Two laser treatments and one surgery may be recommended at different stages in the treatment of glaucoma: Laser Peripheral Iridotomy (LPI), Argon Laser Trabeculoplasty (ALT)/Selective laser trabeculoplasty and glaucoma surgery.
Argon Laser Trabeculoplasty (ALT)/Selective laser trabeculoplasty (SLT)
ALT is used for patients who have already been diagnosed with glaucoma and for whom eye pressure remains too high even after trying treatments with various eye drops. During the treatment, a laser is applied to heat up certain portions of the tissue. This process stretches the pores and opens up the outflow channels for fluid, which decreases eye pressure.
Laser Peripheral Iridotomy (LPI)
This preventative technique is used to preempt the occurrence of a glaucoma attack. The treatment is performed in the office. During an eye examination, an eye doctor may notice that the angle in the eye appears to be too narrow. A narrow angle tends not to drain properly and can lead to a build up of fluid and pressure, a precursor to glaucoma. In LPI, a laser is used to place a tiny opening in the iris in order to improve drainage. The patient is required to use anti-inflammatory eye drops for approximately one week following the treatment. LPI has a very high success rate.
ALT/SLT is an outpatient procedure that causes minimal discomfort. A topical anesthetic is administered in the eye prior to the treatment. A clear lens is placed on the eye to help focus light. The patient experiences approximately 30 to 40 flashes of light while the laser is applied. The treatment takes about ten minutes per eye and patients usually go home after another hour. Anti-inflammatory eye drops are administered for approximately one week following the treatment. Any reduction in IOP is seen within the first four weeks following the procedure. The success rate for ALT is approximately 75%.
When all other treatments fail, glaucoma surgery may be necessary. There are many different surgical procedures currently available when laser treatment and eye drops fail to control the glaucoma. The purpose of the surgery is to create a new outflow channel that works in tandem with the existing channels. The resulting increased drainage reduces the pressure in the eye and prevents any further eye deterioration. It is important to understand that glaucoma surgery cannot improve or reverse the damage already done by the disease. Its use is as a preventative measure to limit further damage or worsening of the disease. The surgery has about an 80% success rate.
Glaucoma surgery is handled on an outpatient basis; no overnight hospital stay is needed. The procedure takes less than one hour. A local anesthetic is administered. The surgery does require some sutures, which may need to be removed during recovery. Patients use antibiotic and anti-inflammatory eye drops for several weeks following the procedure. Blurry vision may occur after the surgery but is typically temporary. This surgery is successful for about 2 out of every 3 people who undergo it.