Glaucoma Surgery

Written by Nicole Campbell

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As the second leading cause of blindness in the United States, glaucoma is a group of eye diseases in which the optic nerve has been damaged by high pressure within the eye itself. While this condition cannot be cured, there are treatments available to reduce or prevent vision loss. Some treatment options include medication, conventional surgery, and laser eye surgery also known as refractive surgery.

Glaucoma Risk Factors

Glaucoma can occur in anyone, though there are certain risk factors which may increase your likelihood of developing it, including high blood pressure, diabetes, long-term steroid use, age, and family history. Those most at risk include African Americans and people over the age of 60. A routine eye exam will usually detect signs of glaucoma. You may be a good candidate for glaucoma surgery if you find daily eye drops unsuitable, or they have been unsuccessful at controlling the pressure inside your eye.

Glaucoma Treatment Options

Unfortunately, there are currently no curative treatments for glaucoma. Rather, the focus of glaucoma treatment is stabilizing intraocular pressure. This either means inhibiting the buildup of the intraocular fluid that increases pressure, or increasing drainage to prevent pressure damage to the optical nerve. Treatment is about preventing further damage to vision.

More often than not, glaucoma can be treated through a drug regimen aimed at intraocular pressure stabilization. Medications to treat glaucoma are eye drops used once per day for life to control the eye pressure. If medications are unable to solve the problem, alternate treatment options like surgery will be required.

Many patients opt for surgery to further reduce the chance of optic nerve damage and to preserve their vision for as long as possible. There are various surgical treatment options for glaucoma, including laser trabeculoplasty, trabeculectomy, iriodotomy, endoscopic cyclophotocoagulation surgery (ECP), and shunts and stents.

Laser Trabeculoplasty

Selective Laser Trabeculoplasty uses a laser to cut selective holes within the section of the eye where the cornea and iris connect in order to improve fluid drainage.

The targeted nature of this laser surgery prevents damage to surrounding, untreated tissues in the eye, meaning that laser trabeculoplasty can be repeated as needed for drainage. In fact, this laser surgery is often used in conjunction with drug therapy (prescription drops).

Trabeculectomy

Like laser trabeculoplasty, the aim of a trabeculectomy is to increase drainage in the eye to relieve intraocular pressure. However, rather than creating tiny holes with a laser, a surgeon creates an incision directly into the drainage system of the eye. This allows for an increase in the normal drainage flow.

Trabeculectomy requires tissue to be removed from the drainage system making it more invasive than the laser alternative. However, there is a variant of this surgery called trabeculotomy that involves making the incisions in the drainage system without the removal of tissue. Speak with your doctor about the pros and cons of each option for your glaucoma.

Iridotomy

The Iridotomy technique uses a laser to create a hole near the iris, resulting in increased flow of fluid.  As is the case for trabeculectomy and trabeculotomy, there is a variant of iridotomy that involves removal of a small section of the iris. This procedure is called an iridectomy.

Endoscopic Cyclophotocoagulation

Endoscopic CycloPhotocoagulation surgery (or ECP) is a form of glaucoma surgery that reduces the amount of fluid produced. It utilizes light energy and endoscopy to target the ciliary body. This process results in a decrease in production of the aqueous fluid at the source of intraocular pressure and glaucoma. Shunts and Implants

If your glaucoma is caused by a fault in your eye’s drainage system, your doctor may be able to surgically implant a shunt into the eye to improve drainage. This shunt essentially introduces a new passage way through which to drain aqueous fluid.

Glaucoma Surgery Risks

While risks are rare, there are some potential complications of glaucoma surgery. Some possible complications include an excessive drop, or short-term increase in intraocular pressure, both of which can be controlled with medications. There is also a slightly increased risk of developing cataracts following the surgery.

Potential complications of traditional glaucoma surgery include infection, inflammation, bleeding, and an excessive drop in intraocular pressure.

Glaucoma Surgery Recovery

Recovery from laser surgery is just a few days, while those who undergo traditional glaucoma surgery can expect a one-to-two week recovery period.

Following surgery, the eye will be irritated and red. Though your eyesight may initially be blurry, vision results should stabilize in as little as a few days for those who have undergone laser surgery. Some patients who undergo traditional glaucoma surgery find that it takes several months for their vision to stabilize. Most patients take at least a week away from work, exercise, driving and other activities, particularly those that could increase blood flow or pressure in the eye.

What’s the Cost of Glaucoma Surgery?

The cost of glaucoma treatment depends on the treatment method chosen and other factors, including where the surgery is performed and the type of vision insurance you have. The medication averages $1,500 to $2,000 per year in the United States. Glaucoma surgery tends to be more expensive, averaging $2,000 to $5,000, though it is a one-time cost rather than the ongoing expense associated with medication.

These costs are typically covered by health insurance. If you are paying part or all of this expense out-of-pocket, ask your eye doctor about financing options that may be available to you.