Glaucoma is a condition which results in damage to a part of the eye called the optic nerve. The optic nerve delivers the visual information from your eye to the brain to allow you to see. When the optic nerve is damaged from glaucoma, areas in the peripheral or side vision are often affected first. If the condition is not treated, more and more of the side vision and eventually the central vision is also affected, resulting in very poor sight or blindness.
Any vision loss from glaucoma is not reversible and the vision loss is often not noticed by patients until severe vision loss has already occurred. Given the vision loss from glaucoma is not reversible it is very important that once detected it is treated appropriately.
Therapies for glaucoma involve lowering what is known as the ‘intraocular pressure’ or eye pressure. Much of the damage to the eye in glaucoma is caused by high eye pressure, similar to over-inflating a soccer ball or football. Lowering the eye pressure is very effective at slowing or even halting any further vision loss from glaucoma.
How is glaucoma treated?
Glaucoma is a relatively common eye condition and fortunately there are many options available to treat it. All treatments aim to lower the eye pressure but achieve this is different ways.
Many types of eyedrops exist that will help lower the eye pressure and reduce further vision loss from glaucoma. Many people will only need 1 eyedrop per day however some may need more than this to lower the pressure sufficiently.
While eydrops are often very effectively at lowering eye pressure, they may have adverse effects which your Ophthalmologist will speak to you about during your consultation to help choose the best option for you.
Laser treatments can be very effective in treating glaucoma and in some cases are more effective than eyedrops. Some of the more common types of lasers used in glaucoma include Selective Laser Trabeculoplasty and Laser Iridotomy.
Selective Laser Trabeculoplasty
Selective Laser Trabeculoplasty, or SLT, is a treatment for glaucoma that being used much more frequently. It is often the first therapy initiated for a newly diagnosed glaucoma patient, often before eyedrops. This is because it is a very safe, simple and effective way to lower the eye pressure without the need for ongoing eyedrops.
How does SLT work?
The laser is aimed at the natural drainage area inside the eye and it’s gentle action helps to ‘un-clog’ this area, allowing more fluid to escape from the eye. This lowers the pressure inside the eye which, in turn, decreases the chance of further damage from glaucoma. It is worth noting that this increased fluid drained from the eye, drains away internally within the eye and has no effect on the tears or watering of the eye.
How is it performed?
This procedure is performed in our clinic and the experience is very similar to having your eyes examined. Prior to the procedure you will have some eyedrops instilled and then you will be sat at the microscope as in the picture below.
A contact lens is rested on the eye to help magnify the image and to keep the eye steady. The procedure itself is virtually painless and you can go home after it is completed.
Who can have SLT?
SLT can be used to treat most of the common types of glaucoma. It can be used as the first therapy for someone newly diagnosed with glaucoma or at any other time when a patient would like to seek an alternative to eyedrop or avoid having to start on extra eyedrops.
Recent evidence has shown that using SLT laser can result in less vision loss or surgery being required compared to patients treated with eyedrops alone.
It is important to note that even if SLT is effective and patients do not need to take eyedrops for their glaucoma, they are not cured of the problem. Regular reviews are always required in glaucoma and the effect of SLT laser can wear off over time. For this reason it is vitally important to have continued follow up with your Ophthalmologist.
For cases of glaucoma where significant vision loss has occurred or when eyedrops or laser therapy aren’t effective or tolerated, surgery can be required. It is fortunate that many surgical options now exist which can be used at various stages of glaucoma. For milder cases, treatments known as Micro Invasive Glaucoma Surgery or ‘MIGS’ have had a revolutionary impact on the approach to glaucoma and have excellent safety profiles. For those patients with more advanced glaucoma, many options also exist with vastly improved success rates and safety profiles. Examples of these surgical procedures are trabeculectomy, deep sclerectomy and glaucoma drainage tube insertion.
How is glaucoma monitored?
Glaucoma is a lifelong condition and requires lifelong treatment and management to ensure people retain their vision. Regular follow up visits are used to make sure the eye pressure remains lowered and repeated testing ensures no further damage to the eye or vision is occurring. Some tests that may be used to monitor glaucoma include:
To learn more about OCT scanning click here.
To learn more about Visual Field Test click here.