Understanding Your Glaucoma Treatment Options

When you receive a glaucoma diagnosis, a doctor will typically start you on eye drops. Eye drops are generally the first choice because they can help slow the progression of glaucoma and reduce your eye pressure.

While eye drops are definitely the least invasive option, they do require commitment. Depending on your condition, a doctor may prescribe more than one type of eye drop. You’ll need to use these drops at least once a day for the rest of your life in order to prevent disease progression.

Here are the most common types of eye drops for glaucoma.

Prostaglandins

Prostaglandins work by increasing the amount of fluid your eyes are able to drain. This reduces the level of pressure in your eye. You’ll typically apply one drop in each eye daily before bedtime.

Potential side effects include:

• red eyes
• change in your eyelash growth
• change in your iris color
• pigmentation

Rho kinase inhibitor

Rho kinase inhibitors, such as netarsudil (Rhopressa), lower eye pressure by reducing fluid production and improving fluid drainage. The usual dosage is one drop in your affected eye once daily. The main side effect is eye redness.

Nitric oxides

Nitric oxide-donating medications, like latanoprostene bunod (Vyzulta), also increase fluid outflow from the eye, decreasing eye pressure. A typical dosage is one drop in each eye every day. The most common side effect is eye redness, but there may also be an increased risk of depression and allergic contact dermatitis.

Miotic or cholinergic agents

These medications, such as pilocarpine (Salagen), work by constricting the pupil and opening drainage pathways, thus improving the outflow of fluid from your eye. The usual use is one or two drops in your affected eye up to four times a day.

Side effects of pilocarpine eyedrops can include eyebrow pain and shrinkage of your pupil. But the risk of side effects is much higher when you take these drugs orally.

Beta-blockers

Beta-blockers such as timolol (Timoptic) decrease fluid production in your eye. You’d typically use these drops once or twice daily. If you have a respiratory condition like asthma or chronic obstructive pulmonary disease (COPD), you might not want to use beta-blockers. Common side effects include eye pain, eye infections, and swollen eyelids.

Laser procedures are another category of glaucoma treatment. They can either be used as initial treatment or when eye drops don’t provide enough pressure reduction.

Laser trabeculoplasty

In this procedure, the surgeon uses a laser to make your eye’s drainage system, known as the trabecular meshwork, perform more effectively and reduce eye pressure. It’s primarily for people with open-angle glaucoma. Potential complications include swelling of your cornea and inflammation of your iris.

Cyclophotocoagulation

This type of laser treatment directs laser light to the ciliary body, the part of your eye that produces eye fluid. This helps reduce fluid production and lowers your eye pressure. This treatment is for more serious types of glaucoma or for when other treatment options haven’t worked. Risks may include bleeding (hyphema) and excessively low eye pressure (hypotony).

Laser iridotomy

Laser iridotomy creates a small hole in your iris to improve fluid drainage. This procedure is primarily for people who have or might develop angle-closure glaucoma. Potential risks include eye pain and redness.

There are three main types of surgical procedures for glaucoma.

Trabeculectomy

Trabeculectomy is a surgical procedure in which your ophthalmologist creates a small opening in the white of your eye. This new opening acts as a drainage pathway, helping to reduce intraocular pressure by letting fluid out of your eye.

The main benefits include reducing your eye pressure and slowing the progression of glaucoma. Potential risks include infection and low eye pressure. Recovery time can take up to 8 weeks.

Glaucoma drainage devices

Glaucoma drainage devices (GDDs), or tube shunts, are small, flexible tubes that a surgeon inserts into your eye to increase fluid drainage and reduce eye pressure.

Like all surgical procedures, some risks exist, such as corneal edema or tube failure. But GDDs are beneficial, as they offer a long-term solution for controlling your eye pressure, especially if other treatments have been unsuccessful. The recovery period is about 4–6 weeks.

Microinvasive glaucoma surgery

Microinvasive glaucoma surgery (MIGS) involves implanting tiny fluid diversion devices or surgically creating new fluid pathways to reduce your eye pressure. The main advantage of MIGS is less risk of postsurgical complications and shorter recovery times. Recovery typically takes only a few days to a week.

But the pressure-lowering effect of this procedure might not be as significant as it is with a trabeculectomy or GDDs. As a result, MIGS may not suit everyone, particularly those with severe glaucoma.

Glaucoma is a lifelong disease without a cure. There’s currently no way to repair or reverse any damage to your eyes before starting treatment.

Catching glaucoma early can make a notable difference in outcomes. People with earlier stage glaucoma have more treatment options available to them and can take steps that slow down their vision loss. But people who received a diagnosis later on in the course of their disease still have several options available to them to reduce their risk of vision loss.

That said, there’s still a chance of vision loss, even with regular treatment.

A doctor can help you make a plan to take your prescription medications. And you’ll go in for regular checkups to monitor how well the treatment is working. If a doctor notices disease progression at any point, they can recommend a more effective treatment option.

Glaucoma is a lifelong condition, and there’s no permanent cure. But many treatments are available to slow its progression, reduce symptoms, and help you maintain your vision. These treatments include topical medications, laser procedures, and surgery.