have to be taken frequently and indefinitely, SLT can provide lasting results with just one or two treatments per year. This makes it a cost-effective option when compared to lifelong medication costs.
Patients undergoing SLT do not typically experience much discomfort during the procedure and are usually able to return home immediately afterward with minimal restrictions on daily activities.
SLT offers numerous benefits over traditional glaucoma treatments such as reduced need for medication, fewer complications associated with surgery and rapid recovery time making it an excellent choice for treating open-angle glaucoma while maintaining quality of life.
Are there any risks associated with SLT?
As with any medical procedure, there are potential risks associated with Selective Laser Trabeculoplasty (SLT). However, the risks of SLT are generally considered to be low.
One possible risk is increased eye pressure. While this is rare, it may occur in some patients after the procedure. This can usually be managed by your doctor and medication.
Another potential risk is temporary inflammation or redness in the treated eye. This should subside within a few days following the procedure.
There is also a small chance of vision loss due to laser energy affecting surrounding tissue. However, this complication occurs very rarely and has not been reported as an issue for SLT procedures.
It’s important to discuss any concerns you have about potential risks with your ophthalmologist before undergoing SLT treatment. They will be able to provide more information about these risks and help determine if SLT is right for you based on your individual needs and condition.
Who is a good candidate for SLT?
Selective Laser Trabeculoplasty (SLT) is a safe and effective procedure for treating open-angle glaucoma. But, who are the ideal candidates for this treatment? Here are some factors that may make someone a good candidate for SLT.
Firstly, patients with open-angle glaucoma who have not responded well to other treatments such as eye drops or medication can benefit from SLT. Additionally, those who cannot tolerate side effects of medications could also be ideal candidates.
Age is another factor to consider. Older adults with limited mobility or dexterity issues may find it difficult to administer eye drops regularly. For these individuals, SLT could provide an easier option for managing their glaucoma.
Furthermore, patients who suffer from dry eyes or allergies may experience discomfort while using traditional therapies like medicated eyedrops. In such cases, SLT would be an excellent alternative solution.
Anyone looking for a minimally invasive treatment option should consider SLT as it has minimal downtime and few complications compared to more invasive options like surgery.
How much does SLT cost?
In summary, Selective Laser Trabeculoplasty (SLT) is a safe and effective procedure for treating open-angle glaucoma. The treatment involves using a laser to reduce intraocular pressure by improving the outflow of aqueous humor from the eye.
SLT has several benefits over other traditional forms of glaucoma treatment such as medications and surgery. It is minimally invasive, does not require any incisions or sutures, has fewer side effects, and works well in combination with other treatments.
Although SLT is generally considered safe, there are some risks involved such as temporary inflammation or increased pressure in the eye. However, these risks can be minimized by choosing an experienced ophthalmologist who specializes in SLT.
If you have been diagnosed with open-angle glaucoma and are looking for an alternative to medication or surgery, then you may be a good candidate for SLT. Your ophthalmologist will evaluate your condition and recommend the best course of treatment for you.
The cost of SLT varies depending on several factors such as location, provider fees, insurance coverage etc. On average it can range from $500 to $1500 per eye but this cost may vary based on individual cases.
If you have open-angle glaucoma that needs treatment but want something less invasive than medication or surgery then talk to your Ophthalmologist about whether Selective Laser Trabeculoplasty (SLT) might be right for you!
MEDICATIONS FOR GLAUCOMA
To keep eye pressure at a safe level, medications must be taken daily to treat open-angle glaucoma. Most medications allow the eye’s fluid to drain better or reduce the amount of fluid being produced. It is possible to safely control eye pressure for many years with medications.
The prescriptions for your medications may change over time. Changing medications does not necessarily mean that your glaucoma is getting worse. When your body becomes accustomed to a medication, it may lose its effectiveness slowly and need to be replaced by a stronger version or another medication. When your body has had time to “forget” your old medication, doctors may be able to return to it.
Eye drops are most commonly used to treat glaucoma. Make sure you put drops in your eye correctly.
The side effects of most medications include changes in vision, eye comfort, and sometimes other body parts. People with glaucoma should watch for changes in behavior or mobility that may be due to their medications. Your doctor may be able to prescribe another medication if the side effects last a long time or are very uncomfortable.
To ensure your glaucoma medications are not interfering with other medications you are taking, be sure to inform all your doctors, including your family physician, about your glaucoma medications and any other drugs you may be taking, including aspirin, vitamins, and natural remedies. If you experience any side effects or allergies, inform your doctor.
Glaucoma medications can have the following side effects:
Analogs of prostaglandins
Changes in the color of the eyes, darkening of the eyelid skin, growth of eyelashes, drooping eyelids, sunken eyes, stinging, redness, and itching of the eyes
Blockers of beta oxidation
-Symptoms include low blood pressure, slowed pulse rate, fatigue, and shortness of breath
The Alpha Agonists
-A burning or stinging sensation, fatigue, headache, drowsiness, dry mouth and nose, or an allergic reaction can occur
Inhibitors of carbonic anhydrase
-Eye drops cause stinging, burning, and eye discomfort; pills cause tingling hands and feet, fatigue, stomach upset, memory problems, and frequent urination.
Inhibitors of Rho Kinase
-There is redness, deposits on the cornea, stinging, and small bleeds on the white of the eye
Treatments on the horizon
Several new forms of medication delivery are being developed to improve glaucoma medication treatment options. One such area is sustained-release medication. Sustained-release medication evenly releases a drug over a longer period of time. This allows medications to be taken on a weekly, monthly, or even longer-distance basis. As a result, the process of taking medications would be more convenient and efficient, and side effects could be reduced. Many sustained-release options are being researched and developed right now.
Furthermore, researchers are searching for glaucoma medications that have fewer side effects, can be taken less often, and are more responsive to the eye, so they lower eye pressure more effectively.
SURGERY BY INCISION
Incisional surgery may be recommended when SLT, glaucoma medications, and other treatments fail to lower eye pressure to the desired level. A cut (incision) is made in the eye during this procedure, which is performed in a hospital or surgery center with a microscope and microsurgery instruments.
In order to prevent discomfort during surgery, you are given a local anesthetic and a medication to help you relax before the procedure begins.
A microscope is placed several inches above your eye while the doctor performs surgery.
Depending on your age, daily activities, and other personal factors, you will need some time to recover from eye surgery. Even though you may need to wear an eye patch to protect your eye, most people are able to get back to their regular activities soon after returning home.
Taking a break from driving, reading, bending, and strenuous exercise after glaucoma surgery is recommended for at least a week.
When excessive scarring cannot be prevented or after a long period of time, glaucoma surgery may have to be repeated.
MIGS (Minimally Invasive Glaucoma Surgery)
MIGS procedures have been developed in recent years to treat patients earlier and more safely than conventional surgery. As with all new procedures, multi-year follow-up studies are required to determine which ones will prove useful in the long term.
In MIGS procedures, small incisions are used to manipulate the eye tissues less, reducing the risk of complications, but at a lower effectiveness.
There are several ways in which MIGS procedures and devices work. Some enhance fluid outflow within the eye’s drainage system, while others carry fluid to the outside of the eye. MIGS procedures may be performed only with cataract surgery, while other MIGS procedures can be performed independently of cataract surgery as well.
MIGS combined with cataract surgery lowers pressure more, helping to reduce the need for medication. Implanting a MIGS device adds a few minutes to cataract surgery.
MIGS devices and surgeries can be categorized based on how they work:
These procedures involve inserting tiny tubes into the eye to drain fluid from within the eye to beneath its outer membrane (conjunctiva) in miniature versions of trabeculectomy. InnFocus (formerly XEN Gel Stent) and PRESERFLO (formerly InnFocus) MicroShunt, for example, were cleared by FDA.
Angle-based surgeries are performed using advanced instruments and tools to alter the pathways of fluid drainage from the eye. This includes cutting trabecular meshwork with techniques like Trabectome, Kahook Dual Blade and OMNI Surgical System; Facilitating bypass of the meshwork by placing stents such as iStent Inject or Hydrus Microstent; Lastly, expanding Schlemm’s canal and collector channels via gels such as iTrack and OMNI Surgical System. Such procedures might be combined to achieve even more efficient flow of liquid out of the eye.
There are conventional treatments for glaucoma, including trabeculectomy or aqueous shunts (see below). While they can offer better results in lowering eye pressure and preventing progression of glaucoma, they also carry a higher risk of complications.
Surgery for Trabeculectomy
By using a small surgical instrument, a small opening is made in the sclera (the white part of the eye) to bypass the blocked drainage canals. In order to prevent scarring and the closure of the new opening, special medications (antifibrotics) may be used. After the new opening is covered by conjunctiva, a bleb appears on the sclera. This procedure requires stitches and usually takes a few weeks to complete.
Surgery for aqueous shunts
In aqueous shunt surgery, a tiny tube is implanted in the eye to drain fluid. Like trabeculectomy, this conventional surgery also requires stitches and recovery takes a few weeks.
In addition to marijuana/cannabidiol (CBD), stem cells, herbal medicines, and nutritional supplements, many unapproved treatments are promoted online and elsewhere. You should talk to your doctor about any additional treatments you are considering before starting them since these treatments are not part of the standard of care in glaucoma treatment.
Treatment of Primary Angle-Closure Glaucoma
Usually, Angle-Closure Glaucoma and eyes at risk for this disease are treated with a laser procedure, laser peripheral iridotomy, to create an opening in the outer edge of the iris.
The other eye may be treated if you have Angle-Closure Glaucoma in one eye.
As with Open-Angle Glaucoma, other treatments include medications to lower eye pressure, trabeculectomy or tube shunt surgery, and, rarely, Selective Laser Trabeculoplasty. In the Treating Glaucoma section (above), you will find information about these treatments for Open-Angle Glaucoma.
Primary Angle-Closure Glaucoma can be treated with cataract surgery. By removing the cataract, the angle is opened and eye pressure is usually reduced.
Treatment of Other Types of Glaucoma
Glaucoma Treatment with Normal Tension
Medications, laser treatments, and surgery are usually used to treat Normal-Tension Glaucoma.
Pigmentary Glaucoma Treatment
Medications, laser treatments, or surgery are used to treat Pigmentary Glaucoma. However, it is difficult to reduce or eliminate the release of iris pigment.
Congenital Glaucoma Treatment
Laser surgery may also be used to treat Congenital Glaucoma. Medication can take the form of eye drops, pills, or liquids taken by mouth.
For lower eye pressure, these treatments either decrease the amount of fluid made in the eye or increase the amount of fluid that leaves the eye. Surgical procedures used to control eye pressure in Congenital Glaucoma include filtering surgery, aqueous shunt surgery, and goniosurgery, a special procedure that opens canals within the trabecular meshwork. In order to control eye pressure effectively, it may be necessary to repeat glaucoma surgery.
Exfoliative Glaucoma Treatment
This type of glaucoma is generally more difficult to control with medications. Patients with Exfoliative Glaucoma often need to undergo a more aggressive, step-by-step treatment plan and often require laser therapy or surgery. The disease progression often requires more frequent visits to the eye doctor.
Neovascular Glaucoma Treatment
In Neovascular Glaucoma, lasers are used to treat the retina and anti-VEGF drugs are administered to slow down the growth of blood vessels. This results in a regression of abnormal blood vessels. In addition to medications for Open-Angle Glaucoma, surgery with trabeculectomy and drainage implants may also be used.
Uveitic Glaucoma Treatment
The treatment for Uveitic Glaucoma is similar to that for Open-Angle Glaucoma in that it lowers eye pressure. Laser treatments are typically not used, as they can cause increased inflammation. Surgical treatment may involve an aqueous shunt when medication cannot control the condition. A rheumatologist may prescribe medication in addition to eye treatment to treat the root cause of inflammation.
Traumatic Glaucoma Treatment
There is a wide range of treatment options for Traumatic Glaucoma, depending on the type of eye injury and when it occurs. Although SLT is usually not effective for glaucoma that develops years after an eye injury, it is similar to Open-Angle Glaucoma. When glaucoma develops immediately after eye injury, the treatment is primarily guided by the type of trauma and the extent of damage to the eye.
Glaucoma Treatment with Normal Tension
Medications, laser treatments, and surgery are most commonly used to treat Normal-Tension Glaucoma.
Pigmentary Glaucoma Treatment
In Pigmentary Glaucoma, medications, laser treatments, or surgery are used to lower eye pressure. Unfortunately, it is difficult to reduce or eliminate the release of iris pigments. Therefore, lowering eye pressure is the primary goal.
Congenital Glaucoma Treatment
Congenital Glaucoma can be treated with both medication and surgery. Medication can take the form of eye drops, pills, or liquids taken by mouth. Laser surgery may also be used.
To lower eye pressure, these treatments either decrease the amount of fluid produced in the eye or increase the amount of fluid out of the eye. Aqueous shunt surgery, filtering surgery, and goniosurgery, a special procedure that opens canals in the trabecular meshwork, are among the surgical procedures that can help control eye pressure in Congenital Glaucoma. To effectively control eye pressure, glaucoma surgery may need to be repeated.
Exfoliative Glaucoma Treatment
It is usually more difficult to control this type of glaucoma with medication. Exfoliative Glaucoma patients often require a more aggressive, stepwise treatment plan, including laser therapy or surgery, and more frequent visits to their eye doctor to monitor the progression of the disease.
Neovascular Glaucoma Treatment
It is common to treat Neovascular Glaucoma with laser treatment to the retina and anti-VEGF drugs that cause abnormal blood vessels in the eye to shrink. In addition to medications for Open-Angle Glaucoma, surgery that involves trabeculectomy and drainage implants may also be used.
Uveitic Glaucoma Treatment
Many of the medications used to lower eye pressure in Uveitic Glaucoma are the same ones that are used for Open-Angle Glaucoma. Laser treatments are usually avoided since they can increase inflammation. Aqueous shunts are sometimes used in cases where medication cannot control the inflammation. In addition to treatment by an eye doctor, sometimes a rheumatologist prescribes medication to treat the root cause.
Traumatic Glaucoma Treatment
When glaucoma develops and the type of eye injury determine the treatment of traumatic glaucoma. Generally, SLT does not work for glaucoma that occurs years after an eye injury, but is similar to Open-Angle Glaucoma. Glaucoma that develops immediately after an eye injury is treated primarily based on the extent and type of trauma.